Many digital projects fail for reasons of design, appropriate buy-in from users or lack of proper understanding of organizational dynamics. Ensuring sustainability of a large IT system requires careful considerations from the early stage.
The eMIS is a large digital initiative implemented by the Directorate General of Family Planning (DGFP) under the Ministry of Health and Family Welfare of Bangladesh. The pilot implementation of the eMIS began in January 2015 in two districts with support from the United States Agency for International Development (USAID). On successful implementation, the DGFP started scaling it up in other districts in 2018, which reached 36 districts in March 2021.
The eMIS is a complex ecosystem of apps, web services and web-based applications in a cloud-based environment. It aimed at converting the business processes of the users and digitized official registers, forms and other documents. At the field level, now different eMIS apps are being used by more than 10,000 users. The apps are loaded in Tablets and work both offline and online. The benefits of digitization are acknowledged by the users and documented in several blogs in this website. The eMIS involves community level health and family planning workers at rural level, their supervisors, managers and others. The tools are also available for first line facilities. The tools are interconnected both vertically and horizontally. Therefore, data could be shared across the organization.
Key elements of sustainability
The eMIS is running for over 6 years now. However, ensuring its sustainability requires many steeps, which are addressed in detail in a MEASURE Evaluation report. Key elements of sustainability of eMIS can be expressed in terms of a) acquisition of hardware, b) software development and System maintenance, c) capacity building, d) implementation mechanisms, and e) the use of data for decision making. These are briefly discussed below.
Acquisition of Hardware
Digital devices replace paper documents. The community level users of eMIS tools need devices on a day to day basis and a non-functional device creates problems in discharging their duties. Devices can malfunction, be lost or stolen and require replacement immediately. They need to be replaced when their working life is over as well. Therefore, a robust mechanism is required to address all these. A robust procurement process supported by yearly budgetary allocations and supply chain need to in place. When purchasing Tablets, durability of the equipment, battery life, and performance should be considered. Finally, a buffer stock at local level is also desired to meet emergencies.
Software Development and System Maintenance
The eMIS is a cloud-based system and require remote databases in a robust data center. Running and keeping the system operational round the year is a huge undertaking. Software development and maintenance is a critical element in this scheme. Software requires regular updating for performance improvement, to remove bugs and to overcome any shortcoming. Skilled and dedicated human resources are required for maintenance and further development. If technical manpower or capacity to manage is lacking within the organization, the services have to be procured from outside through third parties.
Managing digital resources requires special skills for those whether working in the headquarters or the field offices. The users need trainings. Capacities are required to manage field implementation or sustain the use of eMIS tools. A pool of ICT personnel would be desirable to oversee technical works. If development and maintenance activities are out-sourced, there should be capacities to manage contracts.
The eMIS apps are designed for individual field workers (or is assigned to a specific user who have responsibilities in their designated or catchment areas). Desired services are difficult to provide in the field in positions remain vacant for long. While it is administratively possible to assign additional areas to one employee, it is not a realistic solution. All field vacancies should be filled as early as possible.
During implementation of eMIS several formal structures like Technical committees were formed at central and districts levels. These are well positioned to oversee and manage different aspects of implementation. On operational side, the users should have access to staff trained in trouble-shooting. In addition, the users need to have access to stabile and quality Internet all the time.
Data Use and Evidence-based Decision Making
The eMIS is data rich. The eMIS tools generate service data in addition to demographic, administrative and performance data. Intelligent solutions and medical algorithms have been incorporated in the apps to provide decision support. Management should ensure the use of in-app decision support systems. The apps generate notifications when any event has been missed by the particular worker; job aid tools flag cases requiring the attention of the user.
Dashboards and different monitoring tools are elaborate in design and offers myriad ways to view data for day to day to management. Data could be used to improve and measure the performance of the field workers and managers or for any decision-making purposes. The management should strive to create a culture conducive to valuing data and to act timely on the basis of data. Data analytics could provide better insight and lead to targeted interventions, whether for improving services or the performance of the workers. The eMIS tools would serve their purpose when those are used properly by field workers, supervisors, and managers including decision-makers at central level.
The above items have been presented in greater details in the report where responsibility for implementing the activities, cost implications, and timeline, along with the suggested completion date have been outlined in an action plan.