Conversations about governance in 2020 immediately bring up questions about the Health sector. The healthcare landscape has faced unprecedented challenges and has been tasked with not only managing the pandemic but also continuing non-Covid healthcare services. SKOCH studied Health projects in 2020 to assess how the healthcare sector has performed in India.
The Covid-19 pandemic has changed the way we look at everything. This holds true for governance as well. Even though administrative priorities at the micro and macro levels are more-or-less unchanging, the manner in the government approaches the same has been affected significantly this past year. The SKOCH State of Governance analysis shows that certain sectors, like Police & Safety and District Administration have burgeoned this past year. These trends can be understood in terms of focus areas that have been at the frontlines of the pandemic: the police have served as first-responders and districts as the smallest, first-contact unit of governance have been more energetic than ever.
The Health sector itself has evolved in response to and despite the pandemic. Necessity is the mother of invention, they say, and one can see several innovations that have been leveraged because of the pandemic. Most importantly, the drastic shift in favour of digital technologies at a time of lockdowns and social distancing has transformed the delivery of healthcare services. WHO has touched upon the role of telemedicine in Covid-19 for augmenting healthcare infrastructure and improving capacity. One of the most impactful telemedicine projects from 2020 is eSANJEEVANI under the National Health Mission – Arogyakeralam in Kerala.
The Health Tech segment has come up with several exciting new developments and upgrades to existing schemes. Some noteworthy mentions are General Health Services during the COVID-19 under Ayushman Bharat – Arogya Karnataka, the Public Grievance Management system introduced by Rajiv Gandhi Super Speciality Hospital in Delhi and the work done by the National Health Mission across the country.
Changes in governance can be observed both long-term and short-term. The following table is a year-on-year comparative analysis of the shifting governance priorities from 2015. Towards the end of this table, we take a look at the impact of Covid-19 on governance.
| Shifting Governance Priorities: State Governments From 2015-2020 | |||||||
| 2020 | 2019 | 2018 | 2017 | 2016 | 2015 | 2015-2020 | |
| Projects Ranked Per Year (%) | |||||||
| Agriculture | 1.72 | 0.00 | 1.24 | 1.97 | 3.04 | 7.02 | 1.91 |
| Disaster Management | 0.00 | 1.10 | 0.00 | 0.00 | 0.00 | 0.00 | 0.22 |
| District Administration | 40.34 | 9.16 | 12.37 | 8.55 | 0.00 | 0.00 | 17.37 |
| Ease of Doing Business | 0.74 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.22 |
| Education | 1.35 | 3.48 | 3.51 | 6.91 | 6.42 | 9.21 | 4.04 |
| eGovernance | 5.90 | 13.19 | 16.91 | 26.32 | 29.73 | 40.79 | 17.33 |
| Finance & Revenue | 0.12 | 0.92 | 1.24 | 2.63 | 4.05 | 10.09 | 2.06 |
| Food & Civil Supplies | 0.00 | 1.28 | 1.44 | 0.00 | 0.00 | 0.00 | 0.52 |
| Governance (General Administration) | 2.83 | 7.88 | 2.06 | 8.88 | 9.80 | 9.21 | 5.73 |
| Health (Non-COVID) | 4.31 | 11.72 | 4.74 | 6.25 | 6.76 | 5.26 | 6.47 |
| Infrastructure | 0.12 | 0.55 | 0.21 | 0.00 | 0.00 | 0.00 | 0.19 |
| Irrigation | 0.00 | 0.37 | 2.68 | 0.00 | 0.00 | 0.00 | 0.56 |
| Labour | 0.00 | 0.00 | 0.00 | 1.32 | 0.00 | 0.00 | 0.15 |
| Municipal Governance | 11.32 | 19.05 | 18.76 | 28.29 | 30.41 | 15.79 | 18.68 |
| Municipal Sanitation | 3.81 | 4.40 | 12.58 | 0.00 | 0.00 | 0.00 | 4.34 |
| Police & Safety | 12.92 | 9.34 | 1.44 | 0.00 | 3.04 | 0.00 | 6.44 |
| Power & Energy | 2.21 | 3.30 | 2.47 | 0.00 | 0.00 | 0.00 | 1.80 |
| Rural Development | 1.23 | 1.83 | 3.09 | 0.00 | 0.00 | 0.00 | 1.31 |
| Skill Development | 2.46 | 2.75 | 1.24 | 0.00 | 0.00 | 0.00 | 1.53 |
| Social Justice & Social Security | 0.00 | 0.00 | 0.00 | 1.97 | 0.00 | 0.00 | 0.22 |
| Tourism & Culture | 0.00 | 0.37 | 0.41 | 0.00 | 0.00 | 0.00 | 0.15 |
| Transport | 3.32 | 3.30 | 4.54 | 4.61 | 6.76 | 2.63 | 4.00 |
| Urban Development | 0.86 | 3.66 | 6.60 | 0.00 | 0.00 | 0.00 | 2.21 |
| Water | 3.08 | 0.92 | 0.82 | 0.00 | 0.00 | 0.00 | 1.27 |
| Women & Child Development | 1.35 | 1.47 | 1.65 | 2.30 | 0.00 | 0.00 | 1.27 |
| Total number of projects studied | 813 | 546 | 485 | 304 | 296 | 228 | 2672 |
| Response to covid % | 24.97% | ||||||
| Numberof Projects related to Response to Covid | 203 |
The Health (Non-COVID) segment accounts for 4.31% of the total projects ranked in 2020. This is something of a dip when compared to 2019, when the Health sector contributed 11.72% to the total number of projects. But given that the Health sector -along with all others, to be fair- has been focused primarily on the Covid-19 pandemic since 2020, this fluctuation is understandable.
The SKOCH team studies state performances across a variety of governance parameters to arrive at our annual SKOCH State of Governance rankings. The review process is the most meticulous of its kind. For 2020, SKOCH has ranked states on the basis of performance in Health Sector as well, in addition to the overall annual states’ ranking. The top-ranking states by performance in the Health sector are as follows:
| State Rank by Health | State Names |
| 1 | Haryana |
| 1 | West Bengal |
| 2 | Karnataka |
| 3 | Andhra Pradesh |
| 4 | Delhi |
| 5 | Uttarakhand |
| 6 | Kerala |
| 7 | Himachal Pradesh |
| 8 | Gujarat |
| 8 | Punjab |
| 9 | Bihar |
| 9 | Rajasthan |
| 9 | Tamil Nadu |
| 9 | Uttar Pradesh |
SKOCH studies state function on the basis of fundamental governance sectors, such as Agriculture, Economy and Municipal Governance & Sanitation. These sectors are further categorised into different niches. For instance, Health projects that are launched under the Swasth Bharat campaign are classified as such. A strong example is the Know Your Breast, Save Your Self program launched by VMMC and Safdarjung Hospital for disease control. Projects under the Swasth Bharat niche make up 8.57% of the Health sector in 2020. As a result of the pandemic, SKOCH studied Health projects in 2020 under two new niches: Excellence in Response to COVID, which accounts for 37.14% of the total Health projects and Excellence in Inspirational or Transformational Performance during COVID, which contributed 20% to the sector. The Excellence in Health/ Health Tech sub-sector makes up 20% of the total projects in the Health sector.
It is essential to take a nuanced view for a truly accurate appraisal and fair representation of each governance sector and how states perform against these parameters at the macro and micro levels.
The impact of the pandemic on the Health segment is visible in the chart above. The projects studied under the Covid-19 categories account for 57.14% of the total number of Health projects studied for 2020. The following are some of the most impactful Health projects in 2020 in response to Covid-19. These projects have outshined others in terms of planning, performance and impact. It is no surprise that some of these states are also the highest-ranking overall in the State of Governance review.
SKOCH commends the Health Department, Haryana, for the ‘COVID-19 Status in Haryana‘ programme. As part of the project, the department set up a 24*7 helpline that addresses both Covid-19 and general healthcare concerns. Operators helped people with Covid-19 understand and manage symptoms and also escalated calls to medical specialists in serious cases. The project involves a team of around 979 empanelled specialists for telemedicine consultations and has been operational since April 2020. The project also involved large-scale rapid sampling and testing to collect real-time data about clusters in both urban and rural populations.
The Health & Family Welfare Department, Government of West Bengal, started the Integrated Call Centre For COVID-19. The department recognised the traumatic mental health impact of the unprecedented crisis. As a result, the helpline was established to answer people’s questions, allay fears and coordinate aid as needed. Proper communication, accurate information and panic-management have proven crucial to maintaining order, stability and social health in this past year. The call centre incorporated 120 lines dealing with both Covid-specific and general queries. It also worked to arrange hospital care and ambulance services for Covid-19 patients. The project teams also offered telemedicine consultations and psychological counselling services. The 24*7 helpline has not only helped callers from West Bengal and other parts of India, but overseas as well.
The Health Medical and Family Welfare Department, Government of Andhra Pradesh, launched the COVID 19 Digital Handling programme. The use of modern technology to manage the crisis has been a defining feature. Andhra Pradesh effectively used digital technology to map, monitor and update details about the developing situation. The department used mobile and web technologies to record every step of the infection process, right from testing to hospital discharges. Sample collection and results are recorded in real-time in the Covid-19 portal while results are sent to patients immediately via SMS in YES/NO format. Additionally, patients receive an with ICMR result declaration PDF document link, which can then be used to avail hospitalisation and healthcare services.
Analytics were conducted on data to assess and control the spread of the infection. Prior to the project launch, manual testing without an automated database resulted in duplication. The introduction of IT to the landscape has allowed the department to monitor all hospitals in real-time.
While there is no denying that the pandemic is the #1 topic on all our minds, it is vital for the country’s stability and health that other aspects of governance function unfettered. And so, it is reassuring to see that the Health sector has continued to serve the citizenry despite the biggest healthcare crisis in recent global history. The following are some of the most impactful Non-Covid Health projects in 2020.
The Central TB Division, Ministry of Health and Family Welfare, launched the Nikshay V2.0 project. This is a noteworthy step in the Health Tech space because the Nikshay is an integrated National TB Surveillance system and Direct Benefit Transfer scheme in a country that accounts for 1/4th of the world’s TB burden. The scheme has been expanded and developed since its inception in 2012 and the latest reforms integrate a dynamic, scalable structure that addresses previous-generation problems of paper-dependency, manual data-entry errors, duplication, paucity of digital infrastructure etc. Newer agile technology allows all stakeholders to communicate and feedback from users is rapidly incorporated into development projects. To better equip healthcare staff, the programme designers have developed a mobile app for the platform and also distributed 20,000 handheld devices, with more in the offing.
Nikshay offers end-to-end services for TB patients, from test details, prescriptions and treatments to Intelligent Task Lists for staff for improved follow-ups. The scheme reports 2 lakh beneficiaries registered monthly and over Rs. 2.5 Crores worth of benefits allotted to TB patients weekly.
The National Health Mission has done significant work across the country. We’ve already touched upon the contribution of the eSANJEEVANI project from Kerala to the field of telemedicine. Other significant contribution from the state under National Health Mission – Arogyakeralam is the DISHA – Direct Intervention System For Health Awareness and the Response to COVID. The DISHA system is the state’s first 24*7 Tele Health Helpline. The helpline received 7.1 Lakh calls till September 2020 of which 3.2 Lakh calls were about Covid-19. The helpline includes Doctor on Call Support, information about Health department services and complaint registration.
National Health Mission, Punjab, organised Trans-Fat Free Diwali campaign at Health and Wellness Centres of Punjab. The NHM also held Screening, Detection and Management of Diabetic Retinopathy through Health & Wellness Centres in Punjab. Both these projects are recognised for their innovative contributions to the Health Tech niche.
The NHM also started a project for Capacity Building Initiatives in Uttar Pradesh in response to Covid-19.
National Health Mission, Uttarakhand, introduced the Monitoring and Follow up mechanism for Health Services among the population through 104 helpline. The key goals are to monitor programs on the ground, track high-risk conditions and strengthen the healthcare system in order to meet the 2025 SGD targets for decline of MMR, NMR and U5MR. The helpline seeks feedback and prioritises grievance redressal actively.
The Balaji Institute of Research and Rehabilitation (BIRRD) Hospital established a program titled ‘Free Healthcare Treatment To Differently Abled And Physically Challenged People’. The Trust behind the hospital recognises that medical disabilities should not be allowed to hold people back from living fulfilling lives and participating in social, personal and professional pursuits. In light of this, the hospital offers free-of-cost corrective surgeries for poliomyelitis and cerebral palsy. The organisation is pioneering inclusive medical and healthcare services by prioritising patient care without costs. These surgeries have helped patients re/gain the ability to walk and are giving people a new lease on life. At the time of this review, 1,36,000 such surgeries had been conducted.
The State Nodal Cell of the Health & Family Welfare Department of Gujarat collaborated with MDIndia Health Insurance TPA Pvt. Ltd. for Mukhyamantri Amrutum Yojana. The project is an excellent example of Public-Private Partnership. The project services the healthcare needs of the underprivileged people of Gujarat. Key features of the project include excellent treatment protocols and auditing mechanisms that have enforced stringent levels of transparency. As a result, the scheme has the one of the lowest rates of malpractice and abuse in the country.
Beneficiaries under this scheme receive cashless medical and surgical care for a wide variety of concerns ranging from cardiovascular, renal, neurological, neo-natal and malignant diseases and burns and poly-trauma to knee and hip replacement as well as liver, kidney and pancreatic transplants. As many as 698 procedures are offered under the scheme along with follow-up services. The scheme guarantees Rs.5,00,000/- to every beneficiary family per year on a family floater basis. Beneficiaries are also reimbursed Rs.300/- for transport for every visit for treatment at an empanelled hospital.
District Panchayat Ahmedabad launched Mission Indradhanush to prioritise routine vaccinations. The programme looks at capacity building of ASHA and health workers and introducing supervision mechanisms to guarantee programme efficacy. MI educates local populations about the importance of completed vaccinations for children and especially focuses on the labour communities. It also raises awareness and does work in the fields of reproductive and child health as well as communicable and non-communicable diseases prevention. As a result, 80% of the target areas have been incorporated into the immunisation program and no cases of Measles have been reported in this period.
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