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Tanzania achieves digital transformation as it transitions two new regions to fully paperless immunization system

By Celina Kareiva, Engagement Officer, PATH, and Saumu Juma, Project Coordinator and Communications Officer, PATH

Jun 21, 2021

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Photo: PATH/Trevor Snapp. A health worker uses an electronic immunization registry to register patients in Tanzania.

Digital tools are only as powerful as the individuals using them, and only meaningful if they can translate to time savings and better health data. In Tanzania, where the country’s electronic immunization registry has been in use since 2017, the country has hit a critical milestone by starting the transition to a fully paperless immunization process. Now that more than half the country has adopted the Tanzania Immunization Registry (TImR), with a commitment to scale nationally, the government has begun retiring the paper-based tools that were once used side-by-side with TImR. In the past few months it’s expanded the number of health facilities now fully transitioned to a paperless process.

“It is a common practice in most countries to implement electronic immunization registry systems alongside the legacy paper-based tools and thus not to realize the full potential of digital health solutions,” explained Hassan Mtenga, Regional Deputy Director of Africa, PATH. “This transition is a remarkable and bold decision for the country and it paves the way for massive gains in efficiency and improved immunization system performance, especially as Tanzania focuses on identifying and immunizing zero-dose children. Having been part of the BID Initiative from the earliest days of designing TImR, to supporting initial deployment, it’s so rewarding to see the country reach this point of digital transformation.”

Using paper tools alongside the new digital platform was a critical proof of concept and change management approach to ensure the system worked as intended. Just as important was Tanzania’s methodical approach to making this switch. The Expanded Programme for Immunization (EPI) first piloted this transition in Tanga Region to determine what support was needed to facilitate the retirement of paper-based tools.

Tanzania has now committed to transitioning two new regions to paperless – Mwanza and Kilimanjaro. During this expansion, the country will apply lessons from its first region of Tanga. This includes mentoring health workers through a combination of classroom and on-job approaches and involving other departments in the digitalization process, including the President’s Office, Regional Administration and Local Government, Monitoring and Evaluation, Reproductive and Child Health, and Immunization Vaccine Development. In both Mwanza and Kilimanjaro, the government will also create a forum for data use and ensure all districts are actively tracking their health facility progress. Based on lessons learned in Tanga, it will provide technical support to health facilities and share performance on a daily basis.

Throughout this shift, PATH teams have helped the government to assess its approach and determine what additional trainings, system enhancements, and continued monitoring and evaluation may be needed. Based on lessons from Tanga and these two new regions that began the transition to paperless on June 1, the Ministry of Health will then develop practical step-by-step guidelines to be used by existing and future regions when undergoing their own transition process.

Many frontline health workers have already begun to notice the benefits. Magena Rahel, a health worker at Kiliwi Dispensary in Mwanza was bursting with excitement as her district immunization vaccine officer delivered news about the switch.

Hers is one of the busiest and most remote facilities. She sees about 50 children each day for vaccination. Immunization is made more difficult by the fact that many communities in the district live nomadically—traveling seasonally for water, pasture, and farming lands. During this period, her team must use mobile services to reach its patients, track defaulters, and identify zero-dose children.

“There are times that there is only one health worker at the clinic on a busy day which makes it hard to record [immunization data] correctly on two systems”, she said.

Rahel was therefore happy to have a single digital system to record vaccines and notify them about stock levels and patients who are due for upcoming immunizations. They no longer have the laborious, time-consuming process of manual and dual record keeping.

“Tanzania continues to learn from this process and has a lot to share with the global and regional community, as other countries continue to integrate digital tools into their health systems,” said Mtenga.

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