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Rationalisation of registers

The Solution

Rationalising service delivery registers to improve ease and effectiveness

Frontline workers (AAA) maintain numerous, voluminous registers. For instance, the anganwadi worker alone has 11 registers. Several of them contain repetitive fields. Naturally, frontline workers see registers as a burden. We see them as job-aids.

We work with government functionaries to make the service delivery registers and records easy to use. We carry out design changes such as eliminating repetitive columns, introducing a logical sequence and making them visually appealing. It helps to save time, improve data quality and morale of health workers.

Below are examples of some critical design innovations:

1. Reduction of effort required:

  • ­­Removal of duplicate entries and redundant information
  • Ensuring that data required for reporting is aggregated at source

2. User-friendly format:

  • ­­Designing for enabling easy data entry (e.g., the formats are coded with color to provide visual importance)
  • Ease of access to medical history of beneficiaries by ensuring all medical history of a beneficiary is found in one place

3. Compatibility with role clarity and team effort philosophy

  • Institutionalizing the AAA philosophy, with focus on role specific information in the register

4. Meeting government reporting needs

  • Ensuring the inclusion of critical information required for health service reporting, frequently missed out from registers and records
Regs

Discussion on registers with health workers, Rajasthan

Rationalisation of registers

Status

The solution has been successfully applied in multiple use-cases across Rajasthan and Madhya Pradesh

*MP Shri Dushyant Singh - launching the rationalised registers for Rajasthan

ANM's service delivery register - Rajasthan

Rationalising the Auxiliary Nurse Midwife (ANM) service delivery register (SDR) was a key intervention within the Akshada program in Rajasthan. The Antara Foundation rationalised the ANM SDR with a view to reduce workload without losing important information, thus freeing up time for service delivery. By eliminating redundant and overlapping data-recording, this exercise also helped in bringing role clarity among the frontline workers of Rajasthan.

The new register was intuitive, and process driven, including all the critical design innovations. In November 2016, the updated register format was finalised with the Department of Health and Family Welfare and the new registers were printed and circulated. Since Mar 2017, the ANMs have been using the rationalised registers across the state of Rajasthan.

ASHA's monthly work-plan - Rajasthan

The ASHA (Accredited Social Health Activist) worker delivers critical services to beneficiaries at their household, however she is unable to prioritise her work. In 2016, ASHAs of three blocks were provided with a household visit scheduler on a pilot basis. The scheduler was designed with an algorithm that enabled the ASHA worker to schedule visits in advance based on service priority. Regular services were included into the scheduler as well so no beneficiary would be missed. In 2018, the ASHA household visit calendar was added to the ASHA diary as an addendum and scaled throughout the state of Rajasthan.

ASHA diary - Madhya Pradesh

As part of our Akshita program, we rationalised and re-designed the record-keeping registers of ASHA workers (ASHA diary) in Madhya Pradesh (MP). Our field observations indicated several areas of improvement in the existing diary. There was no provision to capture many critical services, poor design elements made data-recording tedious, and many ASHAs even used rough diaries to supplement their main diary.

The re-designing was based on four key principles – ensuring comprehensive recording of all services provided and beneficiaries covered, minimising data-recording errors, reducing data-entry time, and enabling special focus on high-risk beneficiaries. This was an intensive exercise carried out in close collaboration with government, with feedback from ASHA workers, officials from all 52 districts and State representatives. The idea was to make the ASHA diary a job-aid and not a burden, and thus boost the morale of ASHAs.

The revised ASHA diary is being rolled out across all 52 districts of the State by the MP government.

  • Asha Diary Mp 1
  • Asha Diary Mp 2
  • Asha Diary Mp 3
  • Asha Diary Mp 4

Examples from the re-designed ASHA diary in Madhya Pradesh

Rationalisation of registers

Impact

The solution has been scaled up state-wide across the states of Rajasthan and Madhya Pradesh

Scaling up of the solution

Rajasthan

In April 2017, the state government of Rajasthan adopted the revised service delivery register for ANMs. This was then rolled out across the state.

Impact Ro R

In 2018, the new version of the ASHA diary included the household visit calendar and guidelines that were created by the Antara Foundation.

Madhya Pradesh

In August 2020, the revised ASHA diary was accepted by the MP government for scale-up across all 52 districts of the State. This intervention will benefit more than 77,000 ASHA workers state-wide.