Background

Jhpiego is an international non-profit health organization affiliated with the Johns Hopkins University. For more than 40 years and in over 40 countries, Jhpiego has empowered front-line health workers by designing and implementing effective, low-cost, hands-on solutions to strengthen the delivery of health care services for women and their families. By implementing evidence-based health innovations into everyday practice, Jhpiego works to break down barriers to high-quality health care for the world’s most vulnerable populations. Jhpiego’s focus is on training and support for health care providers- including doctors, nurses, midwives and health educators working in limited-resource settings throughout Africa, Asia, the Middle East, Latin America and the Caribbean.

Jhpiego’s program management strategy recognizes the technical complexity and geographical, cultural, socio-economic and political diversity among their programs. They develop global program initiatives and technical interventions that can be adapted for country-specific applications. To support this field-driven philosophy, Jhpiego developed a decentralized organizational structure that consists of a global delivery system designed to implement the entire portfolio of Jhpiego awards with assistance from key technical, programmatic and administrative staff.

In 2012, a centralized management information system was built on proprietary commercial software to collect, analyze and report key global performance indicators of Jhpiego grants and awards. A web-based user interface allowed central system administrators to add new award metadata like award name, donor, start/end date, country specific project name and link project specific indicators to each award. Country project users were able to enter in project data with varying frequency, either monthly, quarterly, semiannually or annually. Completeness reports allowed system administrators to quickly validate if data had been entered into the system.

The Challenges

At the time the system was built, Jhpiego wanted a database to serve the needs of every program with unique indicators as well as serve headquarters by aggregating global achievement data in one place. That concept proved impossible to implement as intended. Eventually, indicators were harmonized and the database began serving more as a central reporting system, but poorly so.

By 2014 the old system faced major challenges. Some of these challenges were based on the software design and some challenges were based on how Jhpiego set up the system.

One major challenge was that the software system architecture did not allow for organizational specific structures. A generic centralized hierarchical entity structure meant that Jhpiego had little flexibility in changing the structure to fit Jhpiego business processes, primarily around how country offices and multi-country projects were tracked within the system. All of the vendor’s clients were forced to use this same structure. Jhpiego was able to work around this limitation, however it was a messy tradeoff which increased the inefficiency of the setup and use of the system. Additionally, the software design required a high volume of “clicks”, or walk-through screens to not only set up a new program but also to enter data and produce reports. Finally, the analytics of the system were limited in their format and the system interface was slow, not very attractive or user-friendly.

Before changing to the harmonized indicators approach the Jhpiego technical and M&E headquarter teams allowed the country projects to uniquely define disaggregation categories and options across standard global performance indicators. This meant that some country projects would have 1 or 2 disaggregation options, while another country project would have up to 5 or 6 disaggregation options on the same indicator. The system would allow these disaggregation options to be set up in any order, so in order to aggregate this to a global performance metric with some standard disaggregation options, like age and sex, there was an extensive indicator building process required across nearly 300 projects.

The Solution

The new system needed to allow users to enter data and targets at the country project level, aggregate all data across projects to the country level, and across countries to the global level and display results in tables, graphs and maps with more than 500 users globally. After a nearly yearlong requirements building process, Jhpiego decided that DHIS 2 would meet their ideal system needs. BAO Systems was recruited to work with Jhpiego in order to build this new and improved system and coordinated with trusted DHIS 2 partners to support their effort.

On the surface of the project, the requirements were very straightforward. Jhpiego had defined close to 150 global performance indicators across all their intervention areas (HIV, Family Planning, Maternal/Child Health, Infectious Diseases, Gender and Capacity Building). However, the data needed to be associated with the project under which it was captured and data entry only available when the project was active. This meant that every award and associated project needed to be “registered” in the metadata structure and ideally, quickly. Additionally the Jhpiego HQ team wasn’t ready to enforce standardized disaggregation categories across the global standard indicators and not all projects captured all the standard global indicators. For example an HIV project wouldn’t capture Family Planning indicators, and in one country they wanted to include a more detailed age category breakdown as opposed to more broad categories like 15. Yet Jhpiego didn’t want to compromise on a streamlined design. BAO Systems was up for the challenge and quickly worked to develop a centralized single-instance of DHIS 2 that could accommodate the 40+ countries and 150+ programs.

To address the need to register awards and projects quickly, BAO Systems worked with partners to design a small custom application that allows the system administrators to register new project metadata such as the name, start/end date of project, which country and administrative level in country the project is operating in, all in one screen in under 2 minutes. This custom application accomplishes many configuration steps all at once and automatically assigns the project to appropriate data entry forms.

BAO Systems also designed custom data entry forms which could be customized per project yet still maintain standardized global indicators. In total, Jhpiego has 5 different data entry forms, but with the customization, each form can be setup in a way that reflects the unique requirements of each project. Only the technical areas that are relevant to the project are shown to the end-user and within each indicator an M&E technical advisor works with the local project team to choose the disaggregation categories that they want to (or are able) collect. This helps to maintain the project “uniqueness” while still respecting the needs of the head quarter’s data consumers.

Results

Today, Jhpiego has 5 years of historic data imported into the system within this new DHIS 2 design, close to 300 current and historical programs and nearly 800 users registered in the system. Upon rolling out the DHIS 2 system, the staff has provided overwhelmingly positive feedback.

Users have commented on several improvements over the old database, specifically:

  • The ease and flexibility of adding new or changing existing metadata objects
  • The customized look and feel of the data entry screens
  • The speed of the page load
  • The in-built visualization and analytic tools