Strengthening Routine Health Information Systems (RHIS) of MOHFW through electronic Management Information System (eMIS) is a collaborative effort of 4 implementing partners (IPs) of USAID with the Directorate General of Health Services (DGHS) and Directorate General of Family Planning (DGFP) under the Ministry of Health and Family Welfare (MOHFW). The IPs are: MEASURE Evaluation, icddr,b, MaMoni HSS and SIAPS.
The aim of eMIS Initiatives is to automate the business processes of community level health workers working under DGHS and DGFP using information and communication technologies. Under this initiative, comprehensive and interlinked electronic tools have been developed for community level health and family planning workers (CHWs) including union-level facilities under DGHS and DGFP based on their existing tools of trade, such as paper registers, official documents and instructions.
The eMIS tools are available on mobile devices or tablet PCs and fit the category of mobile health (mHealth) applications. Such mHealth applications are desirable because mobile devices are portable and cheaper than laptops; have longer battery life and they could easily be connected to the Internet. However, Internet connectivity has been a problem in rural areas for which the apps have been so designed as to work offline. Data is stored in the device and uploaded to a central server whenever an Internet connection is established. A centralized database allows data to be viewed or downloaded by supervisors and managers as needed for decision making through web applications in aggregated form. The applications are interlinked so data can be shared horizontally and vertically as needed among different users. The tools are now used by more than 2000 users that include the CHWs and their supervisors and also upazila and district managers.
The eMIS tools are organized in three layers i) population registration; ii) Community and Facility Modules or apps for services, service data which cover domiciliary or facility level; and iii) Supervisory, Monitoring, and Management Tools (for supervisors, upazila/district level managers and decision-makers), as described below:
- Population Registration System (PRS). The PRS at the bottom layer is foundational to the eMIS. Individuals within a household are registered using this system. Personal data of an individual are required for providing services or identify what kind or services the individual received and what is required to be done in case of maternal care. Such registration allows tracking those individuals who have received services. Registration is conducted by Family Welfare Assistants and Health Assistants in their catchment areas. However, Partial PRS is done for anyone who has not been registered and visiting facilities for services. Health ID cards are distributed to the registered individuals.
- Community and Facility Modules (apps for services, service data). These comprise the second layer of applications. Services applications capture services provided to the clients in community settings (such as at home) or at rural facilities. The CHWs also collect data on different services during household visits, which are recorded in registers. Accordingly, the service applications capture transactional data on services provided to individuals at the community level or in rural facilities as well as data on services received. These apps are based on the routine work carried out by the CHWs. The data entry forms and reports within these applications are exact replicas of the paper-based registers, forms, and instructions used by the CHWs. In this way, the familiarity of the CHWs with the data entry forms and reports within the applications is well maintained. These applications can generate the requisite reports for compilation at the upazila level and submission to national headquarters. These apps can be divided into community and facility based systems, as follows:
- Community Apps: These are used by Family Welfare Assistants (FWA) under the DGFP and Health Assistants (HA) under the DGHS. The FWA eRegister is based on FWA Register; the HA eRegister is based on 6 Registers on EPI and HA Register. There is also a CSBA eRegister which is based on the MNC eRegister, a part of Union Level Facility eRegister. The CSBA or Community Skilled Birth Attendants are those FWAs and HAs who have received training to perform as CSBA and could either belong to DGHS or DGFP.
- Facility Apps: Union Level Facility eRegister is meant for use by Family Welfare Visitor (FWV) and Sub Assistant Community Medical Officer (SACMO) at Union Health and Family Welfare Centers (UHFWCs) under the DGFP or SACMOs at the Union Sub Centers and Rural Sub Centers under the DGFP. There are three parts in this eRegister, which are MNC eRegister, FP eRegister and GP eRegister.
- Supervisory, Monitoring, and Management Tools. The third layer is comprised of apps on tablets and web-based tools for monitoring the activities. These tools help to perform supervisory and administrative tasks. A web-based interface allows users to access these tools from the Internet. System maintenance tools are used by developers or technical persons.
- Supervisory apps for union and upazila level supervisors (such as FPIs/AHIs) and managers are available on mobile devices. These tools help them monitor the activities or performance of their workforce. The apps are based on forms used by the supervisors and guidelines issued by the departments. A module has also been finalized for upazila managers of DGFP or upazila family planning officers (UFPOs), called the UFPO eSupervision System. Such apps are: FPI eSupervision System, AHI eSupervision System, HI eSupervision System, UFPO eSupervision System.
- Monitoring tools can be used by authorized users. Some tools are integrated with the core applications of the provider. Monitoring tools are also used to generate or view reports. These are mostly web-based tools and require connectivity.
- System maintenance tools are used at the central level by developers, system administrators, and other authorized users. These can be used to assign access to users, prepare reports, assign work areas, and manage providers.
“Intelligent” solutions or medical algorithms have been used to provide decision supports in the app interface. For example, a pregnant woman can be automatically identified as at-risk based on patient history and examinations; service providers would then be advised to refer her to a higher level of health facility. In another example, when the date of the last menstrual period (LMP) is entered into the system, the expected date of delivery (EDD) appears on screen; this information can be used to suggest potential dates for ANC visits. Such elements have been incorporated into the system by taking full advantage of digital technologies.
The location of use and users of eMIS are presented in the graphics on eMIS.