ICTworks: Lessons Learned From Working Firsthand in Malawi’s ICT Sector

My article from ICTworks, published last Friday. Enjoy! :-)

Lessons Learned From Working Firsthand in Malawi’s ICT Sector

Published on: Nov 14 2014 by Guest Writer

MalawiHerman2

My name is Herman Fung and I’m a former VSO volunteer in Malawi. In March 2014, I completed an 18-month voluntary placement where I worked with the Ministry of Health to build and implement Malawi’s first national, open source Human Resources Information System for the health sector, called iHRIS.

iHRIS is a suite of web-based health workforce software and it is currently live in 19 countries, supporting over 700,000 health workers.

Our project, iHRIS Malawi, was commissioned by the Ministry of Health in 2012, with support from VSO (funded byTHET) and USAID. The objective was to replace a centralized Microsoft Access database, which became defunct partly due to difficulties in collecting HR data in paper form, from far away rural districts to the MoH Headquarters, in the capital city of Lilongwe. Other reasons for its demise include a lack of working computers and limited continual end user training, which was required due to the generally low levels of computer literacy compounded by a very high turnover of staff.

A total of six volunteers were recruited from the UK and we teamed up with four Malawian colleagues. We regularly received vital help from the Global iHRIS Community, which is a critical part of iHRIS ecosystem and one of the key benefits of choosing iHRIS.

Challenges

As you might expect, there were many challenges of implementing a new system that impacts critical operations like Human Resources. A fair share of these challenges relate to ICT, but a large proportion were to do with people and processes, too.

iHRIS is a web-based system and requires an Internet connection and power. When we first arrived and began working at the MoH Headquarters, we didn’t have enough sockets to plug our own laptops into. Scheduled electricity load-shedding and unplanned outages were a regular occurrence, and the MoH did not have its own generator. There were also regular water outages.

Once we got our project hub running, we began engaging our stakeholders in slow but constructive dialogue:

  • A separate government department which own the central payroll system for all civil servants, which transpired to be our primary data source
  • District HR Officers who would manage the changes to this data
  • Central HR Officers who would organize the data
  • Planning Officers from another MoH department who would use the data to make key decisions
  • A group of Senior Management champions to back the project throughout

We tried to use an Agile approach with regular feedback loops over many iterations. However, this proved difficult due to challenges with regular access to key people and resources. So we adapted to a more traditional Waterfall methodology, which was easier for our stakeholders to understand and actively participate.

The software itself was relatively easy to set up because we had the required technical expertise in the form of analysts and developers, as well as support from iHRIS teams around the world. However, acquiring the hardware and infrastructure required to run it was a considerable task. The logistical challenge and cost behind this part cannot be underestimated.

A 1024 kbps broadband Internet connection costs $850 USD per month, which we shared with other projects, and our server took 5 months to arrive due to a lengthy procurement and import process.

Throughout the development process, we kept long term sustainability high on our agenda. We endeavored to trainour Malawian colleagues and encourage them to take the lead as much as possible, which was a challenge – and also huge opportunity.

Outcomes

One of the key lessons we learned was that the overall journey of delivering the project was just as valuable as the end product or system itself.

Over the course of the project, we exchanged views and built trust amongst ourselves and with our stakeholders. We took on extra capacity building exercises outside of our project such as the overhaul of the communal Computer Room.

MalawiHerman3

Most importantly, we engaged in a two-way knowledge sharing process with a steep learning curve for everybody: volunteers, Malawians, developers, users and managers.

We analyzed and mapped existing manual processes. Where they were broken, we questioned them, which prompted some remedial actions. We were adamant not to automate a broken process, which would have been counter-productive.

We had success in promoting the value of standardized data by setting up a regular User Forum, which mapped 300 different jobs into meaningful categories in WHO standard cadre groups.

MalawiHerman4

The district-by-district rollout of the system is ongoing. My colleagues still working on the project are running continual end user training workshops. They are also making improvements to the system based on stakeholder feedback before handing the project over to the MoH in March 2015.

The valuable lesson I learned was the importance of gradual change. In our experience, evolution, not transformation,is the best approach to introduce an ICT system in Malawi.

MalawiHerman5

Herman Fung is a British IT consultant, health techie and ex-VSO volunteer in Malawi, where he worked with the Ministry of Health to implement the country’s first national, open source Human Resources Information System for the health sector. Follow him on Twitter: @Fung14

Categories: Malawi, Technology, Volunteering, VSO, Work | Tags: , , | 1 Comment

A to Z: K is for…

  • Kamba Puffs – The ubiquitous maize snack. Full of salt but not a lot of nutrients. They’re somewhat hit and miss in my personal opinion. Sometimes, if you get a relatively fresh pack, they’re edible – still kinda fresh and crunchy. They do not taste good when they’re stale and soggy! In any case, all kids seem to love them. Just like rice is a once-a-year treat at Christmas for many, a packet of “Kamba” are traditionally part of a kid’s Christmas gift, along with one set of (second hand) clothes.
    PS. I’m really going to miss the kids and Malawi this Christmas.
  • Kawalazi Tea Estate – We visited Kawalazi when my family came to visit in October last year. It’s a big estate in the Northern Region, between Mzuzu and Nkhata Bay. A high altitude, hilly area with its own tropical micro climate. Hence the tea growing because of the rain. It was wet and muddy on the day we visited. So much so that I almost got our rented Toyota Land Cruise 4×4 stuck while taking a detour to get round a lorry which was really stuck and blocked the main road through the fields and fields of tea! We saw some fantastic scenery, got a tour of the factory and learned about the tea making process. Thanks again to my fellow volunteer Rona for arranging this.
  • Kandewe Cultural Heritage Site – Where the famous Basket Bridge is located. It has allegedly stood for almost 100 years – can’t remember the year it was built off the top of my head. On our way to Kawalazi, we stopped  by Kandewe. It is on one of the few roads going through the north! Kandewe is one of Coffee‘s (another VSO volunteer from Hong Kong) sites for her eco-tourism project, in partnership with the Ministry of Tourism.
A big bag of Kamba Puffs and Danny

A big bag of Kamba Puffs and Danny

Kawalazi Tea Estate, surrounded by beautiful rolling hills

Kawalazi Tea Estate, surrounded by beautiful rolling hills

Kandewe Cultural Heritage Site

Kandewe Cultural Heritage Site

Basket Bridge, Kandewe

Basket Bridge, Kandewe

The obligatory tourist, precariously crossing the Basket Bridge

The obligatory tourist, precariously crossing the Basket Bridge

Categories: Malawi, Travel, Volunteering, VSO | Tags: , , , | Leave a comment

Saturday Mornings

Everybody has a Saturday morning routine.

Mine has changed since coming home and starting work again. I have a recurring calendar entry to remind me to do laundry!

That’s the difference with living back in the first world, as my fellow VSO Malawi returned volunteer, Beth Connolly explains perfectly. Do go read her final blog post: Tionana Holy Family

But I still get a reminder of what it used to be like. Courtesy of Nyack and Catherine, who now run the new Breakfast Club. Nyack keeps me in the loop by WhatsApping me photos of the kids. Thanks big fella, they always brighten up my day!

At the risk of repeating myself once too many, today was worth posting. Because together with a big shout-out for our poster girl Beth, the kids received the photos I sent over with my friend Auden, and you can see the extra sparkle in their eyes. I should have done this sooner.

Photos

Photos

More photos

More photos

Still remembering to wash hands (I hope)

Still remembering to wash hands (I hope)

Iron Man fans: Georgie (George), Jeradi (Gerard), Dani (Danny)

Iron Man fans: Georgie (George), Jeradi (Gerard), Dani (Danny)

Still loving rice!

Still loving rice!

And apples, that unaffordable treat!

And apples, that unaffordable treat!

Categories: Malawi, Volunteering, VSO | Tags: , , | Leave a comment

A to Z: J is for…

  • Jambo – Swahili word for hello. Used plenty during my trip to Tanzania and Zanzibar.
  • Jumbo – Chichewa word for the ubiquitous plastic bag! Earlier this year, the Government of Malawi banned the sale and use of thin plastic bags. But of course, this is Malawi… so there was considerable legal wrangling to overturn this! Officially, it’s an attempt to protect the environment and curb the scourge of littering which happens in most places. Expectedly so since there is no real working waste disposal system, even in the capital city of Lilongwe. So people (including volunteers and expats) resort to burying, or worse, burning all their rubbish (“zinyalala“).

    All in all, a good idea in principle, going by the progress made on this issue by Rwanda - The Country That Bans Plastic Bags.

    However, as my savvy fellow volunteer David pointed out, the way this was implemented with such a short notice, brought severe livelihoods challenges for many street traders. In most markets, you’d find an invariably young boy trying to sell you a jumbo to carry your fresh vegetables and other groceries. I wonder what’s happened to them and their “trade” now.

Rubbish, kids and a "freshy" / FOB Chinaman

Operation Lap Sap

Categories: Malawi, Volunteering, VSO | Tags: , , , , , , | Leave a comment

A to Z: I is for iHRIS

  • iHRIS – see all related posts here.

There are many reasons I went to Malawi, back in October 2012. As I discovered after arriving, iHRIS was probably the biggest reason of them all.

It is the system (and project of the same name) commissioned by the Ministry of Health, to be their new human resources management information system: a database of their healthworkers. VSO were engaged to support its implementation and with funding from THET, recruited 6 British volunteers to help that process.

iHRIS logo

iHRIS logo

iHRIS itself is a piece of free, open source software, described as a “Health Workforce Information Solution“. It has been implemented in 15 countries to date and described by the WHO (World Health Organisation) in more detail here:-

WHO logo

WHO

WHO Global Health Workforce Alliance logo

WHO Global Health Workforce Alliance

 

Many developing countries face daunting obstacles to meeting the health care needs of their people. To ensure that the right health care provider is in the right place with the right skills, countries require current, accurate data on human resources for health (HRH). A strong human resources information system (HRIS) enables health care leaders to quickly answer the key policy and management questions affecting health care service delivery.

The iHRIS Suite Open Source HRIS software supplies health sector leaders with the information they need to track, manage, and plan the health workforce, assess HR problems, plan effective interventions, and evaluate those interventions. Both the software and a program of technical assistance are provided as well as expertise to ensure that the technology is transferred effectively and serves the ability of decision-makers to use data to lead and manage. While the iHRIS Suite was designed with the health workforce in mind, it also can be adapted for other types of workforces or organizations. Some relatively advanced computer and quantitative skills are needed to use this software.

Because the software is open source, it can be downloaded for free and customized for local needs. Each product addresses a specific health workforce leadership issue:

  • iHRIS Qualify tracks health worker training, certification, and licensure
  • iHRIS Manage maintains personnel deployment, performance, and attrition information
  • iHRIS Plan models long-term health workforce needs

.

In Malawi, we were implementing the iHRIS Manage solution because personnel related issues were the most important business problem we were trying to solve. For example, “ghost workers” and the exact planned deployment (i.e. how many doctors, nurses and midwives should be working at each healthcare facility) versus actual deployment (i.e. how many are in reality working at each clinic, hospital etc.).

Regular and critical business processes which we take for granted, like payroll, are not reliable in a country like Malawi. This made collecting and organising data for almost 30,000 employees very difficult. We spent a huge amount of effort to locate a good data source and then developing a way to import it automatically, and in the process, transforming it into a more usable structure in the iHRIS database. From Microsoft SQL Server to MySQL, for those familiar with databases.

This may sound like a fairly simple process. Technically, many would probably say it is. What it meant was, we could produce reports such as how many of each of the 300 job titles were supposed to be deployed at each “cost centre”, district or region.

After some data standardisation, we could also report on some fundamental information like how many “physicians” the Ministry really employed. For this, we had to define cadre groups, by adopting the WHO Health Workforce: Aggregated Data definitions, to make sense of the numerous job titles we had in our data source. Several of which included typos, spelling errors and duplication.

Ministry of Health Employees by Cadre

Ministry of Health Employees by Cadre

In many countries, Nurses and Midwives are two separate jobs but they are combined in Malawi, in the form of a Nurse and Midwife Technician (NMT). An NMT is the entry-level job for that professional career path and who many of my fellow VSO volunteers worked to help train more of, to cope with the ever growing population.

We also found out that there were more drivers than actual vehicles! That might sound astounding at first. But many “drivers” were, in fact, casual workers who also did other jobs. Gardening, cleaning, delivering documents from room to room etc. We still had an internal paper-based memo system and runners shuttling from office to office!

Ok, infomercial over… I really do look back at my time on the iHRIS Malawi project with fondness and a sense of achievement.

There are so many funny stories and anecdotes, which will be a source of amusement (and bemusement) for the rest of my career and especially at Team iHRIS reunions! Including spending a whole week and more trying to track down the seemingly only Internet domain registrar in Malawi. After many attempts, we eventually managed to get our server online at ihris.health.gov.mw… which came after much running around to get an IP address!

Some of my colleagues are still in Malawi, training more and more HR Officers to use the system, which is arguably the crucial step and also the original brief for which we were all recruited. To my personal regret, I’m not there to help Jim, Robin and Judy any more. Although Judy still tries to get Oli and I to troubleshoot, just like this week ;-)

And our response is the same as we were still there: We’ll do what we can.

Funnily enough, I began writing this blog post because I started to look into the current issue and discovered that our system is offline. The server is most probably down because there’s another power cut at our datacentre. Sorry Judes!

(Some of) the iHRIS Malawi team

(Some of) the iHRIS Malawi team

iHRIS Malawi login page

iHRIS Malawi login page

Categories: Healthcare, Malawi, Technology, Volunteering, VSO, Work | Tags: , , , , , | 4 Comments

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