By Mbye Njie, EPI Capacity Building and Surveillance Officer
Jun 1, 2017
Last fall, The Gambia was awarded the BID Learning Network’s (BLN) first small grant to develop a comprehensive web-based immunization registry to capture and track every child born in the country’s Western Health Region, where the system is being piloted. Seven months into the pilot, the system known as the E-Tracker, is already helping health workers see the positive impacts of this digital registry.
In an effort to foster knowledge sharing and skills diffusion, the BID Initiative started the BLN’s small grant program to scale the data-use and data quality interventions being tested and rolled out in Tanzania and Zambia to other countries and health systems. The hope is that each country looking to improve its efforts in data collection, quality, and use will learn from the last – thereby saving time, money, and the headaches and missteps that are typically associated with new interventions.
Since 2009, The Gambia used the Digital Health Information System (DHIS2) to collect, manage, and analyse immunization data. But the current system has its share of challenges, including inaccurate data recording, difficulties identifying children who missed a recent vaccine, and damaged registers, which can result in lost information. Printing data collection tools can also be costly and it is not unusual for health workers to spend days writing reports.
The BLN grant allows The Gambia to pilot and scale a digital tracker using DHIS2. As part of the pilot activities, six laptops were procured and 25 health workers were trained on the E-Tracker, The Gambia’s new digital immunization registry. More health workers in the Reproductive and Child Health teams within the Western Health Region will be trained in June. Because internet access is sometimes unreliable in rural areas of The Gambia, health facilities are also provided with data cards, similar to cellphone SIM cards, to facilitate system use. Under The Gambia’s new system, children will be captured in the immunization registry at birth. Health workers, as a result, will be able to provide consistent, uninterrupted immunization services and track clients if they miss a scheduled vaccine. It will also help them easily analyse their patient data and make sense of it in real time.
Kemo Sonko, a Public Health Officer in charge of the E-Tracker in JFP Hospital said of the new system:
“The E-Tracker has added value to the work and has eased the service for us. Last week, two women lost their child health cards. I [asked them for] their children’s names and I just punched the names into the system and everything [was clear]. I [extracted] their information from the E-Tracker system [for] their infant welfare cards. It was just a click of a button, [and all that] information was reproduced. They were amazed and were encouraging others to have patience to get their children registered [in the system].”
About 2,600 children have been registered as of May 2017 and the system’s first evaluation is expected to take place at the end of June to assess the functionality, its use by different health workers, how it aligns with their workflows, and its acceptability, among other metrics.
“It is gratifying to hear of the progress in The Gambia,” said Chilunga Puta, Director of the BLN. “This is what the BLN is all about…peers from different countries learning from each other and applying the knowledge and experience of others to improve data systems in their own countries.”
Although health workers are highly motivated to use the system, it’s not without its challenges. Internet connectivity is unreliable in rural areas, and because the country has not yet adapted to an electronic system nationwide, health workers are required to use both the paper and electronic systems side-by-side. Kaddijatou Jallow, one of two desk officers at Fagi Kunda Health Centre, said that it can be difficult to manage both at once, while also vaccinating children.
“Using the two systems is time-consuming. For me I [would] suggest that we stop the books and only use the electronic system,” said Kaddijatou. “This will reduce the workload and make the work faster.”
If the pilot continues to prove successful, The Gambia’s EPI expects to look for new funding to scale the system nationally. Already there are plans to expand DHIS2 to major health centers across the country.
“The E-Tracker helps us with our record keeping,” said Kaddijatou. “Before we had the books, and [information would sometimes go] missing…[With] the E-Tracker, you just search by [patient] name or date of birth or any part of the bio-data and the information will be available. It also helps us to identify and track defaulters [and] ensures that a child’s vaccination record is updated, since some of the fields are mandatory and remind you of missing information. For me, this system is very good for record keeping and data management.”
Stay tuned for additional updates on this project and the BLN small grant program.