Strengthening health service delivery and governance through institutionalizing ‘Urban Health Atlas’ - a geo-referenced Information Communication and Technology tool: lessons learned from an implementation research in three cities in Bangladesh

Introduction Urban health governance in Bangladesh is complex as multiple actors are involved and no comprehensive data are currently available on infrastructure, services, or performance either in public and private sectors of the healthcare system. The Urban Health Atlas (UHA) – a novel and interactive geo-referenced, web-based visualization tool was developed in Bangladesh to provide geospatial and service information to decision makers involved in urban health service planning and governance. Our objective was to study the opportunities for institutionalization of the UHA into government health systems responsible for urban healthcare delivery and document the facilitators and barriers to its uptake. Methods This mixed-methods implementation research was carried out during 2017-2019 in three cities in Bangladesh: Dhaka, Dinajpur and Jashore. During the intervention period, six hands-on trainings on UHA were provided to 67 urban health managers across three study sites. Both in-depth and key informant interviews were conducted to understand user experience and document stakeholder perceptions of institutionalizing UHA. Results Capacity building on UHA enhanced understanding of health managers around its utility for service delivery planning, decision making and oversight. Uptake of UHA was challenged by inadequate ICT infrastructure, shortage of human resources and general lack of ICT skill among the managers. Motivating key decision makers and stakeholders about the potential of UHA and engaging them from the inception helped the institutionalization process. Conclusion While uptake of UHA by government health managers appears possible with dedicated capacity building initiatives, its use and regular update are challenged by multiple factors at the implementation level. A clear understanding of context, actors and system readiness is foundational in determining whether the institutionalization of health ICTs is timely, realistic or relevant.