Bangladesh e-TB Manager updates-Nov 2016

Utilization of Digital Application to Improve Recording and Reporting for TB Control in

Bangladesh: Roll-Out Experience and Way-forward

13 November 2016

Mohammad Golam Kibria

Senior Technical Advisor, SIAPS Program Management Sciences for Health (MSH)

Bangladesh

Problem Statement• Submitting complete and accurate TB patient data

records and reports within stipulated time-frame is a significant challenge for the NTP

• Central manual data repository with limited variables hinders further epidemiological analysis

• Absence of capacity to transfer data in real time• Delayed reports’ submission from field and hence,

there is a long lead-time to generate TB MIS reports • Difficulty complying with WHO reporting requirements• Untapped potential to use data to improve surveillance

and performance

What is e-TB Manager?e-TB Manager (e-TBM-http://www.etbmanagerbd.org) is a comprehensive Web-Based Tool for Programmatic Management of TB and Drug-Resistant TB that- allows online and real-time information sharing and

consolidation among different levels within one user-friendly platform.

allows notification, management and monitoring of TB cases, DR-TB cases, medicine management and control

is aligned with WHO recommendations for DOTS and DR-TB program, including WHO standard forms for reporting and recording.

Pilot and Roll-out Stages of e-TBM (I)In collaboration with WHO, pilot programs for six sites started in November 2010 and SIAPS took the lead role from 2012 for further expansion –

In 218 Upazila Health Complexes out of 488 (which is 45% of total Upazila Health Complexes) including two complete Divisions (Rajshahi & Sylhet) and all DR TB treatment facilities

•In January 2013, NTP’s recognition to e-TBM as the “mandatory tool” for recording and reporting•Since December 2014, NTP has been taking care of the cost of internet connectivity after initial one year support from SIAPS•In 29 June- 03 July 2015, a multi-stakeholder assessment was conducted. By NTP, USAID, DFID, WHO, Challenge TB, Global Fund to asses e-TBM functionality.

Pilot and Roll-out Stages of e-TBM (II)• In August 2015, NTP issued notification to 20 districts’ authority

(with full coverage of e-TBM in all sub-districts) to use this tool as for reporting tool

• In January 2016, ‘Epidemiological Week’ was introduced as part of feedback mechanism for improving data quality (data gaps, internal and external consistency etc.).

• Till date, SIAPS trained 950 staff from the NTP and TB partners (BRAC, HEED Bangladesh, Damien Foundation, LEPRA etc.) and developed 13 master trainers to ensure the smooth functioning of e-TBM

Programmatic Implications of e-TBM• TBM data repository allows/assists users to-identify, recent

transmission, multidrug resistance, adverse drug reactions and deaths.

• Identify previous treatment history to select right regimen for patient and reduce DR TB.

• Identify high-risk population groups and their geographic coverage.

• Generate reports on regular and ad-hoc basis monitor and evaluate data quality, conduct epidemiological surveillance, monitor medicine use.

• Provide data for forecasting medicines needs for DR TB cases.

Results (I)• As of 13 November 2016, total 216,686 individual patient’s

information are available in the e-TBM; of which 64.7% is completed or ended treatment (n=140,362). • A site performance analysis done in terms of eTBM utilization and

completeness in the second quarter of 2016 revealed that 83% sites are maintaining high performance• Since the inception of the surveillance calendar (EW-

Epidemiological Week), the accuracy of patient data has significantly improved (data quality issues reduced from 132 cases in EW 1 to 51 cases in EW 44).

Results (II)• A recent web based e-TBM user experience survey revealed:

- 74.3% of respondents (n=149/203) are satisfied with e-TBM - 72% of respondents agreed that e-TBM helps in patient case management while 56.4% agreed strongly with this comment. - 71.8% of respondents agreed that their workplace productivity improved because of e-TBM - 78.7% of respondents agreed that e-TB Manager is reliable.

• The system provides real-time complete MDR patient data for forecasting second line medicines needs and used for recent procurement orders to the GDF; done by QuanTB system. In addition, the system helps NTP to determine MDR TB patterns and trends of the disease and tracking the default and death cases.

Pilot Implementation of e-TBM Desktop version• Introduced in two UHCs under Manikganj and Gazipur Districts • Provision of entering data if there is no stable internet

connection at the site and is incorporated with synchronization feature with the online version http://e-TBManagerbd.org/ to upload the cases later when the internet connection is satisfactory.

• Pilot users’ experience revealed that users’ workload reduced significantly by 66%: It takes only 5 minutes to enter a case in eTBM desktop platform as opposed to 15 minutes in its online version.

Proposed inter-operability options: e-TBM and DHIS2

National Roll-out Strategy• An extensive resource mapping would be conducted to assess the

facility readiness to implement either the desktop or online version• Reduction of redundant variables and customize the system’s

interface, dashboard to make user friendly for the decision makers• Anticipated roll-out will follow through a cascade training approach in

different regional venues. • CTB and SIAPS will engage both their field based Technical Advisors to

roll out and implement e-TBM throughout the country.• In response to NTP’s request, SIAPS will work with them to map-out

and reduce the number of reporting units to bring more efficiency in reporting flow and set the denominator of total reported units.

• Development ‘TB Indicator Analysis’ guideline using e-TB Manager

Transition plan of e-TBM Intervention Areas Transition Activities Timeline Responsible

Handing over the TB patient surveillance system (e-TBM) to CTB

Build capacity of CTB relevant staff on e-TBM and engage them during the roll-out phase and field monitoring

Jan-Mar 2017

SIAPS and CTB

Stabilize the smooth operations (including data exchange) of e-TBM and DHIS2

April 2017 SIAPS

Finalize the source codes, technical documents, user/training guide etc.

May-June 2017

SIAPS

Build capacity of NTP identified relevant IT experts and NTP designated master trainers and troubleshooters and also the CTB staff

July 2017 SIAPS and CTB

Handover the technical guideline, user manual, source code to CTB

August 2017

SIAPS and CTB

Transition Steps to Country Ownership (from CTB to NTP):

In order to ensure smooth transition of the system to NTP below key actions should be completed beyond Sept 2017- •Develop a time bound and role-specific action plan in consultation with NTP (SIAPS developed Supply Chain Management Portal sustainability plan could be used as an example)•Update technical documentation, hand-over source code •Domain migration to GoB, technological infrastructure development •Advocate for NTP to allocate financial budget in their operational plan for maintenance•Advocate for NTP to set up an IT cell at their office (Java Developer, System Administration, Program manager) and build capacity •Develop technical capacity of NTP to use the data for decision making

Challenges: HR issues with frequent turn over of trained users NTP ownership (Frequent changes of policy makers;

changes the mindset). Gaps in manual recording and reporting system Communication gaps in between diagnostics and

treatment facilities. Inadequate supervision and monitoring from Central as

well as facility level Refill the modems’ internet package

Thank [email protected]