Digital Monitoring in support of National eSystems Strengthening: Lessons Learned

UNICEF’s RapidPro Scale Up Initiative

Raquel Wexler, Deepak Bhaskaran, Sean Blaschke, Wojciech Koprowicz, Cary McCormick, Iain Murray, Lil
health worker looking at phone and updating her book
© UNICEF_UNI148584_Vassie

13 November 2018

The Real-time Monitoring through RapidPro Scale-Up initiative is enabling UNICEF teams to leverage information and communication technologies (ICTs) in the delivery of national services and monitoring of programmes, while strengthening the ability of citizens to give feedback on the quality of services.

UNICEF Country offices are reporting increasing use of ICTs by government partners in national health, education, water and sanitation sectors and social protection systems. The rapid expansion of mobile telephone ownership across and within countries has fundamentally changed the way government partners design, implement, monitor and assess sectoral programmes in support of achieving the Sustainable Development Goals.

As Digital Monitoring solutions become increasingly mainstreamed, these innovations provide UNICEF and its partners a unique opportunity to support the building of robust, integrated, national systems enhanced by [real-time] Digital Monitoring and communication technologies.

UNICEF’s Real-time Monitoring Systems Strengthening and Scale through RapidPro Initiative is enabling UNICEF teams to learn how to leverage ICTs in the delivery of national services and monitoring of programmes, while strengthening the ability of citizens to give feedback on the quality of services delivered. US$3 million has been provided to support an initial 11 countries to help plan, test and scale-up national real-time digital monitoring systems using the open source platform RapidPro. Participating countries include Bangladesh, India, Jordan, Malawi, Nepal, Pakistan, State of Palestine, Sudan, Swaziland, Uganda and Zimbabwe.

person typing on a laptop
© UNICEF_UN012561_Adriko

Based on country reports of implementation progress, UNICEF developed a Lessons Learned Brief which has been widely shared within UNICEF and among government partners at the national level. The Brief captures lessons from the first three months of implementation and specifically documents: (1) emerging good practices of what works in designing and scaling innovations such as RapidPro; (2) what has not worked; (3) emerging opportunities and risks; (4) areas required for UNICEF investment to support scale of RapidPro for real-time monitoring (RTM) and other digital initiatives; and (5) how UNICEF investment in RapidPro for real-time Digital Monitoring and communication is contributing to a global good.

UNICEF colleagues at country and regional levels identified many emerging opportunities for the advancement of Digital Monitoring solutions. More than ever, governments are increasingly embracing eSystems, including eHealth and other sectoral eSystems and integrating RapidPro with District Health Information System 2 (DHS2) to support national health systems strengthening. Collaboration with development partners on RTM scale up through RapidPro has increased demand to use this tool across programme sectors.

The platform can also help promote accountability to beneficiaries in the delivery of key services, and engage youth and others around SDG implementation.

 

“Traditionally, UNICEF focuses on addressing the supply side issues affecting service delivery. The Real-time Monitoring Strengthening and Scale-up through RapidPro Initiative is demonstrating how to look at the other side of the coin and integrate feedback from communities – the demand-side consumers of these services – to ensure increased quality. Whether it’s the UNICEF Health Strategy 2016-2030, the Young People’s Agenda, or the community’s involvement with their local school, we are seeing a global consensus in all of UNICEF’s programming areas about the importance of strengthening engagement on the demand-side. RapidPro is a way to implement this – at scale.”

Cary McCormick, UNICEF South Asia Regional Office (ROSA) Technology for Development focal point

UNICEF field colleagues have also identified risks to the implementation of Digital Monitoring solutions, finding that UNICEF has not yet fully embraced digital eSystem solutions within programming, which requires a new way of programming and working across disciplines and sectors. Further, as demand for RapidPro for Digital Monitoring and other applications (U-Report) increases among development partners, so too will expectations for UNICEF technical support and leadership, which will have financial and human resource implications. Speaking of risks, Sean Blaschke, UNICEF Eastern and Southern African Regional Office (ESARO) Technology for Development focal point, noted:

“The technology component is only a small element in the success of a programme. A number of initiatives in the East and Southern Africa Region have not yet achieved their full potential because they focused too much on the technology, or applied “real-time” data collection inappropriately where less frequent data would have been more appropriate. Technologies such as RapidPro should not be seen as a replacement for a flawed or non-existent system, but rather are best placed to complement existing systems by strengthening, expanding or addressing deficiencies within them. Examples of where this has successfully been applied, include merging RapidPro with DHIS2 in Uganda, integrating RapidPro with iHRIS in Liberia during the Ebola outbreak, and using RapidPro to strengthen the national Water and Sanitation platform in Zimbabwe. At the same time, this needs to be complemented by a deliberate human-centered design approach to ensure that these initiatives are clearly tailored to end-users, and that there are clear structures and existing capacity to respond to real-time issues that are identified affecting these end-users. Without this, trust and credibility can very easily be lost, posing a significant risk to UNICEF’s reputation.”

Government extension workers in Insiza district (469 km south of the Zimbabwe capital, Harare) receive training on the Rural WASH Information Management System (RWIMS) – SMS Notification Response (SNR). Photo credit: ©UNICEF Zimbabwe/2018/ Mutsiwegota
©UNICEF Zimbabwe/2018/ Mutsiwegota
Government extension workers in Insiza district (469 km south of the Zimbabwe capital, Harare) receive training on the Rural WASH Information Management System (RWIMS) – SMS Notification Response (SNR). Photo credit:

What has worked?

  • Government ownership. Government investment in the design, implementation, monitoring and assessment of the innovation is important in ensuring its integration in national programmes, priorities and systems and helps to ensure its sustainable ownership. Plan not only for scale, but institutionalization and sustainability from the start. This includes embedding initiatives into national policies, government development plans and budgets, and ensuring sufficient technical capacity exists within a country to take over all aspects of the programme.
  • Anchor innovation within existing programmes. It is imperative to design innovations such as RapidPro within existing UNICEF-supported programmes. In the Swaziland case, Government was conducting client satisfaction surveys once every two years using paper-based questionnaires. Digital Monitoring has reduced the client feedback and government response period.
  • Invest time in quality programme design. Design and implementing innovations such as RapidPro for RTM requires strong emphasis on planning and programme design to ensure that the innovation being deployed will address priority programme bottlenecks, and articulated through robust Theories of Change. Make sure that programme result frameworks and M&E indicators do not simply measure the presence of activities – such as the number of districts where RapidPro has been deployed – but instead are linked to programme results.
  • Assess if and where real-time data will make an impact: In many cases, due to existing policies and regulations – such as public sector absenteeism – existing laws and labour unions prevent any corrective action from being taken based on this data. We must avoid the assumption that simply knowing in real time that there is an issue will result in the issue being resolved.
  • Align with existing governance structures, policies and regulations: Good representation of relevant ministries through a steering committee at the national level is critical to the design, implementation and oversight of the innovation. Whenever possible, it is best to align with existing governance structures. In the health sector, increasingly patient level data is mandated to be stored in a country. If programmes do not anticipate this and store such data in the cloud, there is a significant risk that the programme will be shut down.
  • Need for strong coordination across disciplines: Strong collaboration between ICT, programme, communications and supply teams ensures that every section understands each other’s needs. Constant communication between ICT, communications and programmes within UNICEF helps ensure timely implementation to address bottlenecks and that the innovation meets the needs of the end user. The State of Palestine Office built on the good inter-sectoral work already established on ECD and integrated RapidPro as a new element while bringing in IT and Supply which helps to strengthen internal cooperation. Speaking of the importance of coordination, Lillian Luanda, Middle East and North Africa Regional Office (MENARO) Technology for Development focal point, noted: “The initiative was designed to encourage collaboration between programme, ICT and management from the beginning, this enabled CO teams to articulate needs and collectively address bottlenecks promptly.”

What would UNICEF Country Offices have done differently?

  • Engage with Mobile Network Operators (MNO) early and often as key private sector partners. Country Offices should plan ahead for the required supply contracts and partnerships to support implementation such as the need for a specific shortcode, SMS aggregator, etc. This can be time-consuming and if not sufficiently planned in advance, can result in delays during programme implementation. As mobile phones are becoming increasingly important for parents and families, the services that MNOs offer to reach those mobiles phones now play an important role for service delivery in all of our programme areas.
  • Involve both national and sub-national partners in planning and programme design of the eSystem. Involve the implementing districts at the sub-national level in planning and programme design. This will also help ensure that sub-national partners have the full capacity to support the system. In the Zimbabwe case, the CO noted that involving subnational partners more in the design process at the outset would have improved early ownership of the Rural WASH Information Management System at the district level.
  • De-brand “RapidPro” for RTM with partners and within UNICEF. There is need to de-brand the Digital Monitoring and RTM tool, “RapidPro,” to avoid the misperception that the focus is on the tool instead of the programme interventions it supports – which is to strengthen national eSystems. This has been successfully done in the cases of U-Report and Digital Health.

Additional lessons and information may be found in the Lessons Learned Brief.

For queries to regional technology for development focal points participating in the Digital Monitoring Strengthening and Scale through RapidPro Initiative, please contact: * Sean Blaschke, UNICEF ESARO sblaschke@unicef.org * Lillian Luanda, UNICEF MENA lluanda@unicef.org * Cary McCormick, UNICEF ROSA cmccormick@unicef.org

For headquarter queries, please contact: Raquel Wexler, UNICEF Office of Innovation rwexler@unicef.org