Public Health Department of

Maharashtra Bringing value based e-

Governance in practice

Authors

Sanjay Kamlakar, Nilesh Gauda, Nitin Anand, Monika Malik,

Under Secretary, Sr. Consultant, Consultant, Consultant,
PHD, Maharashtra KPMG KPMG KPMG
Sanjaji9@gmail.com ngauda@kpmg.com nitinanand@kpmg.com monikam@kpmg.com

Abstract

In an emerging economy like India, the
health sectors performance is often
suboptimal due to an increased burden of
factors like underdevelopment, political
instability, weak institutions, inadequately
developed social sectors, scarcity of
resources, and marked social inequalities.
Though huge budget outlays have been
made by the government under ambitious
social sector schemes like the National
Rural Health Mission, accessibility of low-
cost healthcare continues to elude many.
With low-cost innovation, cheap mobile
handsets and more inclusive solutions
filling in crucial gaps in health information
and access, technology has a potential to
grow capacity in this sector tremendously.
Public Health Department under its e-
Governance ambit has developed an array
of applications catering to the internal needs
of the department. The department also
focused on providing various citizen centric
services and employee centric services
aiding all employees and citizens towards a
more channelized, informative and
processed approach. The focus of the
department was primarily on five pillars as:
Human Resource Management,
Hospitals and Medicines,
Communication, Administration and
Citizen Centric. PHD has successfully
conceptualized, designed and implemented
19 live projects and is in-process of
implementing 7 further large scale projects.

Information and Communications

Technology (ICT) has the potential to
impact almost every aspect of the health
sector. In public health, information
management and communication processes
are pivotal, and are facilitated or limited by
the availability of information.

In addition, beyond the formal health sector,

the ability of impoverished communities to
access services and demand a healthcare
system that responds to their priorities and
needs can be significantly influenced by
broader information and communication
processes, mediated by informed decision
making.

The aim of the case study is to showcase

multitude e-Governance initiatives taken by
Public Health Department, how these
projects were envisaged, road blocks faced
while implementation, how to ensure its
sustainability in long run and the future
plans of the department to further
strengthen its e-Governance endeavors.
Section 1 Maharashtra Healthcare Sector
The State of Maharashtra has a well-
developed health infrastructure with three-
tier system to provide comprehensive health
services to the people especially in rural
areas. The State has been implementing
various national and state level programmes
and schemes to bring out a holistic
development in the State.
The State current healthcare infrastructure
is depicted as below:
S.No Health Institution
1 Sub Centre
2 Mobile Medical Units
3 Primary Health Centers
4 Rural Hospitals
5 Sub District Hospitals. (100 Beds)
6 Sub District Hospitals. (50 Beds)
7 General Hospitals
8 Other Hospital
9 District Hospitals
10 Super Specialty Hospital
11 Mental Health Institutes
12 Women Hospitals
13 TB Hospitals
Health & Family Welfare Training
14
Institutions
About Public Health Department
Public Health Department is the prime
organization in Maharashtra providing a
strategic leadership for public health. The
organization focuses on providing an array
of citizen centric services across the State
with its various policies, legislation and
administration. The department has
formulated and executed various health
programmes in line with National Health
Policy enabling a better administration,
better health, better care, and better value
for all.
The department along with implementing
various programmes and schemes has
focused on strengthening its internal setup
and enhancing its Government capabilities
by adopting various e-governance practices.
Public Health Department is probably one
of the well connected departments in
Maharashtra. The department with its wide
array of e-Governance initiatives has
introduced efficient new ways of delivering
government services.
Implementing the ICT Roadmap
The vision of the department was to develop
A more efficient department that
Total delivers implicit information collaborates
10,580 effectively and automates and
40 channelizes the department process
1,811 flows by leveraging the power of ICT.
387
25 Public Health Department has witnessed
56 execution of several successful e-
4 Governance initiatives across its verticals.
1
23
2 The PHD strategy for e-Governance
4 focused primarily on five pillars as:
11 Administration, Hospitals and Medicines,
4
Human Resource Management,
7
Communication and Citizen Centric. The
department basic tenet was to promote the
enabling factors and harness the ICT
benefits to the maximum. PHD has
successfully implemented 19 E-Governance
projects which are actively used by the
department. It also envisages few high
worth applications like e-Ausadhi and HMIS
as its future endeavors.
Section 2 PHD e-Governance Need
Assessment
It was felt that the traditional Government
Health Sector of Maharashtra was
unorganized, fragmented and slightly
unstructured. There was a need to
collaborate and make the department
workflow more structured and information
driven. A need for SMART (Smart, Moral,
Accountable, Responsive and Transparent)
Governance was felt. Public Health
Department envisaged and developed an
ICT roadmap to strengthen the department
capabilities.
The need for implementing ICT roadmap
was felt owing to various factors as:
Difficulty in tracking expenditure on
schemes and programmes
Absence of information related to
physical assets
Brick-and-mortar infrastructure gaps,
capacity building, training of health
professionals who are ICT-illiterate,
and the lack of primary healthcare
staff
No concrete information about
deployment of medical staff
Data Collection happens at various
levels and frequency, leading to non-
consolidated real-time information
and duplicity
Demand and distribution of drugs
not managed effectively
Patient care and medical records not
effectively managed
Inadequate computer literacy among
ANMs and
Biometric Attendance System
Difficult to be implemented as
medical staff work in shifts and it is
difficult to schedule their work
timings
Lack of standardization in
architecture, data standards,
disease and service codes.
Content Barrier Relevant content
and its availability in local land
standard language
Improper and inadequate
information for general citizens
To combat these issues, the department
developed an ICT roadmap to collaborate
all the department functionalities under
the ambit of ICT.
The objective of the ICT implementation
was:
1 Increase internal efficiency of the
department
2 Bringing more transparency in the
department workflow
3 Delivering cost effective, efficient and
secure information and services to the
citizens
4 Empowering general citizens
5 Moving at par with global standards
PHD conceptualized, designed, developed
and implemented 19 live projects with
multiple stakeholders as KPMG as
Department e-Governance Team (DeMT),
Mahaonline, National Informatics Centre
(NIC) and Nelito Systems as Software
Development Team
Section 3 PHD e-Governance Solutions o Aamchi Mulgi
o SADM Disability Software
The PHD strategy for e-Governance
focused primarily on five pillars as: The approach followed for the
Administration, Hospitals and Medicines, implementation can be summarized as:
Human Resource Management,
Communication and Citizen Centric. The
department basic tenet was to promote the
enabling factors and harness the ICT
benefits to the maximum. PHD focused its
e-Governance initiatives on developing
services for G2C and G2E. An array of
exclusive initiatives taken across the
department is as follows:

Administration:
o Biometric Attendance System
o E-File
o NRHM e-Office
Hospitals and Medicines:
o Construction Tracker PHD
o Construction Tracker NRHM
o Drug Inventory Management PHD e-Governance journey so far
Application
o Mother and Child Tracking The first project rolled out by the department
System (MCTS) was Drug Inventory Management
o PCPNDT Application application which automated the entire life
o Rajiv Gandhi Jeevandayee Yojna cycle of drug purchase and disbursement
Human Resource Management: process. The project gradually followed with
o ASHA Application implementation of other initiatives as
o Grievance Redressal implementation of Biometric Attendance
o Medical Officers Certification System across major medical institutions.
Program Application (MOCP)
The project Construction Tracker is
o NRI Registration
another milestone endeavor which
o Transfer Request Group A
exclusively monitors and manages the
o Transfer Request Group B
construction activities carried out in the
Communication:
State. The application has been
o Health Advisory Call Centre
successfully emulated in other departments
o Pull SMS (4 program) Hospital,
of Maharashtra too which are: Social
Primary Health Centres, School
Justice, Food and Civil Supplies, Public
Health, Mobile Medical Units
Work Department and. School Education
(MMUs)
Department.
Citizen Centric:
o Availability of Doctors The PCPNDT application which monitors
o ASHA Search and records all sonography centres and
details of the tests carried out on the
patients. It has brought more compliance to
PCPNDT Act.
Another noteworthy inventiveness MCTS
application has been implemented in the
State which aimed at monitoring and
minimizes Infant Mortality Rate in the State.
On similar lines, Aamchi Mulgi application
has been developed with an objective to
monitor female infanticide by monitoring the
illegal sex determination process in the
State.
Harnessing the umpteen power of mobile
technology Pull SMS application has
brought about an effective monitoring of four
large scale programmes of PHD, which are:
Hospitals, Primary Health Centres, School
Health Programme and Mobile Medical
Units. The mobile technology has been also
implemented in Health Advisory Call
Centre project wherein an expert and an
easy access to information and guidance
regarding health service offerings are
provided on toll free no. of 104; the project
is for intra-departmental staffs.
To spur innovation and solutions
development for a new generation of public
services; PHD has executed online
Grievance Redressal Application to address
the grievances of its current employees in a
pre-defined stipulated time frame.
Additionally, the effective online Transfer
Request application has made the transfer
process more reliable, less cumbersome,
transparent and paperless. The application
recorded a stupendous 1,000+ request in a
span of two month. An exclusive all
encompassing database of medical officers
and employees of PHD has been developed
and maintained. Also as a citizen centric
approach the information on Doctors
Availability has been made online.
ASHA application another coveted project
by Public Health Department captures
information of approximately 60,000 ASHAs
worker operating in the State. The
application effectively monitors training,
recruitment, performance and payment
details of all the ASHAs. The application
has been further extended for general
citizens with ASHA Search application
which aids in providing latest information on
ASHAs working in the searched locations.
NRHM e-Office holds the title of 1st
department in Maharashtra to be automated
completely; gradually the e-File application
is being rolled out in PHD.
Rajiv Gandhi Jeevandayee Yojna Project
is another coveted project of PHD, which
has brought a revolution in healthcare
arena. The project runs on a web based
application wherein the entire process of
beneficiary enrolment, patient registration,
preauthorization, procedure updates,
discharge summary update, claims
settlement and follow up are covered.
Expanding its ambit of e-services, PHD in
association with Social Justice Department
has implemented SADM Disability
Software which provides computerized
disability certificates. Over 4,341 patients
have been assessed till date and certificate
for over 2,221 has been disseminated.
Moving beyond, the department is working
on the next generation of e-solutions as:
E-File Application - PHD
E- Ausadhi
Hospital Management Information
System (HMIS)
Revamping of PHD Website
Bonded Candidate Application
Court Case Management Application
Class C and D Database application
Section 4 Benefits, Sustainability and
appreciations
Public Health Department Front runner in
Information Economy
All-encompassing database of all
medical officers and PHD employees
All-inclusive database of ~ 60,000
ASHAs
100 percent automated transfer process
Application being replicated at different
departments
ASHA Application Winner of SKOCH
Digital Inclusion Award 2012
Inclusion of Mobile applications for
monitoring
Online information on doctors availability
across State
Virtual connectivity by Video
Conferencing across major locations
and hospitals
Public Health Department has
revolutionized the whole aspect of e-
Governance. The department initially faced
numerous hitches but is gradually working
towards sustainability of the projects.
The sustainability factor:
Conceptualization, design and
implementation of a project need committed
push and thorough monitoring for success
and sustenance. Key solution accelerators
which are the need of the hour are
I. Solicit commitment towards e-
Governance at all levels through
appropriate communication and
trainings.
II. Appointment of a Nodal Officer
committed to the project is vital.
III. Defining strict guidelines and
mandating the use of software
application instead of the existing
paper-based processes.
IV. Devising and implementing strong
awareness campaigns directed at
officials across all levels (and citizens
as per need) touching upon the
guidelines, usage, importance and
intended benefits of each application.
V. Generating various MIS reports and
analyzing the same for effective
decision making. Last Login details of
primary users shall ensure to keep a
check on the recency of data.
VI. Arranging and making the relevant
documents available so that there are
no delays in updating the required
information in the software
application(s).
VII. Senior officials of the department need
to also attend training regarding the
applications. This will help in soliciting
commitment from the departmental
staff.
VIII. Government Resolutions need to be
issued mandating the use of online
mechanism and doing away with the
manual mode altogether.
IX. A carrot-n-stick policy could be
adopted to motivate committed
employees and reprimanding those
hindering the successful
implementation
 Section 5 Conclusion
Success of governance ICT projects goes in
tandem with the collaborative participation
of the citizens and the government. The role
of government cannot remain the same in
the globalized and highly competitive world.
More people perceive current governments
as a source of services rather than just as a
regulator. The need is to reach to the
section of the society which has remained
tangential to the government sphere due to
cost and accessibility reasons. Diffusion of
e-governance is much needed to reach out
to these peripheral sections in the
developing countries.
The major benefits accrued from E-
Governance within health will be an
integrated view of the entire system; it will
The Portfolio - From e-Office to e-Hospital
19 Live Projects
Monitoring attendance with Biometric
Attendance System
Converting to paperless office with e-File
implementation
Automate life-cycle of medicines with real-
time information from Drug Inventory
Application
Monitoring infrastructure with Construction
Tracker
Ensuring adherence to PCPNDT Act with
PCPNDT Application
Implementing a comprehensive clinical
information system with HMIS
Exclusive dashboard monitoring facility
Citizen Centric approach with Application for
issuance of Disability Certificate, Availability of
Doctors, ASHA Search, NRI registration etc.
Cornerstone for employees benefit with
Grievance Redressal Application and MOCP
Application
Process Automation with Transfer Tracker
Application
Communication galore with usage of Bulk SMS
Services, Video Conferencing and Pull SMS
Envisaged new applications as: e-Ausadhi,
Court Case Management System. Bonded
Candidate Applications etc.
automatically increase the productivity and
reduce the workload and the overall time
taken in the entire process thereby
enhancing the customer convenience and
experience. There will be transparency
across the hierarchy by most of the
information made available in a single
snapshot through the use of dashboards
and consolidated reports. Various standards
and compliance will be adhered to by the
usage of best practices and world class
standards within the systems in place.
Key lessons .
Jump to tomorrow Government needs to
Focus, Initiate, Invest and Harness with new
e-solutions
Government should break new grounds -
The government can do much to establish
the enabling building blocks that support the
development of an information society
Easy Access is the key Access is where
it all begins if people and companies have
the skills and means to use ICT and get
online, content and services will follow (in
terms of both supply and demand)
Services should be the priority - A service
oriented approach leads directly to the most
useful, high-impact development of e-
government, regardless of the technology
used
Well planned pilot project produces
results - Intelligently conceived pilot
projects are powerful tools for successful
implementation of projects
Focus on existing working systems
Enhance systems which are working and
follow a faster implementation. Reduce
reliance on pie-in-the-sky solutions that take
time to develop and may fail.
Acknowledgements

We would like to express our deepest

gratitude to all the stakeholders who at
multiple junctions supported us in
implementing successfully e-Governance
projects in Public Health Department. Their
vision, guidance and support have been the
major reason for the success of these
projects.

We would exclusively like to thank:

Shri. Jayant Kumar Banthia, Chief

Secretary of Maharashtra, GoM
Shri. Thomas C Benjamin, ACS,
Public Health Department, GoM
Smt. Meeta Rajivlochan, Secretary,
Public Health Department, GoM
Shri. Rajesh Aggrawal, Secretary DIT,
Maharashtra, GoM
Shri. Vikas Kharge, MD, NRHM
Smt. Archana Patil, Director, DHS
Shri. Girish D Bhalerao, Jt. Director
NRHM
Shri. Bahubali Nagaonkar, AD, DHS
Shri. Vijay Bawiskar, JT, DHS
Shri. G K Naik, Jt. Director, Admin and
Finance, DHS
Shri. Navin Agrawal, Partner, KPMG
Shri. Amit Saraf, AD, KPMG
Shri. Srinivas Gandham, GM, Nelito
Systems
Smt. Sanghmitra Tripathi, Jt. Dir, NIC
Major stakeholders; Nelito Systems,
Mahaonline, and NIC