Short Abstract

Regular monitoring provides real-time insights that drive user adoption, strengthen digital system performance, and inform national scale-up decisions for biometric ID in Ghana’s routine immunization program.

Description

Long-standing data quality challenges undermine immunisation planning, resource allocation, and public health oversight in Ghana. Manual data capture errors frequently lead to both underreporting and overreporting across districts (Piu et al., 2024). Digital health solutions such as biometric verification offer the potential to address these systemic issues by creating unique, verifiable patient records at the point of care. Yet, evidence on whether biometric systems function reliably and sustainably in real-world, low-resource conditions remains limited. This session demonstrates how a strong, continuous monitoring and evaluation (M&E) system became the primary evidence base guiding Ghana’s scale-up decisions on digital adoption through biometric verification within routine child immunisation.

The digital health record system, deployed across health posts, prompted a central question: Is the innovation ready for national scale? Instead of relying on the traditional evaluation cycle, stakeholders turned directly to our established monitoring system to answer the strategic questions shaping Ghana’s digital transformation policy. These questions focused on operational feasibility: Are Community Health Workers (CHW) consistently using the system? Does it function reliably in low-connectivity settings? Do caregivers accept biometrics? And can performance be sustained as deployment expands?

The monitoring system was intentionally designed to capture these decision-critical metrics. It relied on mixed methods to gain insights from health workers as well as the backend data from the digital system.

Over the implementation period, biometric adoption by CHWs increased substantially from 34% to 65%, demonstrating that the technology was becoming embedded in routine workflows. Complementary qualitative data supported this trend, with 91% of CHWs reporting strong motivation to use the system. The transition from fingerprint to face biometrics, triggered by early monitoring data showing low performance, proved highly effective; CHWs overwhelmingly reported that face biometrics was significantly easier and faster to use. This real-time adaptation, driven entirely by monitoring evidence, strengthened both usability and system reliability. Community acceptance remained consistently strong, with over 99% of caregivers consenting to biometric capture, an essential condition for national scale-up.

These continuous monitoring insights directly informed and accelerated scale-up decisions. Stakeholders utilised the evidence to assess operational readiness, inform training strategies, and identify resource requirements. The strength and clarity of the monitoring findings led to the system’s expansion into an additional district, with monitoring data serving as the justification for this policy decision. This multi-method and multi-source monitoring system provided the real-time assurance needed to act confidently.

For evaluators and digital transformation practitioners, this case illustrates how deliberately designed monitoring systems, tailored to decision-making needs, can transform evaluation from a retrospective exercise into a forward-looking driver of technology scale-up decisions. The Ghana experience demonstrates how evaluation can become a powerful enabler of responsible, timely, and equitable digital health scale-up, especially within the context of limited financial resource allocation.