Together with your stakeholders, read through the following example and try to identify some root causes or contributing factors impacting the implementation challenge that is being addressed. Attempt to answer the questions below after reading.

Alas, it seems like such a good idea…

An NTP manager wants to determine the number of TB cases being diagnosed by regional and local TB programme staff, and to confirm ongoing reports from supervision visits that many patients diagnosed with TB are not starting treatment. The current monitoring and surveillance system is paper-based and defies repeated efforts to clarify the completeness of enrolment and case-holding.

The manager commissions the leading in-country software developer to build an electronic monitoring and surveillance system, with a goal of connecting at least 80% of all facilities within two years. The system is created in record time and deployed countrywide, accessible at facilities via desktops donated by the main bilateral financing partner supporting the NTP.

Despite an enthusiastic start, only 10% of the facilities provided with equipment and software continue to report cases using the new system 18 months after launch. Among the sites continuing to use the new system, data quality and completeness remains questionable as the reported number of TB patients on treatment is significantly less than the number of cases diagnosed.

Questions

• What is the overall purpose or aim of the digital intervention?
• What is the implementation goal?
• What are the key discrepancies between the implementation goal and current implementation? Which RE-AIM domains does this relate to?
• What is the main implementation challenge being faced in this example?
• What might be some of the likely causes for the project failure?
• How would an IR team start to investigate some of the possible causes?
• What strategies, knowledge or new ways of implementing the project could be tried to test these hypotheses?