Completion of Tanga marks new milestone for the BID Initiative
By Saumu Juma, Implementation Specialist, BID Initiative Tanzania
Oct 19, 2017
Last month, the BID Initiative completed its second region in Tanzania. Expansion to Tanga provided an opportunity to apply and test the efficacy of data quality and data use interventions, such as defaulter tracing to pinpoint which children had missed a vaccine. As a region with more rural communities, Tanga presented certain logistical challenges with mostly farmers, fishermen and a few pastoralist populations. Interventions were introduced in all 321 health facilities in the region and more than 55,000 children have been entered into the Tanzania Immunization Registry (TImR) in Tanga.
This milestone is also evidence of the BID Initiative’s philosophy of adaptive management, or our ability to create iterative, not definitive, approaches to addressing data management challenges in order to address the complex and evolving health landscape. Our learnings from Arusha were immediately applied back to Tanga. As a result, we:
- Involved the government from the beginning for local buy-in and capacity building. In Tanga and now also in Kilimanjaro, BID has evolved its approach to increasingly center the role of the government. BID worked closely with the President’s Office of Regional Administration and Ministry of Health ICT and IVD personnel to foster local acceptance and ownership of the data quality and data use interventions. In Tanga, for instance, because of the government’s early involvement, district staff were provided with human resources, vehicles, and working space within government facilities to aid in rollout. BID built the capacity of select health workers within the district, known as District Data Use mentors (DDUM), to lead deployment and support health facilities. DDUMs were critical to this effort and helped health workers understand that they had a role to play in contributing to a data use culture. DDUMs also provided prompt and localized support in a way that BID staff could not.
- Reconsidered the role of the modified paper system. Although there is still a role for paper-based systems in digital health, BID has encountered several challenges and limitations around the use of a modified paper system in Arusha, including inability to capture all data variables, limited access, and complications around scanning, distributing, and collecting paper forms from facilities. Tanga decided to go fully digital. The 321 health facilities in the region are exclusively using tablets to manage immunization data, allowing for real-time access to information, no matter where health workers are located – a rural facility, or the country’s capital.
- Emphasized data, not the tools used to collect it. In Arusha, training initially focused on the system, and overlooked the ultimate goal behind data quality and data use interventions – a culture of data use. From the BID Initiative’s earliest trainings in Tanga, health workers were encouraged to see the value and utility of more accessible data. Timely, actionable data allow health workers to promptly reference patient records, ultimately resulting in better health outcomes. While tablets and barcode scanners enable health workers, the data itself are also a tool.
Our learnings from Arusha helped us complete Tanga in just under two months, saving us time and resources. Though it’s still in the early stages, health workers in the region are already noticing the value of these interventions, especially around the ability to determine true defaulters, efficiently track and update children’s vaccine histories, and act upon the data available to them.
“All you need to do to get a child’s immunization schedule, is to enter the date of birth,” explained Jamila Kanyali, a health worker at Kilulu Dispensary in Muheza District. “Searching is also very easy when you need to update a record. I look forward to work every day for this.”
Soon we’ll begin rollout to 306 facilities in our third region, Kilimanjaro. Each new region ensures that the interventions are applicable and adaptable to different contexts, a critical component to developing and packaging solutions that are scalable and sustainable. For more updates on our progress, subscribe to our blog and follow us on Twitter and Facebook.