By Chilunga Puta, BLN Director, BID Initiative
Sep 1, 2017
Last week, BID Learning Network (BLN) participants traveled to South America, trading their home countries for a new backdrop. What first struck me about Chile, a narrow country bordered by the South Pacific Ocean to the West, Argentina to the East and its northern neighbors of Peru and Bolivia, were its expansive green spaces. In Parque Forestal, in central Santiago, street lamps line the pathways, and bicyclists and pedestrians weave between the public monuments. In Parque Quinta Normal, an enormous glass greenhouse sits at the middle of the park. Public parks are everywhere in Chile, a testament to the country’s commitment to health promotion and community.
The BLN recently joined the Pan-American Health Organization (PAHO) for a study visit to Santiago, Chile. The trip was an opportunity to exchange experiences in implementing electronic immunization registries (EIRs) and data management systems. Despite our different country contexts, we share many common challenges and potential areas of learning. Participants included BLN members from Ghana and Zambia, and PAHO representatives from Honduras, Bolivia, Colombia, Costa Rica, and Chile. Participants were also joined by a representative from the Bill & Melinda Gates Foundation and from the Centers for Disease Control and Prevention.
In 2010, Chile developed its Registro National de Immunizaciones, or RNI, following a vaccination campaign to curb the AH1N1 flu pandemic in South America. Today, Chile’s RNI covers both public and private institutions, nationwide. The EIR has done better than most in capturing both routine and campaign immunization data. More than ten million people are registered, and the RNI covers more than 1,100 private and public health facilities in Chile. Zambia’s Electronic Immunization Registry (ZEIR) and Tanzania’s Electronic Immunization Registry (TImR), by comparison, have yet to scale nationwide.
BLN country participants, many of whom are in the process of, or interested in adopting electronic immunization registries of their own, had the opportunity to learn from Chile and other PAHO countries. Study visits, such as this one, enable health officials and digital health professionals to swap experiences and advice with countries that have successfully designed and implemented data management interventions. Without these opportunities, countries risk duplicating efforts, investing in technologies or strategies that don’t yield high impact, and wasting precious time and resources to improve their data. BLN participants took part in discussions, site visits, and system demos, and throughout the trip there were many opportunities for participants to learn from one another.
Chile is currently expanding its RNI to include other modules of an immunization information system, including stock-level data, a feature that both ZEIR and TImR have. The Ministry of Health (MOH), which manages the system, also has plans to launch a feature that will alert health workers to the services each patient needs, whether that be a missing vaccine dose, or an overdue check-up.
Although the registry is the country’s official source of immunization data, health facilities still maintain a parallel paper system as backup. And so despite the impressive scale and success of Chile’s EIR, the MOH also had an opportunity to learn from BLN participants. BLN members suggested, for instance, that Chile consider keeping print-outs of immunization registries, instead of requiring health workers to perform the time-intensive task of rewriting patient information for themselves.
PAHO colleagues were also intrigued by Tanzania and Zambia’s data visualization dashboards, which help health workers better understand trends in vaccination coverage rates, facility performance, and where there are defaulters. Chile is considering including similar visualizations in its own system expansion of its RNI. Currently, health workers use Excel files to analyze data.
BLN participants also had much to learn from their colleagues in Chile. For instance, Chile has help desks health workers can contact if they encounter any difficulties with the system. Many BLN participants were also struck by the role of the private sector in supporting the RNI. As Zambia and Tanzania explore sustainability and scale up plans, the private sector is likely to play an increasingly important role in either country.
“I think the most useful lesson for me was about the commitment by the private sector to support the data gathering process,” said BLN participant Charles Brown Davies of Ghana. “This was backed by the strong government legislation and support for the process. The strong will and commitment on the part of all staff to make the RNI system work was also a very high point for me.”
Last week’s study visit promises to be the beginning of a long and fruitful partnership between the BID Initiative and PAHO. To learn more about the BLN, visit our website, and check back on our blog for updates from September’s BLN Discussion Meeting.