Bangladesh eHealth Inventory Report

2014

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Bangladesh eHealth Inventory Report

Prepared by BKMI

July 23, 2014

Background

Under the Bangladesh Knowledge Management Initiative (BKMI), in close collaboration with the Ministry of Health and Family Welfare (MoHFW), digital resources including a health, population and nutrition (HPN) eToolkit and eight eLearning courses were deployed in an eHealth pilot through netbooks to about 300 field workers (HAs and FWAs). The key post-assessment results showed an increase in HPN knowledge among the field workers (FWs); improved integration of health, population and nutrition messages; and an increase in demand for health services among mothers in the communities.

With USAID’s support, BKMI and the MoHFW are now interested to cost-effectively scale up the HPN eToolkit (adapted to include six of the eLearning videos) on a national level using the existing Government of Bangladesh (GoB) infrastructure of tablets and computers, working closely with the MIS units of the Directorate General of Family Planning (DGFP) and the Directorate General of Health Services (DGHS).

In addition to the scale-up plan, BKMI was asked to compile an inventory of current eHealth projects working throughout Bangladesh to improve health, population and nutrition. The eHealth inventory is meant to inform USAID, the BKMI team and other stakeholders about ongoing eHealth projects, in order to inform strategic planning, and to facilitate collaboration and avoid duplication in eHealth activities.

eHealth and mHealth are relatively new terms; they mean different things to different people in different contexts. Sometimes the two terms are used interchangeably. At times, ‘health informatics’ is also used synonymously with eHealth. During the initial stages of developing the eHealth inventory, the team saw the need to arrive at a common understanding of eHealth.

WHO defines eHealth as the use of information and communication technologies (ICT) for health. It encompasses three main areas:

The delivery of health information, for health professionals and health consumers, through the Internet and telecommunications.

Using the power of IT and e-commerce to improve public health services, e.g. through

the education and training of health workers.

The use of e-commerce and e-business practices in health systems management.

(WHO, 2013: http://www.who.int/trade/glossary/story021/en/)

The team determined that mHealth (i.e. using mobile technology) is a subset of eHealth.

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Objective

Provide a snapshot of the current national eHealth project landscape in Bangladesh in order to

inform programming, facilitate coordination, and avoid duplication.

Methodology

The BKMI team consulted with MoHFW, USAID and the mRegistry initiative (http://mregistry.org),

which was officially launched in June 2014, to specify the data fields for the eHealth database structure.

In order to identify stakeholders who would contribute to the eHealth inventory, the BKMI team

reviewed relevant Bulletins, Journals and Reports published by DGHS, DGFP and ICDDR’B1, as well as

met directly with project directors and other implementers. After compiling an initial list of potential

contributors, the team formally requested information about their current eHealth projects.

Each stakeholder was contacted first by email. If no response was received within two weeks of the

initial request, the inquiry was followed up by a phone call. When appropriate, meetings were

organized. Data were collected in March and April 2014.

All available data were input into the eHealth inventory database by the BKMI team. On April 30, all

stakeholders who contributed to the inventory were invited to BCCP for a meeting to share the results

of the inventory.

Respondents

The full database is attached to this report. Following is a summary of stakeholders and their projects,

grouped by sector.

1 In March 2014, ICDDR,B and Institute of Development Studies published Evidence Report No. 60, E-Health and

M-Health in Bangladesh: Opportunities and Challenges.

Public DGHS Health Service through Mobile Phone

Telemedicine Service

Telemedicine Service in Community Clinics

Telemedicine Service in Union Information and Service Centers

Complaints-Suggestions through SMS

SMS Advice for safe pregnancy

Open MRS (Medical Record System)

Attendance Monitoring System for DGHS staff

Online Population Health Registry

HR Database

Annual Development Program (ADP) progress monitoring system

GIS in Health

Schedule Management Software

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The attached inventory is not an exhaustive list, but rather a snapshot of current programs that were

identified by the research team. Since the data were collected, other eHealth nascent programs have

emerged (such as Mamoni and NHSDP), and others have been identified (such as Friendship Bangladesh

and Grameenphone). Other stakeholders were reluctant or unable to provide the requested

information.

One challenge in compiling the list is that multiple stakeholders work on a single project. For example,

mPower supports the eHealth activities of Johns Hopkins Bloomberg School of Public Health. The BKMI

eHealth pilot and the MSH activities listed above are primarily for the benefit of MoHFW, with technical

assistance from NGOs.

Bulk SMS

Digital Training Facility

Internet Connectivity in Health System

Hospital automation

DGFP ICT4RH (with UNFPA)

Provide laptop computers to the FP infrastructure

NGO MSH/SIAPS (with MoHFW) UIMS v 2.5

WIMS v2

SCIP

SCMP

DGDA Web page

e-TBM

PharmaDex

BRAC m-Health for improving MNCH

SMC Marketing Innovation for Health (MIH)

CRP Telemedicine Link Service

DNet Aponjon

Dear Infolady

University Johns Hopkins Bloomberg

School of Public Health

m-Care

m-Tikka

m-JiVita Basic

m-JiVita+

JHU∙CCP BKMI eHealth pilot (with DGHS and DGFP)

Private eHealth Solutions eHealth products and services business

mPower Social

Enterprises Ltd

Amader Daktar

Remote Telemedicine Services in Rural Clinics

Mobile Health Solutions for Breast Cancer Case-Finding, Referral and Navigation in Rural Bangladesh

Empowering Micro-Health Insuring Program through Mobile Telemedicine

MOVE-IT

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Analysis

Based on the collected information from the eHealth inventory database, the following narrative and

figures summarize some key trends and observations about the current landscape of eHealth projects in

Bangladesh. The inventory collected detailed information about 42 different eHealth projects, from

2009 to present.

Type of Implementer

Projects are being implemented by a wide variety of organizations and implementers. Of the 42 eHealth

projects, 26 are being implemented by public entities including the MoHFW (DGHS, DGFP), 8 projects by

private organizations, such as mPower Social Enterprise, and 8 projects were implemented by NGOs

and universities such as Johns Hopkins University and BRAC.

Donors

According to the eHealth inventory, the largest funder of eHealth projects is the Government of

Bangladesh (17 projects), followed by bilateral organizations (12 projects), followed by private donors

(11 projects), and finally, multilateral organizations (6 projects).2

Within each of these donor categories, the number of donors was limited to large bilateral and

multilateral donors, with more diversity in the number of private donors. Only four bilateral

organizations (USAID, DFID, GIZ, AUSAID) were listed as donors on any of the 42 projects. There were

four multilateral organizations (UNICEF, WHO, WB, UNFPA), and seven private donors (Johnson &

Johnson, Intel, UBS Optimus Foundation, Manusher Jonno Foundation, Endless Philanthropy, Women’s

College Hospital (University of Toronto), Swinfen Charitable Trust). The one public donor was the

Government of Bangladesh.

Geographic Coverage and Scale

Many of the eHealth projects are working in similar geographic areas on Bangladesh. A total of 28 of 42

projects specified their geographic coverage. Approximately 12 projects were being implemented

nationally, 8 projects were at the district level, and 8 projects were at the upazila level. Due to the

limitations of the data collection, geographic trends are not available. Some districts where projects are

being implemented include Jamalpur, Sylhet, Chittagong, Gaibandha, Bogra and Dhaka.

Project Objectives and Activities

Although many of the eHealth projects are working to solve cross cutting issues in health, population

and nutrition, the approach and activities of the projects are diverse. The top project purposes include:

leveraging technology to for better supervision and accountability; data collection (EMR, vital statistics

registry); dissemination of information (appointment reminders, behavior change messages and health

education); and drug registry and supply chain tracking. Closely following each project’s purpose and

objectives, project activities included: developing databases; health information systems; health

2 Some projects had multiple donors. Also, some activities are not donor funded, for example those of the private

enterprise eHealth Solutions; mPower lists Endless Health as an investor on Amader Daktar rather than a donor.

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information exchange platforms; SMS text messages; GPS location of clinical services; and supply chain

tracking.

Target Audience

Although not always specified, a majority of the eHealth projects had one or more intended audiences

for project activities. The most frequent target audience was community-level health workers (13

projects) for activities such as counseling using a netbook; data entry for community health statistics

like pregnancies and births; and reporting drug inventories. In addition, health supervisors and

managerial personnel were also frequently targeted (13 projects). Often supervisors and managers are

responsible for collecting or managing data; securing the technology; and supervising other health care

personnel to improve accountability or quality. Both higher-level government officials and clinical

health care providers were the intended audience in 7 projects. Highly segmented groups were

targeted to a lesser degree, such as rural population (3 projects), women and children (5 projects), and

the household-level gatekeepers (husbands & mothers-in-law) (2 projects).

Graph 1 shows the frequency of targeted audience groups among the projects in the inventory.

N=42

Technology Requirements

The table below lists the hardware and software that are currently being used to implement eHealth

interventions.

Hardware Software

Mobile Phone (basic) Data Server

Smart Phone OpenMRS

Laptop computer Linux OS

Web Camera HR Management

Desktop computer ADP Monitoring System

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Tablet GPS Mapping

Modem Skool/DAA

MS Office/Windows OS

ODK and custom coding

Mobile Applications

Android OS

Moodle

Drupal

Communication Materials

Due to BKMI’s focus on communication, the database attempted to capture information on how many projects were producing communication materials as a part of their eHealth project activities. Communication materials could include behavior change communication, training manuals, written guidelines, job aids, or others. Twenty-seven projects responded. A total of 4 projects reported that they had not created any communication materials; 23 projects developed communication materials such as eToolkits, training materials and behavior change communication.

Monitoring and Evaluation

A majority of projects either did not have formal evaluation and monitoring plans or did not release this information during the data collection period for the eHealth inventory. Approximately 14 projects reported conducting formative research; two reported having not done any formative research; and 26 provided no information. Similarly, 19 projects reported having formal evaluation plans; 2 reported no evaluation plans; and 21 provided no information. Thirty projects reported having monitoring plans.

Lessons Learned

Many stakeholders did not provide information about lessons learned, especially when projects were ongoing. Some lessons learned that were mentioned include: improved knowledge and behavior change are achievable using technology; mobile technology is readily acceptable to field workers; and technology increases the efficiency and quality of health service delivery.

Challenges

Challenges were also shared to a limited extent. Some that were mentioned include low internet connectivity/low bandwidth; low acceptability by intended user; maintenance of the technology; and sustainability.

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Conclusion

At the mPossible Regional Health Informatics Conference for South Asia, in Dhaka on June 23-24,

Bangladesh was recognized as being at the forefront of innovation in eHealth initiatives among

developing countries, thanks in part to a supportive government.

The eHealth landscape in Bangladesh is diverse and dynamic. eHealth applications range from HR and

facility management, to service delivery, to training, to workflow management for field workers, to

commodities tracking, to behavior change communication. In addition, the context is changing rapidly

as new stakeholders begin to venture into eHealth, as innovations are piloted and scaled up, and as

new technologies (both hardware and software) are developed. The potential for using eHealth to

implement or complement health, population and nutrition programs will only become larger in the

coming years.

Future challenges will include coordination and harmonization as pilot programs are scaled-up, and as

the Government of Bangladesh continues to invest heavily in IT infrastructure. A national strategy is

urgently needed, including unified protocols; a common taxonomy; standards for interoperability, and

integration with government information systems and tools. In addition, unique national identification

numbers are needed for all citizens of Bangladesh, to ensure accuracy in record-keeping across the

public and private sectors.

Within the Ministry of Health and Family Welfare, eHealth efforts in the Directorate General of Family

Planning should be prioritized and coordinated with those of Directorate General of Health Services; a

similar investment in IT infrastructure and innovation by DGFP is recommended.

BKMI strongly recommends the formation of a multi-sectoral Working Group around eHealth, to share

experiences, discuss innovations, and to proceed in a coordinated manner that supports both the

HPNSDP, and the Digital Bangladesh Vision 2021. Another tool for coordination is the recently-launched

mregistry.com All projects and programs should be encouraged to document their activities at

mregistry.org, in order to keep an accurate record and map of what is happening throughout

Bangladesh.