Design, rollout and early institutionalisation of a digital 360-degree performance management system in Cameroon’s Expanded Programme on Immunization: an implementation study

Abstract Background National immunization programmes depend on competent, accountable and well-supported staff, yet performance management systems in many low- and middle-income settings remain weakly structured, poorly digitized and insufficiently linked to learning and decision-making. Cameroon's Expanded Programme on Immunization (EPI) redesigned its staff performance management system (PMS) from a generic survey-based 360-degree appraisal into a role-specific digital platform embedded in the government Microsoft ecosystem. This paper reports the design, implementation and early institutionalisation of the digital 360-degree PMS. Methods We conducted a descriptive implementation study using the Consolidated Framework for Implementation Research (CFIR) to interpret contextual determinants and Proctor's implementation outcomes to assess early implementation performance. Data sources included diagnostic records, platform comparison materials, alpha-test surveys, implementation logs, backend-user training results, PowerApps/SharePoint/Power BI analytics and the 2025 mid-year PMS review dashboard. Analysis was descriptive and focused on acceptability, appropriateness, feasibility, adoption, fidelity, penetration, implementation cost and early sustainability signals. Results Diagnostics identified major weaknesses in the previous PMS, including missing technical metrics, inconsistent performance objectives, limited structured feedback, absence of end-to-end tracking and weak data aggregation for decision-making. The revised system included 47 general metric items across seven cross-cutting competency domains, 154 department- and cadre-specific technical metric items across 98 technical themes, 8 superior/supervisor metrics and 8 peer-review metrics. Alpha testing with six users showed strong acceptability and appropriateness: all respondents found the platform easy to use and rated its features as satisfactory, while feedback led to practical adaptations including SharePoint migration, bilingual navigation, translation validation, authentication fixes, quarterly reviewer-pairing updates, admin tracking and user guides. Eight backend users were trained; overall competence increased from 31% to 76%, and functional backend skills increased from 0% to 60%. During the first operational mid-year review, 181 staff across the central level and all 10 regions completed reviews. The platform generated personalized staff dashboards and executive Power BI dashboards. Early PMS outputs showed high average scores but also highlighted calibration issues, including higher self-ratings than supervisor ratings in some technical domains and lower technical scores among some operational staff. Conclusions Cameroon EPI successfully moved a 360-degree appraisal process from a fragmented survey tool to a nationally deployed, HR-owned digital performance management infrastructure. The strongest contribution is implementation learning: role alignment, user-centred adaptation, backend capacity, data governance and integration into routine review cycles were central to adoption. Future cycles should strengthen rater calibration, psychometric validation, equity monitoring, cost analysis and linkage between PMS outputs, capacity-building actions and immunization programme performance.