Nagaland has made significant strides in modernising public healthcare through the successful implementation of the Hospital Information System (HIS) under the Nagaland Health Project (NHP), funded by the World Bank. The initiative, which commenced in February 2022 with a pilot at the Naga Hospital Authority, Kohima (NHAK), a 300-bed facility, has expanded to include ten additional district hospitals.
The HIS employs the open-source Bahmni software, integrating five core modules: OPD registration, billing, pharmacy, laboratory, and the Medical Records Department (MRD). Due to the autonomous nature of hospitals and the region's poor internet connectivity, the system utilises a Local Area Network with servers stationed within each district hospital. Performance data is uploaded to a cloud-based dashboard daily to facilitate state-level monitoring.
Overcoming Challenges
Implementing such a comprehensive system in Nagaland posed several challenges, including infrastructure limitations, inconsistent power supply, budget constraints, and staffing shortages. Dr. Imkongliba Memorial District Hospital (IMDH) in Mokokchung, situated at an elevation of 1,325 metres above sea level, emerged as a model of success despite these hurdles.
The collaborative efforts of the Chief Medical Officer (CMO) and Medical Superintendent (MS) were pivotal in this achievement. They strategically redeployed underutilised staff from peripheral areas to support the hospital's operations.
At the State level, the implementation was led by the Department of Health & Family Welfare, Nagaland. Nagaland Health Project provided IT computing infrastructure, HIS software, training and other implementation support.
When the World Bank team visited IMDH in August 2022, they found a fully operational system, demonstrating the district's commitment and ingenuity. The district's mantra, “Pride of the District,” was a driving force behind the motivation and dedication required to overcome substantial obstacles.
Broader Impacts
The HIS project has significantly improved the efficiency and effectiveness of healthcare delivery in Nagaland. Officials noted that integrating ICT into public healthcare has streamlined administrative processes, reduced patient wait times, and enhanced the accuracy of medical records. The centralised system also facilitates better resource management and accountability, which is crucial for a region with limited healthcare infrastructure.
Further, the system has improved the implementation of Ayushman Bharat PM-JAY scheme and Chief Minister's Health Insurance Scheme as HIS provides inputs to the Transaction Management System for submission of insurance claims and reimbursement to the district hospital.
Healthcare experts, during a recent seminar on the Nagaland Medical College Hospital Development Project, emphasised the transformative potential of integrating ICT in healthcare. They highlighted how such systems could bridge gaps in service delivery, particularly in remote and underserved areas.
Community and Government Support
The success of the HIS project in Nagaland exemplifies how community and government support can drive significant improvements in public services. The project received commendation from various quarters, including state officials and international observers.
It is worth mentioning here that Nagaland has gone considerably farther than most other States in the country in terms of community level mechanisms for accountability of health services.
State government introduced “Nagaland Communitisation of Public Institutions and Services Act” in 2002. In the health sector, Village Health Committees are responsible for management of local health services, including salary payment as well as use of small funds transferred by the state government.
Future Prospects
Beyond technological advancements, the project has fostered a sense of pride and ownership among local healthcare providers. Looking ahead, the success of the HIS implementation in Nagaland sets a precedent for similar projects in other parts of India and beyond.
The success of the project also underscores the importance of tailored solutions that consider local contexts and constraints. The state government plans to continue leveraging ICT to enhance healthcare services, with further expansions and improvements in the pipeline.
The HIS implementation in Nagaland exemplifies the transformative power of technology in public healthcare. It showcases how strategic planning, community involvement, and government support can overcome significant challenges to deliver better healthcare services to the people of Nagaland.
This project not only enhances healthcare outcomes but also instills a sense of pride and accomplishment among the district's healthcare providers. It can serve as an inspiring model for other states to emulate as they embark on healthcare modernisation projects
