Asha Soft, an online payment and performance monitoring system has made an impact by providing line list data of pregnant women and birth details of Rajasthan. It is a path-breaking initiative, which has helped in improvement of health services in the state. With its implementation, availability of data of pregnant women has increased by 31 percent whereas data availability of newborn babies has increased by 19 percent. Follow-up visits for home-based neonatal care have also increased significantly resulting in better care of infants and timely referral of sick neonatals.
ASHA is a community-level worker deployed at anganwadis throughout the state to provide support services related to medical, health, and family welfare. Approximately 48,000 ASHA sahyoginies are currently working in the state and they get fixed monthly emoluments from the woman and child development department, and also monthly incentives from medical and health department for providing health services to citizens. Based on type of activities and number of cases handled, incentives are calculated and paid to ASHAs. The incentives range from Rs.5 to Rs.5000 per case depending upon the type of activity. There are 26 different activities for which incentives are paid, which include support services for maternal health, family welfare, and child health.
Implementation. In order to implement the system, master data of ASHAs was prepared for each anganwadi and was linked to the health facility including sub-centers, primary health centers (PHCs), community health centers (CHCs) , and hospitals. The same was also linked to pregnancy, child tracking, and health service management system (PCTS) - operational since 2008 and integrated with ASHA Soft. Case details are entered in PCTS and ASHA Soft, depending on nature of activity, and are verified. Online payment is made by CMHOs from the district level for all ASHAs in the district for which digital signature-based authentication is used for releasing the payment. The system is operational since December 2014 from more than 2000 locations and every month Rs.7.8 crore is released through the system.
Impact. ASHA Soft has created significant impact through better availability of line list data of pregnant women and birth details. This has improved follow up of all listed cases enabling overall improvement in health services. With its implementation, availability of data of pregnant women has increased by 31 percent whereas data availability of newborn babies has increased by 19 percent. Follow-up visits for home-based neonatal care have also increased significantly, resulting in better care of infants and timely referral of sick neonatals.
The days earlier. Prior to ASHA Soft, there were no standard procedures for performance and payment monitoring for ASHAs and there were multiple payment points. Cash was maintained at every sub-center, PHC, and CHC (Total 16000+ locations for cash handling). Incentive payment for certain activities was made by auxiliary nurse midwifes (ANMs) up to sub-center while incentive for other activities was paid through cheque at PHC level (separate cheque for RCH activities, and national health programs), which were handed over to ASHAs in the monthly meetings. Invariably, there was delay of at least one-two months in the payment; the process of approval on case basis generated a lot of clerical work at all levels.
The process. ASHA Soft has simplified the process significantly, which has introduced standardized claim forms for ASHA for all 26 activities. The forms are submitted by an ASHA at her sub-center, where the ANM verifies them. The claim forms for all 26 activities in a month are submitted at the end of the month by ASHAs and once verified by the ANM, the forms are sent to the concerned PHC, CHC, and Block PHC for data entry.
All claim forms are entered into the system as per predefined schedule of data entry and verification (generally 26th of every month to 2nd day of next month). As the next step, sanctions for each of the service category are generated by the MOIC for all ASHAs in his/her jurisdiction and all these sanctions are generated as per predefined schedule (generally 3rd day of next month to 5th day). Sanction letters are generated accordingly, with the system and maintained online in pdf format for later reference and finally the fund transfer order is generated at the district level by the concerned CMHO, using digital signature certificate (DSC). Thus, online payments are transferred by the 7th of next month.
The time taken to make the payment has drastically come down, from about 2 months to 7 days. The process of payment is transparent and has almost eliminated the requirement of repetitive manual work which was also prone to many errors.
Large numbers of monitoring, analytical, and exception reports are generated through the system. The system now informs about ASHAs not providing services or ASHAs who are doing very efficient work. Institute-wise reports can inform PHC/CHC with lowest-performing ASHAs. Analytical reports generated by the system have outlined the areas of activities, which are getting ignored by ASHAs and need more support. Similarly, patterns can be drawn geographically as well for a district or block. Such analysis highlights performance levels of all the staff engaged in providing health services at every location.
Rajasthan is the first state to have this kind of a system. The software has also been provided for implementation in Karnataka state whereas many other states have shown their interest in the system.
Recognitions. This initiative has received many accolades. These include Healthcare Leaders' award, March 2015; Award at Elets Knowledge Exchange Summit, May 2015; and Skoch Smart Governance Award in September 2015.
Ministry of personnel, public grievances and pensions, government of India, has selected the ASHA Soft for national award for e-governance for the year 2015-16. Our vision is to turn ASHAs into medical entrepreneurs one day.