IntraHealth Namibia has been supporting the Ministry of Health and Social Services (MoHSS) through USAID funded HIV Clinical Services Technical Assistance Program (UTAP), to strengthen Namibia’s HIV data management reporting and data use. One of the key outputs of UTAP is a custom developed HIV Electronic Patient Monitoring System (ePMS) also referred to as Quantum. Quantum precedes the legacy ePMS system used at public health facilities in Namibia. This legacy ePMS (LePMS) was the first step toward longitudinal patient tracking, but it was not without some shortcomings, including:
A complex graphical user interface
An unstructured backend for capture and storage of data
Limited business rules for data entry and managing data quality
Fragmented code which made it difficult to modify system functions
Duplication of patient records
Inability to transfer the patient medical history from one facility hosting computer to another facility the patient has moved to.
Lack of standardized reports, which made it difficult for facility staff to consistently generate accurate reports.
In early 2015, MoHSS began extensive deliberations with UTAP and other stakeholders on the feasibility of redeveloping the ePMS. The MoHSS decided in October 2015 to contract the IntraHealth Namibia (IHN) health information system team to redesign the system. IHN began developing the new system in April 2016 after assembling a competent team. The system underwent various phases of development including gathering consensus and approval for the system’s functional requirements specifications, system design and implementation. UTAP released the first beta version of the new ePMS system in September 2017. The new release of ePMS became known as Quantum ePMS, due to the quantum leap the electronic patient monitoring system made from its predecessor.
Quantum beta version underwent preliminary user acceptance testing with national-level program officers and facility-based data clerks—and in November 2017, UTAP deployed the first version of Quantum ePMS (QePMS) for piloting in Oshikoto region. In May 2018, the MoHSS recommended the pilot to be expanded to regions that were not receiving direct UTAP support to assess whether the system could function smoothly with minimal technical support. In October 2018, UTAP deployed QePMS to two additional regions: Khomas, which receives support from CDC implementing partners, and Hardap, which was not implementing any PEPFAR-supported projects at the time. Prior to deploying Quantum in pilot regions, UTAP conducted district-level trainings and carried out necessary IT hardware upgrades on health facilities equipment. At the end of the pilot phase, Quantum was operational in 58 health facilities in the three regions (Oshikoto, Hardap and Khomas) accounting for 19% of the 310-public receiving antiretroviral therapy (ART) sites.
Since the first deployment in Oshikoto region, Quantum has undergone eight updates to improve on its efficiency and usability. In October 2018, the QePMS technical working group was established to monitor the pilot implementation performance, identify, and address challenges, evaluate the system, and facilitate the national rollout of the system. The technical working group is chaired by MoHSS with members from the MoHSS, CDC, USAID and IntraHealth Namibia. The MoHSS Policy Management, Development and Research Committee (PMDRC), chaired by the Ministry ‘s Executive Director, gave final approval for national rollout in May 2020.
The project is currently carrying out implementation activities in the regions of Kavango East, Kavango West and Zambezi with PEPFAR funded USAID DATA FI project implemented by Palladium in collaboration with IntraHealth Namibia. The roll-out of the system in the above-mentioned regions commenced on 1st August 2020 and is planned to be completed on 30th September 2020. In August 2020 roll-out activities were carried out in Kavango East and Kavango West resulting in 47 facilities migrated to Quantum and a total of 35 health workers trained on the system.