The implementation of eMIS, a digital ecosystem of mobile apps and web-based applications supported by cloud databases, began in January 2015 as pilot in 2 upazilas (Basail and Madhabpur) of 2 districts (Tangail and Habiganj) under the Directorate General of Family Planning (DGFP). The eMIS was supported by the USAID through its Implementing Partners (IP) namely, MEASURE Evaluation (later D4I) in partnership with icddr,b and Save the Children/MaMoni HSS later (MaMoni MNCSP). Other development partners (DP) funded projects also lent some form of support at later stages.
Scale up started quickly
The Implementation of eMIS began with developing an Android app called population registration system. It was followed up with addition of new apps/tools and expansion to the remaining upazilas of pilot districts. As results were very encouraging, the USAID provided support for scaling up eMIS tools in 5 more districts, which started in 2018. The DGFP leadership showed enormous buy-in and support for the digital system. Further scale up followed as the DGFP made provisions for funds for different eMIS activities like procurement of Tablets, Internet costs and trainings. At the end of June 2022, the number of districts under eMIS stood at 40 covering 315 upazilas. It took 7 and a half years to reach that level. It is expected that all districts would be brought under the eMIS within current sector wide program of MOHFW (July 2017- June 2023).
Responding to users’ needs
The DGFP have presence at the grassroots level predominantly in the rural areas and work through community level workforce backed by first-line facilities called Union Health and Family Welfare Center (UHFWC). The eMIS tools addressed the requirement of field workforce through community and facility based systems, the responsibilities of which were divided between IPs. As a digital innovation, the eMIS aimed to automate the business processes and apps specific to the responsibilities of each category of users were developed. Apps were developed for Family Welfare Assistants (FWA), Family Planning Inspectors (FPI). App was also developed for Sub-Assistant Community Medical Officers (SACMO), Family Welfare visitors (FWV) who provide services from UHFWCs and satellite clinics. Currently, over 13,000 users regularly use eMIS apps or web-based tools for recording their activities, collecting health and family planning data, submitting monthly reports and connecting with their clients that include eligible couples (women aged 15 to 49), pregnant women, children, adolescent girls.
How users helped to shape the apps or different tools
They users were involved in the different stages of design of apps, testing them and final roll-out. The process was not easy. Even after roll out, work was needed to remove bugs, enhance functions as desired by the DGFP or give users satisfaction through enhanced performance. Attention was given to capacity building. Continuous technical support through project and later a pool of troubleshooters was trained from different ranks of DGFP. The field users as well as their managers extended their wholehearted support for digital tools and acceptance among the users and managers as well as central level officials led to a path of glorious implementation journey. It could be asserted that alignment of eMIS with the digital vision of Government of Bangladesh made it possible.
Population registration and other data
The work of FWAs begin with registration of entire population in the catchment area of the FWAs. The FWAs require such list in order to identify their clients, especially the eligible couples but also others. The registration is done by FWAs at the beginning of their work by app. In addition to personal details of the catchment area population, they also collect socio economic status of the households. By the end of June 2022, the number of registered households stood at 9,392,871 and the number of registered individuals at 42,440,197. The number of Eligible couples stood at 8,766,355.
Paperless districts
Digital tools make it possible to replace papers entirely but time and preparations are needed for that to happen. Tangail was declared paperless first to be followed by Habiganj. Four more districts were declared paperless on 26 June 2021. The DGFP issued a notification that 8 more districts would be paperless in June 2022. It is expected that other districts would be gradually become paperless.
Transition to DGFP
As implementation gained momentum, the volume of data started to grow exponentially. At initial development stages servers and databases were retained with the implementing partners (icddr, b and Save the Children). The IPs continued with advocacy for transferring those to a reliable government-owned location and the National Data Center of the Bangladesh Computer Council was found suitable for hosting server and databases, which also hosts many government servers/databases. The DGFP signed service level agreement for hosting the server and databases with the BCC. Eventually, all the digital resources were transferred to secure government location.
Looking at the future
While all activities other than software development and system maintenance was transferred to the DGFP before the FY 2020-2021, software development remained with IPs supported by USAID (MaMoni would continue to support facility systems till the end of their project period). The eMIS software eco-system is quite complex and handled by a pool of developers with skill in different programming languages and database management (such as Java, Python, JavaScript for web services, PostgreSQL etc.). The end of project support for community systems from USAID was replaced by DGFP procurement in 3rd quarter of 2021-22 and an award was given to the icddr,b, which expired in June 2022. The DGFP has taken over the responsibility of these tasks from 1 July 2022. As such, all eMIS activities relating to community apps would now be fully managed by the DGFP.
Conclusion
The eMIS ecosystem was novel to rural workforce when it was introduced but it was intuitive and could garner strong acceptance from the users. It was not imposed or appended to their system but it brought revolutionary changes the way they work. Basically, the eMIS merely changed their tools of trade from papers to Tablets. But digital innovation not only replicated their business process truthfully but also brought in increased functionalities, which made eMIS tools acceptable to the users.
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