Consultative Workshop/Pre-proposal Conference for Information Technology for improving Public Health in Uttar Pradesh Challenges & Solutions

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1 Uttar Pradesh Health Systems Strengthening Project Training Block-2, SIHFW Campus, C-Block, Indira Nagar, Lucknow. Ph: , Telephone No and Fax No.: : Website: Consultative Workshop/Pre-proposal Conference for Information Technology for improving Public Health in Uttar Pradesh Challenges & Solutions Uttar Pradesh Health Systems Strengthening Project (World Bank funded) has received a credit of US $ 152 Million from the International Development Association (IDA)/World Bank. UPHSSP is implementing a 5 years project to strengthen various functional cells, systems, hospitals and other interventions in the Department of Medical Health and Family Welfare, Government of Uttar Pradesh. Under the Project, the Government is planning to strengthen the service delivery, systems & processes through establishment of Data Resource Centre which will be the central repository of data of the health sector of the State. A Consultative Workshop and pre-proposal conference is scheduled to be held on 25 th April, 2013 in the Conference Hall of U.P. Health Systems Strengthening Project, SIHFW Campus, C-Block, Indira Nagar, Lucknow from am to 5.00 pm. Interested System Integrators, OEMs and Application Solution companies with experience of implementing Information Technology on turnkey basis in Health sector can participate in the Workshop. Brief profile of the organization with their views/approach/methodology for implementation of the IT program in the department will be welcomed in the Workshop. The interested firm may communicate their participation in the Workshop by to the Project. For further details, please check and contact on above numbers during office hours. Project Director UPHSSP:DRC-Consultative Workshop 1

2 Consultative Workshop/Pre-proposal Conference on Information Technology for improving Public Health in Uttar Pradesh Challenges & Solutions Uttar Pradesh Health Systems Strengthening Project (World Bank funded) has received a credit of US $ 152 Million from the International Development Association (IDA)/World Bank. UPHSSP is implementing a 5 years project to strengthen various functional cells, systems, hospitals and other interventions in the Department of Medical Health and Family Welfare, Government of Uttar Pradesh. Under the Project, the Government is planning to strengthen the service delivery, systems & processes through establishment of Data Resource Centre which will be the central repository of data of the health sector of the State. Public Health System in UP Parameter No. of/ location Remarks Population of the State 200 million Census 2011 Directorate of Medical & Health, UP Lucknow State Capital Directorate of Family Welfare, UP Lucknow State Capital Divisional Offices (Additional Director) 18 Administrative office District Offices (Chief Medical Officer) 75 Controls CHCs/BPHCs/PHCs/ Sub-centres District Hospitals (Male, Female, Combined) 157 Urban Health Facility; 30 to 650 beds capacity; Total capacity of 25,000 beds Community Health Centres/ bedded hospitals Block Primary Health Centre bedded hospitals Primary Health Centre 2,830 4 bedded hospitals Sub-Centres 20,621 ANM is posted Number of Medical Officers 11,000 Sanctioned strength is 15,508 Number of Para-medical & other staff 75,000 Directorate Division CMO District Hospital CHC/BPHC PHC Sub-Centre UPHSSP:DRC-Consultative Workshop 2

3 Existing Information System The application of Information Technology is low in the Directorate. It is restricted to Personnel Information System and Budget Allocation & Control. Computer Cell and Monitoring Cells have been created in the Directorate headquarter. Personnel Information System For implementation of the Personnel Information System, a Computer Cell was established with seating capacity of 30 Computers. This Cell has 12 computers with two regular Senior Assistants and two contractual Computer Operators. There is no technical manpower in the Cell. The software was developed by National Informatics Centre (NIC). The data of Medical Officers as well as Para-medical staff was captured. Two forms were designed: P1 to capture the sanctioned strength in each office/facility P2 to capture the personnel details of employees. There are about 90,000 records in the System 15,000 for Medical Officers and 75,000 for Paramedical staff. The data of P1 was not provided correctly. P2 form for Medical Officers has been regularly updated. This could happen by generating salary bills from this system and Treasuries were instructed to accept bills generated from this system only. P2 form for Para-medical staff was captured for about 75,000 employees. However, it was not updated concurrently. Due to this, the data needs validation to be put to use. The transfer and posting of this cadre is made within the district by CMO. The software has provision for updation at Headquarter. CMO/CMS can update joining/relieving of employees. Problems encountered in Personnel Information System There is no technical manpower in the Computer Cell to prepare new reports and to add any features or make corrections. This job is entrusted to NIC. However, NIC has also not been able to regularly update the software or prepare reports as required by the Directorate in desired time due to lack of manpower. The data also is not perfect. It requires cleaning and then put to regular use. The data of retired / expired and absconding employees is to be corrected. New Appointments are to be entered in the System. The relevant Cells in the Directorate - Administration, Karmik and Para-medical Cells are not using the system themselves. They ask the Computer Cell to generate reports. Other Cells should also use this data for their work. Additional fields also need to be captured to make it more useful at Headquarter as well as Field Offices. UPHSSP:DRC-Consultative Workshop 3

4 The software has limited functionality as per the work to be done by the Establishment Cell. Due to this, the system could not be implemented successfully. Budget & Allocation Control The Budget Allocation & Control System was provided by U.P. Health Systems Development Project. It was used at the Headquarter. This has been web enabled by NIC and being used. Budget Allocation is made by this software. The expenditure figures are collected from Directorate of Financial Statistics, UP. Using the budget allocation and expenditure, budget utilization is being tracked. Monitoring Cell Monitoring Cell is manned by three Medical Officers with no access to existing Reporting System. They get reports from Field Offices on few formats (HM and CM formats). This Cell is primarily involved in sending communication through to Field Offices. For ad hoc reports, they send formats to Field, consolidate the data and prepare reports for the Director General. A server and other resources were procured but could not be put to use due to lack of application software. Other systems Field Offices have few implementations. For example, the District Hospital, Ambedkar Nagar and Sultanpur have implemented a Patient Registration System. Few officers have implemented applications for monitoring which are individual dependent. Under RSBY (Rashtriya Swasthya Bima Yojna) scheme, Smartcard is used round the clock in hospitals. Computers are used in most of offices for wordprocessing, spreadsheet based reporting and . For these, Computer Operators have been provided on ad hoc basis with a few computer systems. Under NRHM, computers and computer operators have been provided for reporting of NRHM schemes. However, NRHM computing resources are not available for other purposes. Current Reporting System There are about 70 formats being sent by CMO/CMS monthly. In addition, there are few Daily as well as Weekly formats. In addition, there are formats which are sent on ad hoc basis to provide reports as and when required. These formats are on performance, resources and national programmes. List of existing formats is given in Annexure-B. National Programmes like NRHM, TB, Leprosy have already their reporting formats as well as web portal based software for reporting. There is duplication of data in these formats. There is also no link in the data captured as they are being captured on separate formats which makes it difficult to arrive on conclusion easily. Whenever any UPHSSP:DRC-Consultative Workshop 4

5 information is asked by the Government, format is circulated to Field Offices, which compile the data, send them to the superior office and finally gets consolidated at the Headquarter. This consumes lot of time and by the time information reaches Government, it loses its relevance. UPHSSP:DRC-Consultative Workshop 5

6 Proposed System The aim of Information Technology strategy is to provide better health services to citizens by facilitating optimum utilization of resources and availability of information on services, help employees to improve their efficiency and provide information to the top management for better decision making. Further, it would facilitate timely settlement of benefits to employees. Proposed Strategy Information Technology shall be used for conversion of manual processes to IT based processes in which data/records are to be stored, using user-friendly and simple systems with minimal changes as decided by the end-user in a definite time frame (preferably, six months) to be used by the end-user and are continuously improved and maintained by Data Resource Centre Cell. The end-user shall be empowered through suitable training programmes/refresher courses. Resources of the Department Main resources of the Department are: 1. Facilities, i.e., District Hospitals, Community Health Centres, Block Primary Health Centres, Primary Health Centres and Sub-Centres. Number of patients are highest in District Hospitals and lowest at Sub-Centres. No. of Out Patients are about per day in District Hospitals with working beds of about Pathology labs in District hospitals and CHCs 3. Pharmacy drug stores in CMO and District Hospitals. A typical District hospital issues on an average 100 drugs/ medicines per day to sub-stores (Wards, OPD, OT, Emergency, etc.), 200 receipts of drugs/medicines in a year from Rate Contract and 50 receipts of Local Purchase in a year. 4. Medical Officers deployed all across the State at Headquarter, Divisional Offices, CMO Offices, District Hospitals, CHCs and PHCs. There is a sanctioned strength of Medical Officers. Para-medical staff has a sanctioned strength of 37,700. There is other staff with strength of 35, Infrastructure and Equipment in terms of X-ray machines, Ultrasound machines, CT scan, ambulances, etc. 6. Annual Budget of the Department of Rs.4388 crores (includes all Directorates of Health Department, excluding NRHM). Proposed modules The Department has planned to implement an Integrated system covering the following: a. Health Management Information System b. Health Geographical Information System c. Hospital Information Management System d. Personnel Information System e. Central Medicines Stores Department f. Financial Management System. UPHSSP:DRC-Consultative Workshop 6

7 Proposed System An Overview (Information furnished below is an indicative description and is not restricted to contents given below) A process based system is proposed for implementation. Divisional Offices Cells at Directorate LAN LAN PIS, CMSD LAN Sections DG State Govt. LAN Data Centre Leased line Disaster Recovery Centre Internet Manual LAN CMOs LAN CMS with HIMS Other CMSs PHCs CHCs Local Area Network - LAN Hospital Information Management System - HIMS ANM Manual/Mobile/PDAs Transactions of Personnel Information System shall be done at CMO, CMS, Divisional Offices and at headquarter. All transactions related to personnel shall be recorded through this system only. For this purpose, all draft notesheets and orders shall be printed through this system. Once the drafts are approved by the competent authority, the approval shall be posted in the system and final orders shall be printed by the system. Once the posting is done, then the data can not be changed. Reports can be generated at any point of time by the authorized users. Central Drug Stores Department transactions shall take place at Headquarter, CMO and CMS offices. The Purchase Order shall be generated by the system at CMO/CMS. Receipts from Supplier shall be accepted UPHSSP:DRC-Consultative Workshop 7

8 by the system. Issue to CHC/PHC shall be done at CMO and issue to various sub-stores shall be done at District Hospital. The system shall have provision for inter-hospital medicine transfer. The Financial Management System can be implemented at the Drawing Disbursement Officer (DDO) level. At present, the bills are made manually and presented to Treasuries for payment. Directorate of Treasuries has already implemented a computer based payment system. Budget allocation software is already in use at the Headquarter. For budget control purpose, at present, expenditure is brought physically from the Directorate of Financial Statistics at Headquarter. By developing the DDO module, the expenditure control can be monitored at DDO level itself and bills can be made with improved accuracy. The budget allocation can be imported in the DDO module. The salary bill can be integrated with the Personnel Information System. The district hospitals shall be taken in phases for implementation of hospital information management system. The focus shall be on patient registration for OPD and IPD, Drugs distribution, Pathology Labs, Wards and Operation Theatre use. Suitable displays may be made in hospitals for people to know the availability of bed in wards, Operation Theatre, drugs/medicines, status of equipment, pathology tests available, etc. CHCs, BPHCs and PHCs shall send their periodic reports to respective superior offices in tailor made software either through internet or physical transfer of computer file. These will be consolidated at CMO offices. ANMs shall submit their report on paper to PHCs. An attempt would be made to implement a mobile based application or a special device for reporting by ANMs which should be userfriendly, simple and cost effective. An IVRS based reporting system can also be used for reporting by PHC and ANMs for few parameters daily. The data of National Programmes shall be extracted from the software being used by them. Reports shall be generated as per needs. Health Geographical Information System shall facilitate viewing queries on map better understanding of the situation. Data of Health Management Information System shall be used. Health Management Information System shall get periodic data from different facilities and offices on a web based system. Reports shall be prepared as per requirements of various stakeholders. Reports can be added later as and when required as the data would be available in the database. This will include data of private sector in the State (about 20,000 private health facilities in the State). Scope of work for the System Integrator on Turnkey basis This includes Design, development, installation, testing, training and implementation of the system. The implementation involves a number of components which are as given below: 1. Servers 2. Data Centre/DR Centre 3. Desktops 4. Printers 5. UPS and power backup 6. Networking equipment 7. Networking Service Provider UPHSSP:DRC-Consultative Workshop 8

9 8. Application software (and their integration) for a. Health Management Information System b. Hospital Information Management System c. Health Geographical Information System d. Personnel Information System e. Central Medicine Stores Department f. Financial Management System, including salary 9. Data migration and initial data entry 10. GIS data capturing 11. Training 12. Operations of the system for three years 13. Site preparation including network cabling, electric wiring and earthing. Proposed Implementation Schedule No. Activity Scope of Work Duration in months A Procurement Information for Bidders (IFB) to Contract signing 6 Assessment, requirement gathering, designing, B Execution procurement, installation, commissioning, Data migration, Data Digitisation, Data Collection and testing, site preparation 6 covering Headquarter, one Division, two CMOs in the C Pilot Division, 4 District Hospital - Male, Female, Combined; site preparation, if required 6 D I Roll out 17 Divisions, 73 CMOs and 36 District hospitals under UPHSSP; site preparation, if required 6 E II Roll out another set of 60 district hospitals; site preparation, if required 6 F Final Roll out balance 57 district hospitals; site preparation, if required 6 G Facility Management Two years from the date of start of start of Initial roll out(activity D) 24 H Sustenance & handover Six month from the date of completion of facility management 6 Important Note: Please send your profile as per the attached format alongwith synopsis of your presentation by to reach UPHSSP by 19 th April, The time slot of your presentation shall be communicated to you by . Information on Directorate of Medical & Health, UP and UPHSSP is available at UPHSSP:DRC-Consultative Workshop 9