Technology

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

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

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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

Umoyo Scale

Scary to think that this was almost a year ago…

Back in June 2013,  I attended The World Bank Data Literacy Bootcamp. It was a really eye-opening experience, where I learnt new skills like geocoding with Google Fusion Tables and met a lot of like-minded people who wanted to apply technology to their aid efforts. I also learnt a few funny words like “ideate“, which being reservedly British and all, I would never normally use!

Part of the #dbootcamp was dedicated to forming projects to tackle data related problems specific to Malawi. There was a $1000 seed grant for the winning project idea and pitch.

We formed a Healthcare sector team and brainstormed lots of ideas to tackle. Eventually deciding on starting up “Umoyo Scale” (Umoyo in Chichewa means health), which is a TripAdvisor like crowd-sourcing system to collect and share reviews of healthcare facilities. The main add-on is that Umoyo Scale would also be usable via SMS because most Malawians simply do not have access to the Internet.

There was stiff competition with lots of interesting ideas (see full list from our Hackpad) but we finished runner-up!

Unfortunately, due to work priorities and logistical difficulties to get the whole team together, we were not able to take this much further the submission of a concept paper. But it really was a great experience, which I hope inspired everyone to use data more creatively.

Before it fades further in my memory, I thought I’d share the ultra persuasive presentation we put together.

Categories: Healthcare, Malawi, Technology, Volunteering, VSO, Work | Tags: , , , , | Leave a comment

CEPA Techies

Some more excellent work done by my fellow VSO volunteer, the super enthusiastic Doris! She’s based in Blantyre, working with CEPA (Centre for Environmental Policy and Advocacy).

We had tried to arrange for the iHRIS team to provide this training but scheduling proved difficult. iHRIS end user training is now in progress – more on that to come! Luckily, Andrew (boyfriend of another volunteer) was available and has all the right skills to share.

dorisnuval

yes, we shall do this or die trying:) yes, we shall do this or die trying:)

IMG_0001

IMG_0002

Today we FINALLY started our IT training here at CEPA where I work. There are 8 of us trying to acquire skills in desktop publishing, basic web editing and social media do’s and don’ts. I’m pretty confident that all of us after 3 days will have become certified geeks like our trainer, Andrew Styles … THE man.

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

A to Z: D is for…

  • d.light – A good range of solar lights sold here in Malawi. A couple of these lights were our saving grace when there used to be frequent load-shedding power cuts, which results in darkness and inevitable delay to dinner!
  • DAPPDevelopment of People from People (an acronym which isn’t quite right) is a big development project. But in the context of Lilongwe, when people say DAPP, they mean the main second hand clothes shop in town! It’s where you find all types of weird and wonderful apparel. From Dr. No style dictator suits to modern Burberry hoodies. Apparently, they also sell books now too. When there is a new shipment due, it is kind of a big event. There’s always overly loud music blasting away by the door. The dust always triggers my hay-fever. So I try not to go very often. Not that I like clothes shopping anyway!
  • Dzaleka – is a long term refugee camp, established almost 20 years ago; In the Dowa district, I believe. Not too far from Lilongwe. A bit farther than the airport.
    My fellow volunteer David and I went there back in February last year. It was an arranged exchange visit. We each gave a lecture in our profession. Him in clinical. Me in project management. The students were extremely bright and hungry to learn. We were both very impressed by their attitude and willingness to take on new ideas, ask questions and challenge any lack of clarity! There are also some very well managed educational facilities there. Including a nice computer suite and library. It was a very humbling and inspiring experience.

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DAPP not GAP!

DAPP not GAP!

Learn from reading. Learners become leaders.

Learn from reading. Learners become leaders.

Ubuntu = Human kindness

Ubuntu = Human kindness

Dzaleka. Photo from http://www.jc-hem.org/Projects_Detail?Region=001

Dzaleka. Photo from http://www.jc-hem.org/Projects_Detail?Region=001

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

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