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Learning Fast, Moving Ahead

By Henry Mwanyika, Tanzania Director, BID Initiative

Jul 11, 2016

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Photo: PATH. Health workers familiarize themselves with the new electronic immunization registry in Arusha City district.

Photo: PATH. Health workers familiarize themselves with the new electronic immunization registry in Arusha City district.

Last year, the BID Initiative began the implementation phase in Arusha City district in Tanzania, rolling out BID solutions to 48 immunization health facilities — 33 facilities using the new electronic immunization registry and 14 low-volume facilities using the simplified paper version (one facility has since closed).

Throughout planning and now implementation, we gathered feedback from members at all levels of the health system through our User Advisory Group (UAG), which includes community leaders, health care workers, and Immunization and Vaccine Development (IVD) officials to ensure designed interventions operate seamlessly and health workers are adequately trained. During this process, we’ve worked to balance our desire to scale quickly with the need to ensure identified solutions are sustainable over time and meet the needs of Tanzania’s health system. Along the way, we’ve celebrated many successes, but also encountered several challenges, including a pause in rollout to make enhancements to the registry and ensure it’s scalable beyond the Arusha Region.

Since then, we’ve completed rollout to all immunization facilities in Arusha City district and have moved forward with implementing BID solutions in Meru district. Implementation in our first district provided us with many key learnings and in the spirit of our “learn fast, fail fast, share fast” philosophy, we want to share some of the lessons we’ve learned to date:

  • Aligning with other initiatives and projects is important to leverage and integrate with each other’s work (e.g., the DHIS2 and RITA systems), and align with government strategies.
  • On-the-job training for health workers is not a common strategy and was often not well received. With this strategy, health workers did not get the opportunity to leave their workplace to attend a workshop outside of facilities and receive per-diem allowances. While the on-the-job training approach minimizes disruption to service provision and provides immediate, hands-on use of the interventions as opposed to a classroom setting, we had to find a way to address health worker concerns. We did this with close collaboration at the district and regional levels to send consistent messaging on the value of the on-the-job strategy.
  • Seek ways to manage frequent rotation of healthcare staff and leadership at all levels of the health system. After returning to facilities to continue health worker trainings on BID solutions, the team observed many health workers had rotated to other departments or facilities. We worked closely with the regional and district levels to limit the rotations of BID-trained health workers.
  • Ensure sufficient time for the development of any system and intervention to allow for a truly iterative process that invites user involvement at all stages. Initially, as part of a more rigid development process, we found it difficult to sufficiently include users and more development time was required to ensure the final interventions met all user requirements as much as possible.
  • Poor quality of back entry data had negative impacts on the registry. Initially, BID staff entered the data from the existing paper register books into the electronic registry to have baseline data at the start. The information in the registers was incomplete, duplicative, or did not account for true defaulters (i.e., children registered in one facility, but receiving their immunizations in another facility). Rather than move forward with this approach, BID is now providing support to nurses to do the original batch of child registrations into the system directly and is using the data off the child health cards that can be verified with the mother as needed.

Our engagement with health workers, IVD, the Ministry of Health, Community Development, Gender, Elderly and Children; regional and district officials, and other key partners continues to be critical for success and sustainability of the initiative. District level officials in Meru and Arusha City have been highly collaborative at every step to make sure interventions are well implemented and sustained.

We are completing the final visits to facilities in Meru district. To date,

  • 101 facilities are implementing BID Initiative solutions in Arusha City and Meru districts.
  • 37,964 children are registered in the new immunization registry.
  • 148 health workers have been trained on BID solutions.

Follow our progress as we continue rollout in Tanzania on our demo map.

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