Use of Blogs as a Tool for Monitoring and Evaluation – A case report from Health Department

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Introduction
Tamil Nadu Health System Project is a World Bank Funded Project for improving the Quality of Care in Secondary Care Hospitals. Project work undertaken across the state in various districts has to be continuously monitored and evaluated for timely implementation of the project. In addition to depending on the report by routine mail telling in words “completed” / “ongoing” / “started”, the project decided to monitor the actual scenario by looking at photos taken at the work site.
Conventional Method of (M&E)
In the Conventional method of monitoring with photographs, for a work being undertaken (for example) at Kanyakumari District, a photo is taken. The negative is then developed, photograph printed and is send by Courier / Post and it reaches Chennai. There are quite a few disadvantages with this method like
? Time Lag
– Time needed for Developing and Printing
– Time needed for sending the photos from Periphery to Chennai
? High Cost involved
– Cost involved in Film, Processing
– Courier Charges
? Difficulties in monitoring
– Additional Copies needed to be sent to all the personnel involved
– Difficulty in Filing and Retrieving
– How to arrange
? Whether district wise
• Finding the works undertaken in the current week is difficult
? Or Date Wise
• Finding the progress of the work in a hospital over two months is difficult
Using E Governance for Monitoring and Evaluation
So it was decided to use a form of electronic system that does not depend on Developing and processing of the films, does not depend on Post /Courier, does not need additional copies and makes life simple while accessing the data using a various of parameters. The traditional softwares were usually a Server – Client Model, and software of those model has inherent shortcomings like Problems with Updating each Client Software and the system can be sued from particular systems only.

A Web Based System system, on the other hand, can be used from any computer that has Net Connectivity, can be accessed from Any where with a computer connected to Internet and data can be uploaded from anywhere with a computer connected to Internet
Options for Web Based Monitoring Interface
There are 4 Options Available
1. Development of a new custom made software from scratch
2. Use any “photo sharing” software already available and “modify” it to suit Tamil Nadu Health System Project ‘s needs
3. Use a Blog and Modify the Template to suit the purpose
4. Ask the persons to just send the photographs by Mail marking copies to all concerned
Case Report
We created a group blog, with administrative control with the Project Management Unit and stakeholders in periphery as blog users and modified the template to suit our pattern. The advantage with this system was many. There was no need to develop negatives, there was no need to print, no need to post/courier the copies, no need of Multiple Copies and more over the access was in real time. Any one from the Officer Manning the Particular Programme at the Project Management Unit / Project Director / Health Secretay etc see the images in real time
The Next big Advantage was Categorization. Photos can be accessed by name of Builiding (eg Maternity Ward), Name of the Hospital (eg Annavasal), name of the District (eg Theni), Week / Month the photo was taken (eg 19th March to 25th March)

Since The software is web based and does not need any installation at the Client End All the data are also stored in the server. The Photos and other Data can be viewed and assessed from the following URL http://civil.tnhsp.net/from any computer with Internet facility and a browser.

And this does not need a dedicated server. Can be hosted on Web Hosting Servers at a cost of about Rs 5000 – 10000 per year (depending on the number of photos) or can be hosted at NIC Servers

The project took very little time from conception of the idea to actual implementation and can be seen from the timeline below

9th March 2007 The Need for a Monitoring and Evaluation Tool was discussed
12th March 2007 A prototype was developed and tested in Chennai
13th March 2007 Added the list of Hospitals in the Civil Works Software
15th March 2007 Moved the civil works monitoring software to civil.tnhsp.net
16th March 2007 User Manual Prepared
20th March 2007 One day Hands on training given to End Users
23rd March 2007 First Round of Photos received from Theni and Kanyakumari

Time From “Discussing the need for a software” to “final implementation” took only 2 weeks. The project is running successfully from March 2007 till today at http://civil.tnhsp.net
Discussion
Comparing Various Options
The Pros and Cons of the various options are listed below
Option Pros Cons
Custom Made Software
Tailor Made and so suits the purpose to the maximum
Time Lag
? Time to Get Administrative Sanction
? Time to get Financial Sanction
? Time to call for tender
? Time to Finalise Contract
? Time to Prepare SRS
? Time to Pilot
? Time to Debug
? Time for implementation
? Time for the Users to get used to the interface
Work Flow has to be defined
Newer Bugs
Modification of Photo sharing software Quicker and with less bugs as compared to previous Users have to learn the interface
Group Blog Minimum Time and Minimum debugging while implementation
To post in a Blog = Write a Mail To be labeled as a “lazy” approach

E Mail Least Learning Time and most easy Learning Curve for the End Users Categorization and Retrieval is difficult
Advantages of Group Blog
Minimum Learning Curve for the User
In the Training it was stressed that posting to a blog is similar to sending a email
E Mail Our Software
Login Login
Compose New Photo
Subject Subject
Text Details
Attachment Upload Photo
Send Post
Familiarity for those already blogging
No need to learn new commands or shortcuts
Users can use their old user name and Passwords (if they already have one) – No need to remember one more user name
Lessons Learnt
1. For any software implementation, user acceptance is more important than the choice of technology
2. The lesser number of keystrokes and mouse clicks you give to the end user, the more will be the acceptance
3. Familiar interfaces and Graphical User Interfaces (GUI) are more acceptable than a entirely new interface
4. Lesser the number of error messages or interruption, more chance for users to adapt to the system
5. Web based software is better than client server based
6. Use of Local Language Interface increases user acceptance
Moral for Software Implementation
Latest and “Hi end” Technology need not be used just because they are available
KISS – Keep it Short and Simple
Use Local Language
Suggested Use of this method
This method is most suited for small projects which may not have the time or budget or both for a custom made software, especially when implementation has to be started immediately. Also suited for emergencies (Tsunami Relief, Flood Relief) and temporary programmes (Pulse Polio, Chikungunya)
Acknowledgement :
The authors thankfully acknowledge the contribution of Staff involved in photographing and sending the photos for having made this project a success
References:
1. http://en.wikipedia.org/wiki/Blog
2. http://en.wikipedia.org/wiki/Collaborative_blog
Source of Support :
Tamil Nadu Health System Project is a world bank aided Project
Conflict of Interest :
Nil

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