Population Services International (PSI) is a global nonprofit organization focused on improving the lives of people in the developing world by encouraging healthy behavior and improving access to affordable health products and services. PSI was founded in 1970 to improve reproductive health using commercial marketing strategies and has expanded to work in over 50 countries in the areas of malaria, family planning, HIV, diarrhea, pneumonia and sanitation. PSI works in partnership with local governments, ministries of health and local organizations to create health solutions that are built to last. PSI has over 8,000 employees and is headquartered in Washington, DC.

Since 2012, BAO Systems has worked with PSI to host the DHIS 2 system as an enterprise level management information system, supporting the data of 50 countries globally.

The Challenges

In 2010, PSI conducted a global assessment of local systems and found that the organization was spending millions of dollars to rebuild poorly designed data management systems. These inefficient boutique systems did not continue or scale beyond the life of a project and did not provide valuable insight into operational or programmatic decision making. While research and monitoring information influenced program implementation, data was primarily used for performance monitoring to external donors; however headquarter technical advisors required more robust data to evaluate programs.

These disparate systems on many platforms led to challenges in consistency and internal reporting across countries. Compiling results from different systems was time-consuming and led to lower data quality and data integrity. It also prevented the organization from being able to easily analyze regional and organization-wide trends.

By 2012, PSI identified DHIS 2 as a potential solution to establish a single central database to house all country data. However, at that point, DHIS 2 had only been used as a national system. No organization had tried to establish a shared DHIS 2 architecture that supported multiple countries within a single database. The potential solution needed a server that could scale and maintain stability and performance as thousands of users and millions of data values were added quickly. Additionally, the DHIS 2 default 24-hour period for the analytic table to be generated was unacceptable for PSI users. Users wanted to see their data in the analytics immediately after data entry so they could get a clearer picture of trends in real-time.

The Solution

BAO Systems set up the DHIS 2 database on Amazon Web Services, tuning the database for performance, configuring security, and focusing on continued scalability since the system was envisioned to keep growing.  By creating this stable environment, BAO paved the way for a system that helped PSI’s instance of DHIS 2 scale so that it is able to serve dozens of countries.  The system continues to scale, as new projects and countries are added on an annual basis.

BAO’s hosting setup for PSI relies on a highly tuned version of PostgreSQL and seperate servers for the application front-end. This approach also allows for another BAO first: Continuous Analytics. With this setup, DHIS 2 runs analytics constantly versus the standard 24 hour wait time or manual process that most DHIS 2 instances experience. With Continuous Analytics, DHIS 2 performance does not bog down server performance while analytics runs in the background. This allows users to see their newly entered data within minutes rather than waiting to have the analytics run manually or waiting 24 hours to view their data.


As of December of 2017, the PSI DHIS 2 global instance supports data management for 30 countries using all three data models (aggregate, event and tracker) and collects global aggregate performance metrics for all 50 operating countries. Hosting DHIS 2 with BAO has allowed PSI to focus on their mission and build an institutional culture of data use, rather than trying to build in-house capacity to manage server stability, backups, upgrades and monitoring server performance. PSI leverages BAO’s system technical expertise to also manage syncing test and development server. BAO’s hosting has proven to be scalable, reliable, and still continues to grow and expand. As of December 2017, BAO hosts over 15 different servers for PSI. Ultimately PSI’s commitment to a culture of data use has proven them to be a data driven decision making using DHIS 2. BAO is proud to be a partner enabling the technology to achieve this.