10.6 Rollout and Adaptation

10.6.1 Clear, simple processes

Keeping the DHIS2-WASH system simple to use and clear to understand at all levels was the key to its successful implementation. Data collection forms, such as the one in the example below, can be completed very easily by community volunteers who retrieve information in each village.

By keeping data collection sheets simple, by using clear data indicators, this meant that the data entered in to the system was also clear and only critical information was retained. As a result, analyzing and interpreting the data was much more straightforward. Another benefit of using very basic indicators was that any errors that slipped into the data could be spotted and rectified fairly simply.

10.6.2 Defining Roles

Akros has created three detailed end-user capacity assessments: the Stakeholder Role Rubric, the CLTS Surveillance Protocol and the CLTS Events Protocol. These documents serve the purpose of defining what each person does within a program so as to avoid ambiguity about responsibilities. Furthermore, the documents help to improve, monitor and assess the implementation of CLTS programs at the different roll out stages. Stakeholder Role Rubric

This document can enable a Community Health Worker to understand the full scope of his or her role. For example, they would know that they would be in charge of decision making in areas covering disease diagnosis, treatment administration, patient referrals, and commodity resupply checks. They would also know about the reporting requirements to follow such as the frequency and method to use. CLTS Surveillance Protocol

The Surveillance Protocol is a document that is used to assign monitoring methodologies for each event. It is a detailed analysis of surveillance techniques against each critical event in CLTS deployment. Responsible parties, periodicity, the role of automated functions and manual (surveillance officer) functions are all identified. CLTS Events Protocol

The CLTS Events Protocol is a document with a more detailed description of the critical events to be monitored. Responsible parties, periodicity, purpose and expected outcomes are identified, along with a brief narrative for context.

10.6.3 Promote a sense of responsibility

Promoting a sense of data ownership amongst participants has a great influence in helping to build up sustainable programs. It is therefore important to develop standard operating roles, by outlining the tasks and duties of every person interacting with the system.

Thus by making participants feel responsible for the data they’re in charge of and by promoting how their role is connected to the successful outcome of a CLTS project, this helps to maintain the flow of communication between all of the levels involved, whether it be at village, ward, constituency, district, province, national or organizational level.

10.6.4 Lessons learned Backwards compatibility

Everything has to be backwards compatible to make upgrades into a smoother process. For example, in 2013, DHIS2 version 2.1.4 was unable to handle the growing volume of users as more and more districts started to use WASH. The system had to be upgraded, due to the number of legacy issues and bugs that were encountered. However, this was not a straightforward task and meant re-installing applications on all devices. Using clones of tried and tested WASH programs

Akros learned that it was beneficial to use clones of production instances as a means to ensure stable implementations of WASH. Upgrades were performed on the cloned instances and then upgrades were applied to the production instances. By proceeding in this anticipatory manner, costs were kept down and troubleshooting was reduced. Use data to drive decision making

Using DHIS2-WASH is one thing; in fact it’s the easiest part. Getting people to use the data in order to drive decision making is the real challenge. To achieve this, Akros made it clear that all participants in a program should understand their role, responsibility and their intrinsic value within the program. Creating a sense of data ownership and a sense of accountability was therefore crucial. For example, by generating DHIS2 reports, district officers had the possibility to make comments about areas of improvement within their district. This information was then forwarded to a provincial coordinator who took action at his or her level.

Lastly, by ensuring that communication channels remained active and were maintained, Akros was able to see how their CLTS program took on more importance and credibility, which in turn generated positive results and recognition in many areas.