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BID expands to five more regions in Tanzania, accelerating progress

By Saumu Juma, Communications Associate, BID Initiative

Jun 13, 2019

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Photo: PATH/Trevor Snapp. Patients wait for immunization services at Usa River Health Center in Tanzania. Data quality and use interventions are now in place in nine regions across the country.

In Tanzania, the government expanded data quality and use interventions to five more regions, including Mwanza, Njombe, Morogoro, Geita and Lindi. The Tanzania electronic immunization registry (TImR) is now being used in nine regions and 2,060 facilities in 66 districts across the country. It’s an exciting milestone for the BID Initiative because it represents the largest number of regions to implement data quality and use interventions in the shortest period of time.

The regions represent a diverse geography and demographic. Some regions are geographically large such as Morogoro. Others are very populous, such as Mwanza and Geita. There are more children in these two regions than any other to implement data quality and use interventions to date. This has big implications for TImR and immunization coverage because the system will be able to identify, record, and track children’s vaccinations. It will also ensure they receive the necessary vaccines in a timely manner.

District data use mentors and health workers were all trained over a three-month period. These trainings were followed by facility visits and individual mentoring for health workers who needed additional coaching in the TImR system and data use. WhatsApp groups for each district were created, allowing health workers to pose questions, resolve issues, exchange experiences, and motivate their peers who were struggling. To ensure the five regions are on track, Regional Immunization and Vaccination Officers monitor and evaluate their district performance on a weekly basis and recommend corrective actions to address issues at a district and health facility level.

The government in the driver’s seat

The five regions also represent a different milestone for the BID Initiative. They symbolize the growing leadership and technical capacity of the government of Tanzania as it increasingly scales data quality and use interventions. Teams from the national, regional, and district councils are taking a frontline role in training, mentoring, and sustaining the data quality and use interventions developed under the BID Initiative. Under the leadership of the Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC), with the support from Gavi, the Vaccine Alliance, Tanzania will roll out interventions to the rest of the country. As the government embraces this new role, BID will increasingly take a passive role to ensure the MOHCDGEC grows its capacity.

“It’s exciting to see young and energetic teams within the government, at a district and facility level embracing the digital revolution in immunization,” explains Hassan Mtenga, BID Tanzania Lead. “Four years ago, several partners, including government partners, said TImR was too complex for frontline health workers to learn, use, and train others and  too early for Tanzania to embrace digital tools at primary health care level. I believe we have enough technical capacity within the government to deploy and support TImR in the remaining 60 percent of the country, with less and less support from partners. Our focus is now on enhancing the predictive power of the TImR software and building data analytics skills within the immunization workforce for proactive planning and interventions.”

BID has always operated under the principle of innovating fast, failing fast and learning fast from its missteps and mistakes. The MOHCDGEC has also embraced this approach by learning from the challenges of previous regions. In doing so, it has changed the composition of its national training of trainers (TOT) team, changed device specs, and used different training techniques, engaging more partners in the process. The government has also begun using zonal health colleges to coordinate logistics.

“I am still [learning the new system], but I am positive that I will be a super user in just a few days,” explains Zalia Deogratius, a reproductive and child health nurse at John Mongella Dispensary in Mwanza. “Once you attend to a child and have their records stored in the system, you don’t have to search paper records over and over, like we used to do. If I use the system accurately, at the end of the month I won’t have to write any reports because they are auto-generated. I can also easily get my daily vaccination summary report and follow up with children that have missed a dose before they are overdue.”

Evolving training methods

Unlike the first four regions in Tanzania, where the BID team used on-the-job training, health workers in the five new regions were centrally trained with others from their district. That helped to expedite the process. Centralizing trainings only allows for one health worker in each facility to attend, as opposed to the three people required for on-the-job trainings. But this method can reinforce and create better data use champions. It only took three months to train the entire five regions, instead of the three weeks previously required to complete a single district.

Time savings aren’t the only benefit. Because they are trained centrally, health workers receive the same unified message from facilitators, which helps to reinforce and institutionalize data quality and use. In the past, district data use mentors sometimes misrepresented portions of the training, which led to inconsistencies. However, the classroom training needs to be supplemented with targeted supportive supervision to help nurses apply their classroom lessons. The government is also monitoring knowledge retention and facility performance under this approach.

 

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