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Express_Healthcare__February_2018

POLICY WATCH system

POLICY WATCH system throughout the state. Guidelines were translated in all local languages like Assamese, Bengali, Hindi, Bodo and English and ensured that it is made available with all ASHAs, all accounts persons and all programme officers. Distribution mechanism of the guidelines up to ASHA level was properly monitored and documented. All old guidelines were inactivated by issuing order to avoid conflict. ◗ Implementation of master claim forms: Master claim form was developed covering all activities which simplified the claim process. It was also translated in all local languages and made available in sufficient quantity. ASHAs found it simple to fill up the claim form as only number of claims to be mentioned. Name of the activities and rate were pre-printed which reduces the work and minimised mistakes. Implementation of Master Claim form also simplified the work of accounts persons and streamlined the entire process. ◗ Implementation of single window system for all claims: Single window system for submission of claims was introduced so that ASHAs need not require approaching each programme officers separately for submission of claims. ASHAs need to submit all claims in the Master Claim Form and submit it to Accounts Manager. ◗ Fixation of accountability for verification of claims: After receipt of the claims through single window system, the claims are verified by the respective programme officers. It raised accountability and ownership of the programme officers on their respective programme and to ensure proper verification and validation of claims. ◗ Fixation of time frame for submission of claim and release of payment: Fixed time frame was defined and notified for submission of claim, verification of claims and release of payment. The objective was to ensure timely and regular release of payment to ASHAs. Timeframe was finalised and notified after due consultation with all stakeholders. ◗ Opening of bank account of all ASHAs: It was ensured that, bank accounts of all ASHAs are opened and registered and validated through Public Financial Management System (PFMS) to ensure authenticity. ◗ Development of online ASHA payment and monitoring system: Online ASHA Payment and Monitoring System was developed in open source platform using the in-house capacity of National Health Mission, Assam. The system was developed under 'Health Services Monitoring System' and hosted in the NHM, Assam server. The objective was to use the power of information technology to create comprehensive ASHA database and streamline ASHA payment and monitoring system. Claims submitted by the ASHAs are captured in the system and acknowledgements are sent to ASHAs through SMS. Information of approval and release of payment through DBT is also communicated to ASHAs through SMS. This transparent system streamlined the ASHA payment system by ensuring timely release of payment and ASHAs are relived to visit accounts persons. The system also identified good performing, poor performing and non performing ASHAs. Activity wise report up to ASHA level helped the programme officers for proper monitoring and implementation of the programmes. The system was integrated with PFMS portal for release of payment to ASHAs through DBT. ◗ Monitoring of quality of ASHA trainings ASHA database was created with all vital information of ASHAs along with bank account information, mobile number, photographs etc. The system is also used for monitoring of capacity building workshops of ASHAs. Pre-assessment and post assessment findings of each ASHA is monitored through the system to evaluate quality of trainings. Innovative aspects of your project / activity ◗ Implementation of single window payment system: one of the major objectives of this approach is to implement hassle free single window ASHA claim system. Development of comprehensive guidelines covering all programmes and implementation of innovative Master Claim form simplified and made the system hassle free. ◗ 100 per cent Direct Bank Transfer (DBT) mode payment: One of the major strategies of the system is to implement 100 per cent DBT mode payment. The ASHA Payment system was integrated with PFMS to ensure 100 per cent DBT mode payment to ensure transparency in the system and ASHAs need not required visiting accounts managers and standing in queue for collection of cheque. ◗ Use of power of Information Technology for development of ASHA Payment System: ITbased online system empowered proper monitoring of claim and release of payment. Now, account managers cannot keep the payments pending which is reflected in the dashboard. Activity wise performance could be monitored and tracked at all level (state, district, block, sectoral, SC and ASHA level) by click of a mouse. The system also generates alarm if payments are made more than normal level allowing the higher level authorities for proper monitoring of the system. Dashboard and different analytical reports helped programme officers for proper implementation of the programme. ◗ SMS-based alarms: The system send automatic SMS to ASHAs during receipt of claim, approval and release of payment to ensure transparency in the system. ◗ Categorisation of ASHAs based on performance: ASHAs are categorised as good performing, poor performing and non-performing based on claims submitted. It helped to identify the good performing ASHAs for nomination of awards. Similarly, non performing ASHAs were identified, motivated, re-oriented to improve performance. ◗ Categorisation of activities based on performance: Activities were categorised based on performance by ASHAs. Low performing activities were identified and causes of poor performance was analysed and necessary strategies adopted to improve performance. Solution / technologies implemented ASHA payment and monitoring system was developed using open source technology. The system has been developed and implemented using in-house capacity of NHM, Assam and hosted in the NHM Server. The system is developed under secured user login and role-based user access is provided to the different users. Following modules are implemented: i) ASHA Master Database: ASHA database was created with all vital information of ASHAs along with Bank Account information, mobile number, photographs etc. ◗ Incentive claim: Information of incentive claims by ASHAs is captured through this module. Automatic SMS is delivered to ASHAs on submission of claims in the system. ◗ Approval of claim: Information of approval of claims is captured through the system. automatic SMS is delivered to ASHAs on updating of approval. 32 EXPRESS HEALTHCARE February 2018

POLICY WATCH ◗ Payment process: After approval of the claims, payment process is generated to enable payment through PFMS in DBT mode. Automatic SMS is delivered ASHAs after release of payment. ◗ Monitoring of ASHA trainings: The system is also used for monitoring of capacity building workshops of ASHAs. Pre-assessment and post assessment findings of each ASHA is monitored through the system to evaluate quality of trainings. ◗ Dashboard: Dashboard to highlight the ASHA payment system. ◗ Analytical reports: Different customised analytical reports are generated from the system. State, district, block, sectoral, sub centre and ASHA wise reports can be generated. There is option of generation of drill down reports from state level to ASHA for each activity. Activity wise performance reports are also available. Report of good performing, poor performing and non performing ASHAs can be generated in mouse click. Comparison of the pre-deployment with post-deployment scenario Highlighted comparison of predevelopment with post-development scenario of the system: i) Before implementation of the system in 2014-15, average monthly income per ASHA was ` 1188 in 2014-15. After implementation of the system it has increased to ` 4326 in 2016- 17. ◗ Before implementation of the system, ASHAs were not aware about the list of activities for which they are entitled for incentives. Now all ASHAs are aware about the list of activities for which they are entitled for incentives. ◗ Multiple forms used for claiming incentives for different schemes before implementation of the system. Now, single Master Claim form is used for all activities. Swacchata initiative by ASHAs ◗ Before implementation of the system, multiple window payment system was followed, i.e., ASHAs used to approach each programme officers to submit claim forms, enquire about status of approval and collect separate cheques from each programmes. But, after implementation of the new system, 'Single Window System' has been implemented. Now, ASHAs submit all claims together using single master claim form and need not visit to any person as the amount is directly transferred to bank account. ◗ There was no system to track good performing, poor performing and non performing ASHAs. Now, list of good performing, poor performing and non performing ASHAs could be generated in a mouse click. ◗ There was no method for analysis of activity wise performance. Now, activity wise performance can be analysed automatically from the system. ◗ There was no method to check over payment to ASHAs. Now, alert messages appears for doubtful payment cases. ◗ Before implementation of the system, there was no fixed time frame for receipt of claim and release of payment. After implementation of the system, fixed time frame developed for receipt of claim and release of payment followed. ◗ Issue of regular non payment was major concern before implementation of the system. Now, payment is regular throughout the state. ◗ Interaction with ASHAs with the accounting staff was not formal. Now transparent system implemented by sending automatic SMS to ASHAs. ◗ Issue of red tapping and corruption offend complained. Now, after implementation of the transparent system, it has reduced substantially. Benefits derived from the solution implemented ◗ Increase of income of ASHAs: Exceptional outcome of this initiative witnessed sharp increase of average monthly income of ASHAs from ` 1188 in 2014-15 to ` 4326 in 2016-17. ◗ Timely payment of ASHAs: ASHA payment system has been streamlined and monthly payment is released to ASHAs as per fixed time frame. All backlog payments were identified and cleared within three months from the date of implementation of the system. Now, there is no complaint of delay of payment. Now, ASHAs used to submit claim on time as non submission of claim by ASHAs are also categorised as non performer. ◗ 100 per cent DBT mode payment: Now, 100 per cent payment is made to bank account of ASHAs through Direct Benefit Transfer only. More than ` 150 crore payment has been released to ASHAs through this system. ◗ Free from non performer: Around 5000 non-performing ASHAs were identified and converted to zero non performer within two years through motivation, reorientation and replacement. It could be achieved through monthly follow up of non performing ASHAs from the report generated from the system. ◗ Transparency in the system: The major achievement of the system is to establish transparency and accountability in the system. Interaction of ASHAs with accounts persons minimised by implementing single window system. Substantial reduction in issue of red tapping and corruption. ◗ Structured monitoring: Using the alerts and reports, now the administrators and programme officers are more empowered for monitoring. Using the analysis reports and alerts, instances of overpayment to ASHAs were tracked and those were recovered after thorough investigation. Potential for replicability arising from the success of your project/ activity ◗ Cost effectiveness: The initiative is cost effective. The entire project was managed from the available fund and existing human resources without any hassle. The system was developed using in-house capacity of National Health Mission, Assam using open source technology and it is hosted in the NHM Assam server, so no extra cost was involved. ◗ Customised solution: The system was developed within reasonable time of three months despite several technical issues like integration with PFMS, validation of bank accounts etc. As the system is developed in-house, so it is easy to customised and include new features without any problem. New customised reports could be included as per requirement. ◗ Utilisation of PFMS platform for DBT payment: As PFMS portal is utilised for payment to ASHAs through so there was no cost involved. As PFMS is used by all State and Central Government agencies so it is easily replicable. ◗ DBT payment: Establishing a DBT Payment System in the pursuit of a sustainable development and economic growth is very important. ASHA Payment System develops the e- payment system by transforming traditional payment process to electronic payment practices which has broken new grounds and has taken a global dimension. ◗ Motivate ASHA, develop their economic growth and improve health services: After payment to ASHA become regular, it motivates the ASHA in performing their activities regularly. It also helps in the economic growth of them and helped improvement of health of the community. ◗ Transparency: Using the new system, the payment process to ASHAs became very transparent. All the data can be viewed anytime using the web-based system. (Source: National Health Mission, Ministry of Health and Family Welfare, Government of Assam) EXPRESS HEALTHCARE 33 February 2018

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