E- HEALTHCARE

Dr Madhu RaikwarDirector & Head

Central Bureau of Health Intelligence(CBHI)

Dte. G.H.S.Ministry of Health and FW

Govt. of India

INTRODUCTION TO CBHI • Established in 1961 by an Act of Parliament after Mudaliar Committee’s recommendation

• National Nodal Health Intelligence Wing of the Dte.GHS/MOHFW/GOI

•WHO Collaborating Centre on Family of International Classifications (ICD-10 & ICF) for India

A strong Health Intelligence System in the country

VISION

To strengthen health information system in every district of the country up to facility level, for evidence based decision making to improve population health

MISSION

Web Based Maintenance and Dissemination Of

National Health Profile of India (NHP) Health Sector Policy Reform Options

Database National Health Resource Repository

OBJECTIVES RELATED WITH E- HEALTHCARE

NATIONAL HEALTH PROFILE Contains information under 6 sub-heads:

a. Demographic Profile

b. Socio- Economic Status

c. Health Status

d. Health Finance

e. Human Resources &

f. Health Infrastructure Indicators

NATIONAL HEALTH PROFILE Collection of Data

Monthly online morbidity & mortality data from all States/UTs on – Communicable diseases & Non-communicable diseases.

Annual online data of the country on:– Health Infrastructure, Health human resources & Health

Finance

Dissemination of NHP online thru CBHI Website and e- book on national Health Profile.

Health Sector-Policy Reform Options Database

Developed by the CBHI with the aim to share information about good practices and innovations in Indian health sector.

Initially developed as a collaborative venture between GOI & European Commission

CBHI uses its 6 FSUs located at different RD offices to explore information related to reform initiatives

An easily accessible tool to publicise successful endeavours and share reform know-how to solve common problems.

Grouped under 16 major health sector areas  Further details about HS-PROD are available at

http://hsprodindia.nic.in

CBHI website HS-PROD India (Home Page)

NATIONAL HEALTH RESOURCE REPOSITORY

MAPPING AND PROVIDING INSIGHTS INTO HEALTH FACILITIES IN INDIA

Capturing evidence and providing analytics across:

around 2 lcs public health facilities

over 8.5 lcs private doctors

close to 7 lcs chemists

1 lacs diagnostic labs

7.3 lcs AYUSH doctors

15k private hospitals

398 medical colleges

CONTEXT---- High patient fall in private sector:

in-patient services are provided in private sector

Lack of information on private sector health resources:Numbers and types of private sector health facilities (Hospitals, Labs, Imaging centres) along with their locations, HR and types of services provided

No uniform nationwide system for comprehensive intelligence :Inadequate mechanism for obtaining and analyzing information on healthcare infrastructure and manpower in these sectors at the district level

PROJECT AIMS AND OBJECTIVES

Single platform for comprehensive information of

approx. 18.5 lacs public and private health resources

including hospitals, doctors, chemists, diagnostic labs

etc. capturing over 400 data variables

Key outcomes

o Comprehensive data on all health resources including private doctors, health facilities, chemists, and diagnostics labs

o Establishment of a National Health Resource Repository for evidence based decision making – aligned with Digital India mission

o Enhanced coordination between central and state government for optimization of health resources and effective development of PIPs

o Accessibility of data at all level, including State HODs, thus, decentralize the decision making at district and state level

Key benefits

Harmonization of public health information for judicious health resource allocation, management & monitoring through real world intelligence

Visibility of private sector health resources to enable public-private partnership - this will help in bridging the gaps in public health sector in specialized departments

Common platform with standard information for the use of central/state government, providers, payers, citizens and other stakeholders

Key benefits

Technology enabled mass outreach campaign to doctors, hospitals, chemists, etc – especially useful during the time of disaster management

Integrate with the Digital India Programme of easily accessible platform for information on healthcare service delivery

Geo-tagging of distribution pattern of health resources in the country

Creates transparency and establishes an accountability mechanism for effective centre-to-state health care funding

FRAMEWORK FOR NATIONAL ROLL-OUT

Jan 2016

Formulation of Project Steering Committee

Awareness and consensus building

Appointment of External agencies for different roles

Pre-test in few states

Dec 2016

Data collection across all 676 districts in the country

Development of technical applications

Till 2017

Periodic data updates and validation

Awareness and consensus building

Capacity building and training workshops

Knowledge transfer

Program Initiation Data Collection Data update,

Communication

Data collection Monitoring support

oEvery 3 year data updateoLinkage with National Registry Network (NRN)oMechanism of periodic updateoMechanism of monitoring and data validationoSynchronizing with HMISoUtilizing existing technical infrastructureoUtilizing existing manpower capacity in CBHI

Continuity Plan

Prioritization of the states

Phase 2: August’16

ChandigarhPunjabDaman & DiuUttarakhandAndhraTelanganaTamil NaduKarnatakaMaharashtra

MPGoaDadar & Nagar

PuducherryKeralaHimachalTripuraLakshadweepAndaman

SikkimAssamMizoramArunachalOdishaWest BengalMeghalayaNagalandManipur

Phase 3: December’16

Phase 4: August’16

Phase 1: Feb’16

UPBihar HaryanaJ&KRajasthanChhattisgarhGujaratJharkhandDelhi

Launch of National Health

Resource Repository 15th August

2017

Progress summary…

pilot to test the feasibility in four districts:DimapurDungarpurHazaribaghVellore

2016

Data across 400+ data variables was collected and analyzed

22 September 2015Hon’ble Union Minister for H&FW, announced the nationwide roll-out of National Health Resource Repository

Project implementation

20152014

Stakeholder meeting on NHRR and demo of pilot tool

2017

Based on the successful pilot, a detailed project report for national roll-out was prepared and submitted

Overview Of Project Pilot project covering 4 districts – Dungarpur, Vellore, Dimapur,

Hazaribagh

Exhaustive mapping done for health resources for both public and private facilities

Geo tagging for abt. 2,100 health facilities with over 400 data variables

The pilot was funded by Bill & Melinda Gates Foundation and executed by IMS Health

District PopulationPrivate Public

Doctors Hospitals SC PHC CHC SDH DHVellore,

Tamil Nadu 20,00,000 869 56 231 57 5 - 3

Dimapur, Nagaland 3,78,811 107 14 38 10 2 - 1

Dungarpur, Rajasthan 13,88,552 66 15 346 50 14 1 1

Hazaribagh, Jharkhand 17,34,495 56 17 116 12 10 - 1

Data Variables for Pilot study

Quality Control

Equipment and Drugs

Manpower & Training

InfraStructure

Services

Access

Facility Details

Technology Orientation

400+Data

Variables

Facility Name Facility Contact NumberRegistration NumberConsultation FeesConsultation Days, timingWard charges

GPS CoordinatesDistance between facilitiesDistance from farthest village

Basic ServicesSpecialist Services Services under National Programs

Building Sections Beds and WardsUtilitiesFurniture

No of Management Staff, Clinical Staff, Paramedical Staff, IV grade StaffType & Level of TrainingNumber of staff trained

TypeAvailabilityFunctionality DurationEssential and Critical drug availability

Citizen charter DisplayedRecord MaintenanceRogi Kalyan Samiti

Usage of computer/internet

Email Id,Website

KEY FINDINGS FROM PILOTUn-availability of specialty services – one of the key concerns for adequate service delivery

Roadblock to deliver AYUSH Mission – 75% of PHCs do not have Medical Officer for AYUSH

Un-availability of Manpower non-availability of specialty services – one of the key concerns for adequate service delivery

Roadblock to deliver AYUSH Mission – 75% of PHCs do not have Medical Officer for AYUSH

19%

77%

58%

39%

19%32%

42%

3%

94% 97%

General Surgeon

Physician

Pharmacist

Gynecologist

Peadiatrician

Anesthetist

Public Health

Program Manager

Eye Surgeon

Laboratory

Technician

ANMs

CHC fulfilling I PHS HR norms

Geographical AccessRemote villages still far away from service delivery point – 40% CHCs have farthest village located at a distance more than 25 km

Access to tertiary care (DH) is a major concern

39%

39%

22%

0-25 km 25-50 km >50 km

58%

36%

6%

CHC to farthest village

CHC to DH

KEY FINDINGS FROM PILOTQuality of service Lot of CHCs not performing c-section because of either manpower, infrastructure or equipment unavailability

Infrastructure Basic infrastructure not adequate – Unavailability of Piped water supply, Toilets, etc

Technology orientation Computer usage shows a declining trend - Relatively good in DH and CHCs, however, needs significant improvement at grass root

83.33% 80.64%

40.31%

9.16%

DH CHC PHC SC

Facilities using Computers for Record Keeping

65% 67%40% 31%

10% 17%30%

27%

26% 17% 29% 43%

CHC DH PHC SCBelow IPHS As per IPHS Above IPHS

>1.2L80K - 1.2L

<80K

>10L9 - 10L

<9L

>30K

20 - 30K

<20K

>5K

3 - 5K

<3K

Facility Utilization

To function as India Head for WHO Family of International Classification

• CBHI collaborates with all the WHO – Collaborating Centers on Family of International Classifications (FIC) in the World, Asia Pacific Network on FIC and Countries of South East Asia Region.

• International Networking

WAY-FORWARD :-

CBHI is in the process of digitalization of Medical Records of govt. hospitals

Planned to use ICT in implementation & advocacy of WHO- FIC in India for standardized coding of diseases

THANK YOU