Tanzania and Vietnam forge South-South learning exchange to advance electronic immunization systems
By Sang Dao Dinh, Program Officer, Mekong Regional Program, PATH
Jul 19, 2018
Last month, PATH’s Vietnam office and delegates from the country’s Ministry of Health had the opportunity to learn from the BID Initiative in Tanzania. The learning exchange is part of a new South-South partnership forged between two countries implementing electronic immunization registries (EIR). To date, BID and the government of Tanzania have rolled out to four regions, with ten more planned for 2018. In Vietnam, PATH’s pilot EIR, called ImmReg, was first developed and tested in 2012, before expanding into the National Immunization Information System (NIIS), which was launched in 2017. Last month’s visit was a chance to deepen this partnership and trade lessons about the challenges and successes of securing government buy-in and building health system capacity for EIRs.
The Vietnam team was composed of Mr. Tran Huu Quang, Chief of Cabinet at the General Department of Preventive Medicine, Dr. Vu Hai Ha, Expanded Program on Immunization Officer at the National Institute of Hygiene and Epidemiology, and myself. Throughout our study visit, we experienced the full spectrum of digital potential. In Dar es Salaam and Tanga, we visited four facilities, each at varying phases in rollout. The first facility, Magomeni Health Center, serves hundreds of patients weekly but has not yet begun use of the Tanzania Immunization Registry (TImR). Health workers still use thick immunization registers to record vaccine data, a tedious process that can lead to inaccurate, incomplete, and untimely data. Mikanjuni, the second health facility we visited, had been using TImR since July 2017, alongside the legacy paper-based system. Though maintaining the two parallel systems could be time-consuming, health workers toggled between them and TImR made it easy to detect when information was missing or incorrect. In the third facility we visited, Nkumba Health Facility, health workers had fully transitioned to a paperless system, retiring paper records in favor of a dashboard that enabled them to efficiently monitor current stock balances, track defaulting patients, and register new children in the system.
There were many lessons and takeaways from the recent study visit. We learned, for instance, about Tanzania’s phased transition to a paperless system in select health facilities in Tanga, and about the integration of TImR with the Vaccine Information Management System (VIMS), which allows for end-to-end visibility into the vaccine supply chain.
We were particularly excited to see TImR’s offline functionality, which automatically syncs when internet is available. This ensures seamless functionality of the system, so it is not reliant on an internet connection and electricity to operate. We were also inspired by the use of barcodes on child health cards. They provide unique identification for children and help track patients when they visit other health facilities for vaccination, to avoid duplication.
BID also had a chance to learn from Vietnam. We shared our nationwide scale-up experience with Dr. Dafrossa Lyimo, Program Manager for Immunization and Vaccine Development. During that meeting, we provided several recommendations, including:
- The government of Tanzania should consider issuing a policy requiring compulsory use of the EIR to register newborns, update, and record vaccine data.
- BID and the government of Tanzania should document lessons learned from its shift to paperless in select health facilities, and share with other facilities and countries undergoing a similar process.
- The government of Tanzania could save on equipment costs by designing child health cards with the barcode incorporated, so they do not require separate, specialized printing. It could also work with a developer to design tablets that use the device’s camera to scan barcodes, so they do not require external scanners.
- Tanzania should consider using SMS reminders to increase on-time vaccination. Partnering with mobile network operators might help to reduce the costs associated with a SMS system.
Despite our different health contexts and challenges, Vietnam and Tanzania have much to learn from each other as they both work to scale up their respective EIRs. This month, Vietnam will begin to transition to a fully paperless system. We also hope to host the BID Tanzania team in Vietnam in the next few months. This is the beginning of an exciting partnership that we hope will have far-reaching benefits for the global immunization and digital health communities.