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Going beyond denominators: Defining the value of electronic immunization registries to solve for health system barriers

By Emily Carnahan, Monitoring, Evaluation, and Learning Manager, PATH

Aug 27, 2020

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Photo: PATH/Trevor Snapp. Patients wait to receive immunization services at the Usa River Health Center in Tanzania, which uses an electronic immunization registry to record vaccine data.

This is the first in a two-part blog series about the BID Analytics portfolio, which will use electronic immunization registry data to consider how the data captured by these digital systems can help address immunization program barriers.

Data can make the invisible visible. More complete, reliable, and real-time information on health trends, coverage rates, and service gaps can help strengthen health systems and better allocate precious resources. This fact has been recognized by a growing number of countries embracing electronic immunization registries (EIRs) to help monitor individual immunization schedules and vaccination histories. But even as countries adopt EIRs and understand their value, there are many questions about how best to implement them, as well as their effectiveness, cost, and impact on health outcomes.

As has been demonstrated by the BID Initiative in Tanzania and Zambia, EIRs have tremendous value for countries and their health systems, helping to address data challenges related to patients defaulting on their vaccines, missing or incomplete immunization data, and inaccurate denominators, among other challenges. These core EIR benefits have been well documented under BID. But immunization programs face other persistent immunization challenges that EIRs can help to address, such as a limited understanding about what drives demand, or the insufficient number of skilled health workers. In an effort to think “big picture,” beyond the core benefits of EIRs, a BID Analytics team comprised of PATH staff collaborating across the U.S. and country offices are using EIR data to consider how the data captured by these digital systems can help address other immunization program barriers.

“There’s so much potential for the individual-level data from EIRs to solve other immunization and health challenges,” explained Emily Carnahan, a PATH Monitoring, Evaluation and Learning (MEL) Manager leading the BID Analytics team. “By understanding what sort of routine data challenges health professionals and country leaders grapple with, we can make sure these digital systems are responsive to their needs.”

Crowdsourcing barriers to design for stronger digital systems

In order to prioritize and solve for these challenges, it was important to hear directly from country leaders about the immunization barriers they faced. In July of last year, Gavi convened a workshop with participants from the Gavi Secretariat, Gavi partners, and country representatives about improving data use in immunization. Approximately 40 participants joined the discussion and helped to identify the biggest barriers for country immunization programs using data to achieve coverage and equity goals.

A key output of the workshop was a list of 17 common barriers to achieving immunization program goals. They ranged from a lack of strategic planning for new vaccine introductions to geographic and social barriers to accessing vaccines. Based on this list of barriers, the BID Analytics team identified ways that EIRs can help address each barrier. We conducted a targeted set of interviews, focus groups, and online surveys with EPI managers, implementing partners, donors, and members of multilateral health organizations to add to and refine this list. Though early successes with EIRs, like those in Tanzania and Zambia, have demonstrated the benefits of the digital platforms, it was important not to limit discussions to the current functionalities of the systems. For example, EIRs could be designed with embedded training resources for health care workers who are accessing the system – although most systems do not currently have this functionality in place. Capturing these benefits, even if they are still hypotheticals, can help inform where we go from here.

“We’ve demonstrated in Tanzania and Zambia that EIRs are valuable, scalable, and sustainable if countries invest in and implement these systems appropriately,” said Carnahan. “These findings will help future countries understand the value of EIRs for their health systems. They will also contribute to version 2.0 of these digital systems, by demonstrating how the data made available in real-time by EIRs can solve for common immunization challenges.”

As the result of these discussions, the BID Analytics team summarized the different ways EIRs may be able to address the most common immunization program barriers. For example, data captured in EIRs can help inform vaccine forecasting for better planning, or identify unimmunized or under-immunized children to allow for more targeted outreach based on the demographic characteristics of patients. A full table of challenges and the many ways EIRs can respond to these barriers can be found here.

We’d love to hear from you! Are there other immunization program barriers you face in your work? Or are there other ways that EIRs can benefit immunization stakeholders? If something is missing from the table referenced above, email us at bidiniative@path.org or add your thoughts in the comments below.

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