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Lessons from the frontlines of the digital revolution: The BID Learning Network mentors countries invested in digital solutions

By Hassan Mtenga, Country Lead Health System Strengthening, BID Initiative

Jan 23, 2020

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Photo: PATH/Trevor Snapp. Health professionals visit Kaoleni Health Center in Arusha Region, Tanzania to observe the country’s electronic immunization registry in use.

Since 2014, the BID Learning Network (BLN) has brought together digital health experts and immunization program managers from across sub-Saharan Africa to share experiences about implementing electronic immunization registries (EIRs), data management systems, change management approaches, and data use policies and practices. The BLN has since expanded its scope to provide a set of holistic services and mentorship on the design, implementation, and scale-up of digital and data solutions to address routine data challenges. For the past few years, the BLN has been mentoring a range of countries interested in adopting digital and data solutions of their own.

Working initially with The Gambia, Kenya, Rwanda, and Uganda, the BLN has built a bridge between countries and regional and global partners through mentorship, peer learning opportunities, and knowledge management. Under the umbrella of the BLN, mentors provide targeted expertise to governments, offering impartial, technology agnostic guidance, and a spectrum of services, whether countries require short-term, one-off, or long-term support to achieve digital transformation. In The Gambia, for example, the mentors have helped the government evaluate three different EIR pilots; and in Kenya the mentors have hosted a learning exchange with representatives from the Ministry of Health (MOH) so they could learn from the BLN’s experience in Tanzania.

Below are a few key learnings from each country.

Lessons from The Gambia

The Gambia has achieved high immunization coverage over the last 15 years, but the country still faces immunization challenges. As early as 2017, The Gambia became an active member of the BLN as it embarked on its own digital journey to pilot three EIRs, including MyChild Solution, the Vaccine Visibility System, and the District Health Information System 2 (DHIS2) Tracker. Hoping to build its digital and data capacity and to learn from its experience in Tanzania and Zambia, The Gambia engaged the BLN mentors, who helped assess the country’s digital and data landscape and country readiness. Mentors provided key guidance on digital and data best practices that aligned with global principles and standards, and helped assess the health information landscape, ICT infrastructure capacity, and the solutions available in the country. Eventually the MOH of Gambia made the decision to prioritize smart paper technology solutions with the ability to interoperate with the DHIS2 and the vaccine supply chain system for countrywide implementation.

Lessons from Uganda

Since 2016, Uganda has had national immunization coverage rates of more than 95 percent, but the country still faces regional disparities and challenges managing its immunization data.

The country has experimented with a number of interventions to address these challenges, including several EIR pilots now being implemented in different areas in the country. These initiatives include MyChild Solution, mTrac, FamilyConnect, UgandaEMR, ClinicMaster, Integrated Clinic Enterprise Application, Microsoft Dynamics Navision, and Mobile Vital Records System. The mentors began working with Uganda’s MOH in September 2018 by landscaping the country’s health system to better understand the challenges it faced. They helped Uganda determine that a more rigorous assessment of its existing pilots was needed to select an appropriate solution and the MOH’s division of Health Information Systems needed to be engaged throughout the process.

Lessons from Kenya

Kenya is among East Africa’s top performing countries when it comes to immunization service delivery and coverage rates. But it still faces a number of data-related challenges, limiting its ability to reach the fifth child with lifesaving vaccines. To address challenges around data management and vaccine inequities, Kenya is implementing a number of interventions, including a national health information system (DHIS2) at the national and district levels; a mobile health project at the health facility level; and an EIR pilot in two counties (Siaya and Homa Bay).

Mentors worked with the MOH to assess its digital health infrastructure and its immunization program challenges, performance, and interventions, all information that is important to support the introduction of an EIR, which is the MOH’s primary interest. A delegation from Kenya’s MOH also visited Tanzania for a learning exchange to better understand the digital solutions implemented under the BID Initiative and to learn from the country’s implementation of an EIR system.

Lessons from Rwanda

In Rwanda, the difference in vaccine coverage between the country’s highest and lowest wealth quintiles is less than 5 percent—a remarkable achievement for the country. However, the country still faces several challenges related to data quality and data analysis. In August 2018, the regional office of the World Health Organization and the MOH contacted the BLN mentors, hoping to learn from their experience and introduce a national EIR system of its own. After a meeting, demonstrations of different EIR solutions and sharing lessons and experience from Tanzania and Zambia, it became clear that the government needed to further align on the most appropriate solution given timelines and priorities. After a series of internal discussions, the MOH decided to deploy the DHIS2 Tracker at the health facility level, while developing a custom electronic medical record system as a long-term solution for the country.

 

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