Quality of End-of-Month Reports Increases the Buy-in of eMIS Tools

End-of-month (EOM) reports, prepared by the field workers of Directorate General of Family Planning (DGFP), are an important source of national routine data. The reports summarize all the activities carried out by field workers in the previous month and bring out the overall health and family planning situation in their catchment areas.

The DGFP has been implementing the eMIS since 2015 which is now available in 32 districts. eMIS is an ecosystem of mobile apps and web-based applications linked to a cloud-based environment. Within eMIS, FWA eRegister has been developed for Family Welfare Assistants (FWA) and FPI eSupervision System for Family Planning Inspectors (FPI), who supervise FWAs. These are mHealth apps that run both online and offline and allow the users to conduct all their activities digitally using handheld Tablets. These tools are linked or fully integrated with each other.

Digital Innovation

The FWA eRegister is a digital innovation that is fully based on the FWA Register (paper-based) and other approved documents of DGFP (such as monthly MIS reports and monthly advance workplan) that the FWAs use. The FPI eSupervision System similarly is based on the workflow of FPIs. Both type of users uses these apps for submission of EOM reports. Currently, 6,251 FWAs are using FWA eRegister and 1,557 FPIs FPI eSupervision System. They are generating monthly MIS reports, known as MIS1 and MIS2, using their apps. The FPIs review MIS1 and afterwards combine all the MIS1 reports to prepare their MIS2 reports specific to the union. We reviewed the submission status of the reports and also tried to find out the level of acceptance of the apps together with the reasons from users at different levels.

The digital copy (accessed via webpage) of MIS1 is an exact replica of paper form, which the users could easily understand and identify.

Screenshot_2020-09-29 eMIS Monitoring Tools(3)

The following image shows the submission status of MIS 1 in Mirzapur upazila of Tangail (August 2020):

Screenshot_2020-09-28 eMIS Monitoring Tools

The following image shows the submission status of MIS 2 in Mirzapur upazila of Tangail (August 2020):

Screenshot_2020-09-28 eMIS Monitoring Tools(1)

The following image show the submission status of MIS 1 all over the district of Tangail (August 2020). The managers and supervisors can use this web-based tool (with access control) to identify the status of submission. They are able to drill down to the individual users as personal details with phone numbers are given in the list (personal details, such as names and phone numbers have been erased in the image).

Observation by an FWA

For the FWAs, compared to paper-based systems, there are obvious benefits in preparing MIS1 through eRegister.

Homaera Akhter Meli, FWA, Monoharganj, Cumilla

Report preparation needed time and efforts. We had to record and count daily activities. We would calculate the use of each method by users. We had to show number of ELCOs and population by household. All these are time-consuming and also a difficult exercise. It used to take 1/2 days to prepare the MIS 1 report in paper. This is now done instantly in the Tablet or completed in a minute or two.

How the FPIs see it

An FPIs also testified about the benefits and observed that additionally, accountability mechanisms are a built-in feature of the app.

Tariqul Islam, FPI, Gharinda union, Tangail Sadar

Digital system ensures quality of report. Discrepancies between the report data and the Eligible Couple Register (paper) were common in the past. We had to go through each entries of the register to find out the mistakes, which was troublesome and extremely difficult. Digital report is free from errors or discrepancies. It also ensures the accountability of users. It was possible to fill in pregnant register, child register and adolescents register without even providing services to such clients. But no fictitious data could be entered in the eRegister, only services provided are recorded in the respective registers. Now, we can approve MIS1 of FWAs and generate our own MIS2 in the shortest possible time.

Jahir Ahmed, FPI, Monohorganj, Cumilla

There could be errors in a report prepared manually. A digital report is free from errors. Manual report has costs in terms of making photocopies, travelling from a distant union to upazila headquarters. A digital report can be generated at home and be submitted instantly, saving both time and money. Paper copies could get lost or be misplaced. The digital report can be retrieved at ease from anywhere and anytime.

Views of sub-district managers

The upazila (sub-district) managers explained benefits in multiple ways. For example, one saw improvement in timely and effortless submission.

Md. Hasin, UFPO, Dimla, Nilphamari

Digital eMIS is an epoch-making step. The workers or supervisors are able to prepare their reports on time and without any error. They can submit their MIS forms on the 1st day of the month. Analogue system was time-consuming. No report could be submitted before elapse of 7 or 8 days; at times, for some people, it even took 10 days. Supervision and monitoring has become so easy now.

Another explained how the need for prior preparatory meetings were eliminated:

Mr. Gulam Rasul, UFPO, Kotchandpur, Jhenaidaha

MIS reports are submitted in the first week of each month. Towards the end of the current month, a fortnightly preparatory meeting is held with FWAs (which is known as report meeting). FPIs lead this meeting. After discussion, MIS 1 & 2 are created and submitted to the upazila office. Digital reports are created automatically and be accessed instantly. No need to rummage through the paper sheets, or pile of files. No need to call the FPIs. I can review the report and provide feedback. It helps us to successfully achieve the government's goal of building a Digital Bangladesh.

Managerial and logistics angles were highlighted by one respondent.

Sahidul Islam, UFPO, Mirzapur, Tangail

The MIS1 and MIS2 lead to auto-generation of MIS4, which is the MIS report for whole upazila. Earlier, time was needed for preparation of this report. Often mistakes would creep up in calculation of various fields, which has been eliminated totally. At times, we would face shortage of forms. Now, I don’t have to worry about replenishing stock.

Conclusion

The eMIS apps are brining many types of benefits to the end-users, managers and decision-makers. The quality of EOM reports increased on every count. Reports could be submitted in time, those are free of errors and generated effortlessly. It has eliminated some processes used for preparing reports. Overall benefits in terms of saving time and money have also been reported. The managers now have additional tools to supervise and monitor their field workforce. Report data are stored in databases chronologically and have potential for further analysis beyond current use.

Credits:

Kazi Md. Obaydul Haq, Health Systems Manager, icddr,b conducted the interviews.