Building a digital supportive supervision system for improving health service delivery in Low- and Middle-Income countries through the collaborative requirements development methodology (CRDM): Experience from Tanzania

Abstract

Background Supportive supervision is pivotal for both health service providers and managers to improve the quality of services and health outcomes. Tanzania's digital supportive supervision system is called Afya Supportive Supervision System (AfyaSS ®). The latter was designed and developed using a human-centered approach called Collaborative Requirements Development Methodology (CRDM). This paper describes the experiences of building the digital supportive supervision system through CRDM in Tanzania, a transition from the paper-based supportive supervision system. Methods In 2018, with the support of PATH, the government of Tanzania adopted a participatory human-centered design by carrying out desk reviews of existing guidelines and tools, field visits, stakeholder workshops, and user advisory groups to gather information for developing a digital supportive supervision system. The gathered information was analyzed with the lens of identifying the common challenges and system requirements. Results AfyaSS was successfully developed using CRDM and deployed in all regions across the country. It has consolidated multiple checklists for distinct health domains, and dashboard functionalities to track progress toward health system indicators, objectives, and action plans. As part of the deployment, several resources were developed to aid in the deployment process, such as a comprehensive user manual, facilitator's guide, training slides, and video tutorials. Health workers and managers can be empowered and motivated to implement comprehensive and coherent supportive supervision by using the lessons learned from this digitalization process to transform the current supervision processes to improve the quality of care by offering instruments that promote evidence-based actions. Conclusion A human-centered approach has been shown to be useful in developing digital tools for use in Tanzania’s health system. Tanzania's lessons can be applied in other low- and middle- income countries (LMICs) with similar contexts when considering implementing digital health interventions. While using the human-centered approach, it is crucial to establish a system development roadmap, conduct appropriate training, provide sustained information and communication technology, and management support for unforeseen issues, and ensure ongoing maintenance.