This document summarizes Bangladesh's experience rolling out an electronic TB management system called e-TB Manager. Key points: - e-TB Manager allows online reporting and real-time data sharing to improve TB monitoring and management. It has been piloted and rolled out in over 200 health facilities. - Evaluation found the system improved data quality, helped generate timely reports, and satisfied most users. It provides complete patient data to forecast medicine needs. - Further scale-up is proposed, along with customizing the interface, training more staff, and developing guidelines for using the data. A transition plan outlines handing ownership from partners to the National TB Program by 2017. Challenges include staff turnover and gaps in the previous manual

1. 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

2. 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

3. 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.

4. 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.

5. 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

6. 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.

7. 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).

8. 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.

9. 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.

10. Proposed inter-operability options:
e-TBM and DHIS2

11. 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

12. 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

13. 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

14. 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

15. Thank You
mkibria@msh.org