Process of implementing e-TB Manager, 2008–2016: a summary of 10 countries

The system integrates data across all aspects of TB control, including information on presumptive TB cases, patients, medicines, laboratory testing, diagnosis, treatment, and outcomes. e-TB Manager was first developed and implemented in Brazil in 2004 and was rapidly implemented in more than a dozen countries. The system has been continuously improved with additional functionalities and general fixes for enhanced use. Updated versions have been regularly released and shared with selected countries that use the system. As of September 2016, e-TB Manager was operating at more than 1,600 sites in 10 countries, with 2,876 active users managing 571,613 TB cases, MDR-TB cases, and presumptive TB individuals. The implementation of e-TB Manager in each country was influenced by local context, including functionality, organizational issues, and technical infrastructure. A multicountry user experience analysis of e-TB Manager and an in-depth study in Ukraine were published, but the procedural aspects of e-TB Manager implementation in each country were not documented. This paper aims to summarize the tailored implementation approaches given local context, which is a crucial consideration. The Global Plan to Stop TB makes the case for investing in electronic patient information systems in various country and regional settings. Donors such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the US Agency for International Development (USAID) recognize the benefits of national health information systems at all levels, including patient-based electronic recording and reporting systems. The current Global TB Strategy supports the introduction and scale up of case-based and/or patient-based electronic recording and reporting systems to improve TB control, national and global surveys, and other data gathering to inform programs and policies. The implementation of e-TB Manager in 10 countries involved a range of stakeholders, including national authorities, facilitators, and technical experts. The system was handed over to national authorities in all 10 countries, with the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, its predecessor programs, and other USAID global programs playing a key role in the implementation process. The procedural aspects of e-TB Manager implementation in each country were influenced by local context, including functionality, organizational issues, and technical infrastructure. The paper summarizes the key lessons learned from the implementation of e-TB Manager in 10 countries, including the importance of tailoring implementation approaches to local context, the need for strong technical infrastructure, and the importance of stakeholder engagement. The implications of these lessons for other electronic health systems are also discussed. The implementation of e-TB Manager in 10 countries demonstrates the potential of electronic health systems to improve TB control and management, and highlights the importance of careful planning and implementation to ensure successful outcomes.