Design, rollout and early institutionalisation of a digital 360-degree performance management system in Cameroon’s Expanded Programme on Immunization: an implementation study
This implementation study documents the successful design, rollout, and early institutionalization of a role-specific digital 360-degree performance management system within Cameroon's Expanded Programme on Immunization, highlighting how user-centered adaptations, capacity building, and integration into routine cycles facilitated adoption while identifying areas for future calibration and validation.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Imagine the Expanded Programme on Immunization (EPI) in Cameroon as a massive, bustling orchestra. For years, they tried to check if every musician was playing in tune using a generic, paper-based survey. It was like asking a violinist and a drummer to fill out the same "how are you feeling?" form. The results were messy, the feedback was vague, and nobody really knew who needed extra practice or who was ready for a solo.
In 2024 and 2025, the EPI decided to upgrade their system. They didn't just buy a new instrument; they built an entirely new digital stage right inside the Microsoft ecosystem they already owned. This new system is a digital 360-degree performance management platform. Think of it as a high-tech, interactive mirror that doesn't just show you your reflection, but lets your conductor, your fellow musicians, and even yourself rate your performance on specific skills, all in real-time.
The Big Switch: From Paper to Power
The old system was like a broken radio: it collected data but couldn't play it back clearly. The new system, built on PowerApps and SharePoint, is a smart, connected dashboard. It replaced a generic survey tool with a role-specific digital platform. Instead of one-size-fits-all questions, the system now asks 47 general questions about things like teamwork and leadership, plus a whopping 154 technical questions tailored to specific jobs (like vaccine logistics or data management) across 98 different technical themes.
The authors found that the old way had "missing technical metrics" and "weak data aggregation." The new way? It's a central command center. When a staff member finishes their review, the system instantly generates a personalized dashboard for them and a giant, colorful Power BI dashboard for the leaders to see the big picture.
The "Beta Test" (Alpha Testing)
Before rolling this out to the whole country, the team invited six key players (from HR, planning, and data teams) to try it out. This was the "alpha test."
- The Verdict: Everyone agreed the new platform was easy to use. 100% of these testers said the features were "very satisfactory."
- The Tweaks: But it wasn't perfect yet. Some users found the login tricky, and the system was initially only in English. The team quickly fixed this by adding bilingual navigation (since Cameroon speaks both French and English), fixing authentication glitches, and creating a "user guide" so no one gets lost.
- The Lesson: The paper suggests that listening to these early users was crucial. They didn't just build the software and hope for the best; they adapted the design based on real feedback, turning barriers into features.
Training the Conductors
You can have the best instrument in the world, but if the orchestra doesn't know how to play it, nothing happens. The EPI trained eight backend users (the people who manage the system) on how to keep the digital engine running.
- The Result: Before training, these users had a competence score of 31%. After training, that jumped to 76%. Their ability to use the backend tools specifically went from 0% to 60%.
- The Goal: This wasn't just about teaching them how to click buttons; it was about making sure the EPI could run this system themselves without needing outside help forever.
The First Big Performance
In the first full operational cycle (the 2025 mid-year review), the system went live across the central level and all 10 regions.
- The Crowd: 181 staff members participated. This included 102 men and 79 women, ranging from top executives to support staff.
- The Score: On a scale of 1 to 5, the average score across the board was 4.2. That's a "high" score, suggesting people felt they were doing well.
- The Catch: The paper is very careful here. It says these high scores are a "baseline" and a "calibration signal," not proof that performance suddenly improved. In fact, the data showed some interesting gaps:
- People rated themselves higher (4.3) than their supervisors rated them (4.1).
- Support staff scored lower than leadership.
- Some regions had higher scores than others (ranging from 3.7 in the West to 4.4 in the North and South-West).
The authors argue that these gaps aren't failures; they are exactly what the system is supposed to find. It's like a coach spotting that a player thinks they are great at passing, but the coach sees they need practice. The system surfaces these differences so they can be discussed and fixed.
What the Paper Rules Out (And What It Doesn't Claim)
It is vital to understand what this paper does not say.
- It is NOT a magic cure: The paper explicitly states it did not prove that this system caused staff to perform better or that immunization rates went up. It is an implementation study, meaning it studied how they built and used the tool, not whether the tool fixed the health outcomes yet.
- It is NOT a "solved" problem: The authors are cautious. They note that sustainability is "promising but early." They identified risks like connectivity issues, staff turnover, and weak leadership enforcement that could break the system later.
- It is NOT a final verdict on staff: The high scores might just mean people were being nice (social desirability) or were excited about the new tool. The paper warns against using these first-cycle numbers to judge staff capability definitively.
The Bottom Line
The main finding is that Cameroon's EPI successfully moved from a broken, paper-based survey to a digitally owned, role-specific performance system. They proved it is possible to build this within a government's existing Microsoft setup, train local staff to run it, and get 181 people across a whole country to use it.
The paper suggests that the real win isn't the software itself, but the process: aligning the tool with actual job descriptions, training the people who manage the data, and using the results to start conversations rather than just handing out report cards. As the authors put it, this is a "feasible pathway" for turning performance reviews into a real management system. But the journey is just beginning; the next steps involve checking if the scores actually lead to better training and, eventually, better health outcomes.
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