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Hearing from the health workers themselves: User feedback on digital solutions accelerates progress

By Daines Mgidange, Change Management and Data Use Associate, BID Initiative, and Paul Nindi, System Project Manager, BID Initiative

Nov 5, 2020

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Photo: PATH/Trevor Snapp. Health worker experiences and feedback are critical to designing effective digital health systems.

Sharing health workers’ experiences with digital solutions is a critical step to ensure the new tools and systems are adopted and embraced. It matters to users, implementing partners, decision makers, developers, and all who are engaged with digital health solutions. Throughout implementation of the BID Initiative in Tanzania and Zambia, feedback was collected from health workers about the devices and systems they used. This helped to inform the design of the digital tools and—once they were rolled out—contributed to their refinement and improvement.

The BID Learning Network, a country-led peer learning network established in 2014 as part of the BID Initiative, has been connecting with these health workers to share their experiences using digital solutions.

Improving care on the frontlines in Tanzania

A frontline health worker from Tanzania working at Mawenzi regional hospital in Kilimanjaro Region said that immunization data is now easily visible at a facility level through the Tanzania Immunization Registry (TImR). She can identify the number of children who have received their BCG and oral poliovirus vaccines (OPV) and no longer needs to manually count patient records in paper tally books.

“Our hospital is a delivery center where, in a month, we vaccinate around 50 to 150 newborns with OPV and BCG,” she explained.

Because so many patients rely on her hospital for lifesaving early childhood vaccines, it’s important to keep them in stock. Accurate, digital vaccine records help her order stock as she can estimate the number of doses needed each month. Also, TImR has helped her and her colleagues adopt best practices for capturing vaccine data. Using TImR, they can assign newborns to specific facilities, register them in the digital system, and give each a child health card.

A nurse also said that because of TImR, she can assign children to facilities of the caregivers’ choice: “I now know where those children went for routine immunization.”

She highlighted that the patient experience is also better. With digital records and child health cards, caregivers now have a clear understanding of when their children are next due for vaccines.

Adopting the digital systems has not been without its challenges though. One registered nurse said she still faces challenges using TImR on a daily basis because she works within multiple programs that use different data tools in her Reproductive Child Health Department. She hopes to one day be able to view all data within a single dashboard.

Tracking coverage rates in Zambia

In Zambia, Nkomesha Luhamba and Elizabeth Kaumba both work as nurses at Kabulamwanda, a rural health facility. During a data review meeting, Kabulamwanda was identified as a well-performing facility for their use of the Zambia Electronic Immunization Registry (ZEIR).

At first, their facility used ZEIR without fully understanding its benefits. As they continued using the system and talking to other ZEIR users, they learned about the coverage reports it generates based on vaccine records. ZEIR creates monthly reports that helped Elizabeth and Nkomesha better track their facility’s birth cohort, something they had previously struggled with under the paper-based system. With the digital system in place, they know how many children they are likely to receive for vaccines at any given time. If they notice a drop in the number of children coming to the facility, they use ZEIR’s defaulter notifications to track down these children and make sure they resume their vaccine schedule.

Strengthening data use at a district and national level

Mr. Michael Ndowa, a district immunization and vaccine officer who supported TImR implementation was also happy to share his experience. Supporting health facilities as they adopt the new tools motivates health workers to not give up and keep using the digital solutions. Mr. Ndowa said: “close follow-up at a health facility level is very important. District coordinators need to be committed to supporting frontline health workers.”

Recognizing this, he convinced his council health management team to approve support for internet bundles on an annual basis so that health workers can use the system without worrying about recharging monthly.

Mr. Ndowa said that his district had greatly improved its use of TImR and was selected for the national Training of Trainers program to support other regions in the rollout of TImR.

Mr. Peter Kihamia, Kilimanjaro’s regional immunization and vaccine officer, has been using the Vaccine Information Management System, which simplifies his work by helping him analyze data and quickly pinpoint gaps in care. He can also visualize the amount of stock available in regional vaccine stores without having to manually count it. The system prompts him to distribute the right stock by issuing batch numbers. Previously, he had to manually provide batch numbers for antigens based on their lot numbers.

You can hear more from health workers by following the BID blog. Follow our journey!


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