Real-Time, Real Change: Impact of Distributed Governance
At a small Health and Wellness Centre in Nalanda (Bihar), a routine digital screening took a critical turn when a nurse identified four pregnant women as severely anemic and high risk. Empowered with real-time data and digital tools, the frontline health team responded immediately. The women were referred to the District Hospital, treated with Iron Sucrose, and their lives and babies were saved.
This is the power of Distributed Governance- the convergence of data, technology, and decentralized decision-making to build health systems that listen, adapt and act in real-time.
The Heart of Distributed Governance: A System Shift
In an age where health data is rapidly growing, the gap between information and action remains wide. Why? Because data alone doesn’t drive change-it’s how we use it that matters. In many public health systems, valuable insights sit idle in dashboards, and decisions are made without real-time, on-ground perspectives. Fragmented systems and siloed data only exacerbate these challenges leading to low service quality, poor accountability, and persistent inequities in access and outcomes.
This is where Distributed Governance steps in. At its heart, this Centre of Excellence (CoE) is about enabling technology-driven, data-led decision-making, and empowering actors across the information ecosystem – from frontline workers (FLWs) to program managers – to influence outcomes more effectively.
By bringing the right information to the right people at the right time, Distributed Governance closes the gap between insight and action, making health systems more responsive and accountable. It strengthens governance at four key levels: State Governance, District and Block Governance, Facility Governance, and Outreach Governance.
State Governance: Creating Informed decision-makers
The ability to make informed decisions starts with reliable data. The Swasthya Samiksha Kendra (SSK), a centralized data hub, integrates information from multiple health portals into unified dashboards. These real-time dashboards provide state and district leaders with a comprehensive view of key health indicators and program performance. But it goes beyond just dashboards – through data analytics and actionable insights, the SSK enables leaders to act swiftly and precisely.
In Uttar Pradesh, for example, real-time monitoring highlighted critical gaps in the healthcare system- missing wheelchairs, oxygen shortages, and unmanaged hospital waste. With this data, the state responded quickly leading to a 99% reduction in waste issues and an 86% improvement in essential service availability – restoring both dignity for patients and confidence among healthcare workers!
Impact at the Ground Level: District and Block Governance
For state-level transformations to truly take root, they must reach every corner of the system. This is where District and Block Governance becomes crucial. It serves as the bridge between state-level insights and on-the-ground action, ensuring that data insights are translated into actionable strategies.
In Gaya, Bihar, for instance, health indicators such as antenatal care and institutional deliveries improved by up to 30% in just three months. This was largely due to restructuring the District Health Society’s Monthly Review Meetings (MRM), which incorporated data-driven discussions into their planning.
A vital enabler of this transformation is Virtual Field Support (VFS), a program that empowers local stakeholders to act on real-time data. Through initiatives like the Karuna Fellowship, over 171 young women from rural areas across Assam, Bihar, Jharkhand, Maharashtra, and Telangana now have the digital capabilities, to support FLWs and local leaders in making data-driven decisions.
Facility Governance: Building a Culture of Trust
While District and Block Governance empower local stakeholders, Facility Governance ensures that health facilities are equipped with the tools and resources to maintain quality care. It focuses on mentorship and supportive supervision to drive lasting change.
Through tools like SaQshi, health facilities have shifted from simply checking compliance to actively mentoring staff. By performing internal assessments, generating action plans, and tracking key health indicators, these facilities are better able to identify gaps and implement sustainable improvements. The results speak for themselves: in early 2023, only two public health facilities in Bihar were nationally certified. A year later, the number had soared to 24. This shift is a testament to the power of building a culture of trust and collaboration.
Empowering Communities Through Data-Driven Outreach
Just like the nurse in Nalanda who saved lives by using real-time data, Outreach Governance ensures that ASHAs, ANMs, and others are equipped with the tools to act quickly and effectively. By using dynamic dashboards, actionable data insights, and structured mentorship, healthcare delivery at the community level is transformed. Outreach Governance fosters a culture of continuous improvement, helping health workers prioritize quality care, make informed decisions, and drive better health outcomes.
Distributed Governance is more than a framework- it’s a mindset shift. By ensuring access to real-time data and strengthening the agency of key decision-makers, the CoE doesn’t just build individual capacity – it activates entire ecosystems to respond smarter and faster to the challenges on the ground.