Transforming Birth Certification Issuance through Advance Technologies (eBirth)
Ministry of Health/ eGA

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Issuance of birth certificate in Bahrain was done manually since 1939. In 1993 ministry of health started using a health information system (MDIS) to record the births of citizens and residents. In 2009, the data was migrated to an oracle system where all births data is registered by the Birth and Death section of Ministry of Health, after a long process that includes many parties. The process is defined briefly as follows: • The Birth Notification Form was filled in the Maternity Hospitals then was sent by fax to Central Informatics Organization (CIO) to get Personal Number for the new born, and that was taking a long time and delay in getting response from CIO. • The manual forms were transferred from maternity Hospitals to Birth & Death Registration Section, so the forms were expected to be delayed or missed. • The registration was done is Birth & Death Registration Section that caused a high workload in entering the information into the system by one entity. • Parents were requested to visit Health Center/Birth & Death Registration premises to request/collect the Birth Certificate. Unnecessary procedures were performed and It was very hard for the parents to request and receive the Birth certificate due to many reasons:  A lot of administration work was required  Many government agencies were involved in the process  Movement of documents and legal papers between those parties may result in loss or damage.  It is very hard to track the status of the request.  The process required more than 10 employees. All of which was resulted in the following:  Delay in providing the service: o Time needed to register and issue birth certificate may reach 4 weeks o Time to issue the CPR (Personal ID) may reach 10 days  Lack of proficiency: o Fault percentage of Data entry reaches 40% o The parent or the informant may visit the hospital many times o Difficulty in generating instant reports & statistics o Delay in booking appointment for vaccinations for the new born. In 2008, a joint initiative was taken by Ministry of Health and e-Government Authority to solve this problem. Serious actions were done to automate the Birth Registration Process in order to ensure an effective delivery of the government services to citizens and residents, to be in line with the Economic Vision of Bahrain 2030.

B. Strategic Approach

 2. What was the solution?
Kingdom of Bahrain is focused on ensuring effective delivery of government services to citizens, residents, businesses and visitors. Accordingly, Ministry of Health (MOH) in partnership with EGA (E-Government Authority) are leading several development initiatives in the health sector, in line with the Economic Vision 2030 and the NES, "All Bahraini nationals and residents have access to quality healthcare. Bahrain will be a leading center for modern medicine, offering high-quality and financially sustainable health care in the region." E-Birth service was introduced as a joint idea of MOH and EGA in 2008 to automate the process of Birth Registration through MOH website and e-Government Portal. The Ministry of Health in partnership with stakeholders leads an informed, integrated, regulated, sustainable, equitable and affordable health system to ensure the availability of high quality service to all population. The Ministry plays a major policy making role, promotes health and ensures that resources are used efficiently and effectively for a high standard evidence based care. Four interrelated principles guide the above aspiration: 1) Sustainability 2) Accessibility 3) Equity 4) Quality The main objectives of this strategy is summarized in the below points: 1) Integrating e-services throughout the (MOH) Portal between the Ministry of Health and other government institutions. 2) Access for all healthcare services  Increase public awareness by providing the primary, secondary and tertiary healthcare facilities offline services related information and details through the MOH portal.  To build relationships with MoH users including patients, Health Care professionals, suppliers, pharmacies, private hospitals and clinics. 3) Enhancing MOH’s role in policy making and governance by using KPIs such as opinion polls and web analytics. 4) Sustaining the population’s health through health promotion and prevention  Strengthen primary healthcare system through early detection and prevention through increasing awareness.  Promoting and strengthen national policies and plans for prevention and control of non-communicable diseases (NCD).  Promote healthy lifestyles to reduce non-communicable diseases:  encourage healthy lifestyles by covering a number of programs, including timeframes and KPIs  Introduce health-enhancing anti-smoking programs /initiatives in coordination with all sectors.  Introduce health-enhancing physical activity programs to reduce the current prevalence of obesity. 5) Putting quality first  Maximize patient safety throughout the portal by maintaining evidence based clinical and non-clinical guidelines in different aspects of patient care.  Promote a culture of quality assurance throughout the portal 6) Health service sustainability  Continually improving the (MOH) portal to meet international levels and standards. Implementing the Birth Registration eService helped in the following: • Improve in the process of birth certificate issuance. • Reduce Administration work for processing birth notifications and issuing birth certificates; Less than 6 employees to complete the administrative procedures. • Improve data accuracy and integrity by integrating the birth system with (CIO); Fault percentage of Data entry does not exceed 5%. • Report the birth cases in public Hospitals within the same day. • Eliminate the need to pass the birth notifications between maternity hospitals and Birth & Death Registration Section; Time needed to register and issue birth certificate does not exceed 5 days. • Reduce the time for validating the information. • Issue CPR electronically for the new born; takes less than an hour • Enable the Birth informants or parents to validate the information on the portal, pay the fees electronically and receive Birth Certificate via Post Mail. As a result, Implementation of these initiatives will help transform Bahrain into the finest country in GCC to visit, do business with or live and work in. This aim is the reflection of the Kingdom’s desire to set the benchmark for quality of life and not just compete with others in the region.

 3. How did the initiative solve the problem and improve people’s lives?
This e-service simplified a time consuming, complicated, manual process into a more convenient, accessible, cost-effective and reliable service. This change is illustrated in the below diagrams. Request for Birth Certificate – Before 1. Labour room fill in birth notification 2. Submit the notification by hand to medical records 3. Medical records Send the notification to CIO by fax to issue the CPR 4. CIO Fax back the notification to medical records with the issued CPR 5. Medical records will submit the notification by hand to Births Section 6. Births Section will insert, review and validate the notification into the system. 7. Reporting faults in data to CIO 8. CIO inform births section upon completing the modifications 9. Informant/Parent should visit the health center with the documents to request issuance of a birth certificate 10. Health Center will then submit the Issuance of birth certificate request by hand to births section 11. Births section will send the birth certificates to the health center 12. Health Center should return to the hospital in case of mistakes in filling the notification 13. Informant/Parent must visit the health center to receive a birth certificate Request for Birth Certificate - After  Birth Registration: Labour room: 1) Insert birth data through internal web portal, connected to CIO and Birth section database. 2) Print birth notification and approve it by the attendant 3) send the data to the CIO to issue CPR Informant/Parent: 1) Receive an SMS with child’s CPR sent by CIO 2) Pay hospital charges if any, receive birth notification from  Requesting Birth Certificate Informant/Parent will have to options to request the birth certificate: 1) Internet portal -> Enter eGA portal -> Receiving the certificate by Express Mail service 2) Hospital -> Enter EGA Portal from the Health Center -> An email is sent to the Maternal and Child section with child information to take the necessary procedures to schedule vaccinations

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
For better control and effective project management, the project was divided into four major phases: 1. The initial phase was the strategic planning, which is considered as the key factor to the project success. That includes : a. The identification of the project vision and objectives. b. Assessment of the current state (services, capacities, e-Readiness, institutional structure ….etc) c. Prepare an overview documents and flowchart of the current service process (AS IS document) that should clarify the service delivery, workflow, owner of the process, legal and IT requirements. d. Prepare an overview document and flowchart of the new service processes (To Be document) that should clarify the areas of improvements within the service in term of ease, duration …etc. in addition to redefine the process owners. e. Prepare a detailed action plan including all infrastructure projects and services redesign. All of the above activities were accomplished within intensive workshops with the concern stockholders. 2. The second phase was both backend and frontend design and development. Once the development was completed both backend and frontend was properly tested and validated. 3. The third phase was the implementation, which includes the communication, change management and service implementation. Where the new service design was communicated to the concern parties in Ministry of Health & Central Information Organization. The main purpose of the communication plan and change strategy was to ensure the eService initiative Buy-In and adoption. The following tasks were addressed to develop them: • Stockholder Identification, where all audience were addressed. • Stockholder Analysis which includes an investigation of their main roles and responsibilities and any expected questions. • The Communication messages and channels to address these messages based on the analysis done. • A full marketing plan was developed to market the service within the public as well as the worker. • Training manual and workshops was done for the key users. Due to the criticality of the service, the huge changes done within the process and the involvements of several parties from different governmental entities, a simulation environment was created for testing purposes and that was applied at Salmaniya Medical Complex only and started on 25th May 2009. Several technical and process issues were faced and fixed; hence, the deployment of the corrected version was deployed on 22/7/2010. Afterwards, e-Birth service was deployed in another 2 governmental hospitals which are Jidhafs Maternity Hospital & King Hamad University Hospital. The deployment criteria were carefully chosen in order to minimize a negative impact of the system substitution.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
1) Ministry of Health a. Nursing Services of Hospitals b. Administration Services of Salmaniya Medical Complex c. Health Centers Directorate d. Birth and Death Registration Section e. Directorate of Finance f. Nursing Services for Primary Care and Public Health g. Administration Services of External Hospitals h. Public health Directorate i. Health Information Directorate 2) Central Information Organization (CIO) a) Identity Card Directorate b) Directorate of Information Systems  Improve data accuracy and integrity by integrating the birth system with Central Informatics Organization (CIO). 3) King Hamad University Hospital (KHUH) a. Gynecology Section b. Information Technology Section 4) Ministry of Transportation a. Bahrain Post Office 5) E-Government Authority a. Directorate of Policies and BPR b. Directorate of Service Delivery and Channel Enhancement c. Directorate of Public Relations and Marketing
 6. How was the strategy implemented and what resources were mobilized?
In terms of financial resources the funding was covered by both Ministry of Health and E-Government Authority. However, the project team was from all organizations who are contributing in Birth Registration Process (MoH, EGA & CIO) Resources: • Project Management (EGA & MoH) • Frontend Developers (EGA) • Backend Developers (MoH) • Integration Team (MoH, EGA & CIO) • Key users (MoH) Hardware & Software: • Project Management (EGA & MoH) • Frontend Developers (EGA) • Backend Developers (MoH) • Integration Team (MoH, EGA & CIO) • Key users (MoH) To facilitate eBirth deployment a Helpdesk system for the key users, and another one for the end users where introduced. Both systems offer support to all users and to infrastructure elements, playing a key role for the success of the project. The Helpdesk provides a wide variety of services such as preventive activities, maintenance, monitoring, channeling complaints and suggestions and troubleshooting assistance. To offer this assistance, there is a telephone hotline and email available 24 hours a day /7 days a week in both Arabic and English. The eService was mainly sponsored by e-Government Authority (EGA).

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
A) Providing better Governmental Services • Providing high quality e-Services (Improve in the process of birth certificate issuance): o Each citizen/residents in Kingdom of Bahrain is identified by a unique Personal Number which is used as identification to avail services in all Government/Private entities. Before the initiative, the personal number was generated manually by faxing the Birth Notification form to CIO to generate personal Number. However, this initiative automated the process of Personal Number Generation for new born; the Birth Registration Application now is integrated to CIO Application. o Enable the Birth informants or parents to validate the information on the portal, pay the fees electronically and receive Birth Certificate via Post Mail.  Providing users with integrated, highly secured and user convenient services. (Appointments for Immunization for new born is done automatically once the Birth Registration is completed) • Easy access to governmental services for everyone 24/7 from anywhere inside and outside the Kingdom. • Reducing time taken to complete transactions and ensuring data integrity (Eliminate the need to pass the birth notifications between maternity hospitals and Birth & Death Registration Section) B) Increasing level of efficiency and effectiveness in the public sector • Centralized data accessible by concerned government agencies at any time • User Authentication and data security • Utilizing human resources

 8. What were the most successful outputs and why was the initiative effective?
From the strategic and operative point of view several committees were created in order to follow the status of the deployment. At the highest level it was created a Steering committee composed by high representatives from the Ministry of Health, Central Information Organization and e-Government Authority. The follow-up was based on the agreed master plan. There was also a functional team to deal with any operational issues. From the results point of view a series of evaluation tools were put in place in order to ensure a proper follow-up: - Usage statistics. Data collected through the backend of the birth system allowed to review and draw conclusions on the usage of the system. - Qualitative analysis. A network of key informants (key users) was created so they could report regularly. Their feedback was very valuable since they provide qualitative information that, afterwards, was contrasted with quantitative data. - Satisfactory surveys. Number of questionnaires was delivered on regular basis to monitor the satisfaction of service providers about many issues: the usability, the speed, the quality of the training, etc. All inputs gathered from these methods were seriously taken into consideration and actions plans were designed and implemented accordingly.

 9. What were the main obstacles encountered and how were they overcome?
The eService’s are not about technology. They are about equipping organizations to reach critical business objectives by providing people with technical capabilities that make new things possible and by engaging people in changing their behavior to effectively use the new capabilities to generate results. To overcome this it was necessary to implement three different and parallel strategies: - Create a network of key professionals (leaders in their fields, centers…) and communicate frequently and openly on the status of the project. - Create and implement a robust internal communication plan to empower the employees and ensure they carry a unified and coordinated message. Internal communications provided the critical data points needed - Outline the purpose and benefits of meaningful use. It was very important to find out what role each employee will play in attesting for meaningful use to help midwives, Hospital Administration, finance … to see the real and long-lasting impact (improving communication between all stockholders, eliminating errors, removing redundancy, improving the quality of care … - The readiness of the public to request the service through the internet. That was overcome through the social centers that were distributed all over the Kingdom and the free training campaign that was offered by the e-Government to all citizens to enhance their basic knowledge to use the automated services. The transition period was also a challenging issue. In such a complex deployment, we have encountered many situations in which both systems, the old and traditional one (paper) and the new one (electronic) live together in the same hospital, areas such as the labor room, Admin office, cashier, CIO concern personal …etc This have generated some difficulties and confusion which only could be solved with frequent training, constant communication and a strong support area (help desk) which was at the disposal of end users 24 h. x 24h. 365 days x year.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
Key Benefits: A) Providing better Governmental Services • Providing high quality e-Services (Improve in the process of birth certificate issuance) • Providing users with integrated, highly secured and user convenient services. • Easy access to governmental services for everyone 24/7 from anywhere inside and outside the Kingdom. • Reducing time taken to complete transactions and ensuring data integrity (Eliminate the need to pass the birth notifications between maternity hospitals and Birth & Death Registration Section) B) Increasing level of efficiency and effectiveness in the public sector • Centralized data accessible by concerned government agencies at any time • User Authentication and data security • Utilizing human resources • Increasing productivity level and quality. Below is a comparison between the manual process of requesting and issuing of the birth certificate and the new process. Man Power Now: Less than 6 employees to complete the administrative procedures Before: More than 10 employees to complete the administrative procedures Fault percentage Now: Fault percentage of Data entry does not exceed 5% Before: Fault percentage of Data entry reaches 40% Time Now: - It takes less than an hour to issue the CPR - Time needed to register and issue birth certificate does not exceed 5 days Before: - Time to issue the CPR may reach 10 days - Time needed to register and issue birth certificate may reach 4 weeks Convenience Now: No need to attach copies of the identification documents except very few legal cases Before: It is requested to attach copies of the identification documents multiple times, and being passed to more than 4 government agencies, which my result in loss or damage • Service usage percentage was 15.7% from implemented cases in the demo start. • Electronic Birth certificates comparing to normal Certificates implemented during the project stages, 62.2% in 2011, 97% in 2012 All transactions for the government hospitals are done through the e-service whereas the private hospitals are still using the manual approach. The next phase will include the private hospitals as well. When comparing year 2011 with 2012, 100% increase in the number of online transactions. Year Manual Online Grand Total 2010 17822 1014 18836 2011 12819 5563 18382 2012 8416 11167 19583 2013 6653 10043 16696 Total 45710 27787 73497

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
E-Birth is an avant-garde project in the Arabian Countries in terms of implementation and operation of an integral e-Service. The Bahraini framework for E-Birth could not be more positive. In the last few years, Bahrain has made a strong commitment for E-Government activities, using digital tools and systems to provide better public services to citizens and businesses. E-Birth then fits in a more strategic long-term nationwide vision which, somehow, warrantees its financial and political support. Besides, the implementation of E-BIRTH entails an important return of investment due to several financial savings: o From efficiency improvements by reducing the number of staff involved within the process o From documentation-less requested from the customer due to the integration with central governmental database o From reduction in the time required to issue an important document like Birth Certificate and the creation of the CPR number o From Delivery related documentation and storage o From reallocating Midwives & Nurses time from manual documentation to direct care o From reduction of errors because of handwritten Birth Notification Form o …. These savings would also contribute to the financial sustainability of E-BIRTH at long term. While the potential for measurable cost savings are impressive, the real return on investment comes from the many intangible benefits that we cannot yet accurately measure and translate into monetary savings, e.g. better quality of care, improved work efficiency, increased customer satisfaction, less work done by the governmental staff … E-BIRTH has improved the actual reimbursement system, minimizing the risk of mistakes since provides certain task automization. And lastly, it is important to highlight that E-BIRTH includes functionalities which may facilitate future integration with private hospital networks.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
- Technology is a means, not a goal itself. While many organizations focus on complete installation of new technologies as a goal in itself, the MoH of Bahrain has always believed that this is a means to improve institution’s performance goals. - Workflow design. This is a key issue since all Health Information systems must take into consideration changes in work process and routines, general inconveniences and time costs. - Training and user support. Experience has shown the importance of investing heavily in and requiring upfront training for all staff members in order to avoid negative impacts on workflow, costly setbacks, and productivity losses. - Change management strategy is very important since it helps the technological deployment process and minimizes the risk of resistances. - The commitment of professionals and stakeholders is absolutely essential to get satisfactory results from this process. And it takes time and several strategies. - It is a long and demanding process, full of obstacles and difficulties. So, more than ever, determination and a clear roadmap is essential to reach the end. - End users opinion must be taken seriously into consideration. They are those who will finally use the system and decide whether or not it is worth to embrace it. - The customer should not be left aside in the process. A continuous communication with them increases his/her satisfaction with the governmental services and helps to recognize its value.

Contact Information

Institution Name:   Ministry of Health/ eGA
Institution Type:   Government Agency  
Contact Person:   Fatima Jamal Al Mahmeed
Title:   Computer Systems Analyst  
Telephone/ Fax:  
Institution's / Project's Website:  
Postal Code:  

          Go Back

Print friendly Page