Tanzania makes history as first facilities retire paper immunization registers
By Celina Kareiva, Communications Associate, BID Initiative and Saumu Juma, Communications Associate, BID Initiative Tanzania
Apr 25, 2019
Posted in Policies & Practices
Photo: PATH/Trevor Snapp. A health worker consults immunization data on his tablet at Mareu Health Center.
Aziz Seif Ahmed works as a reproductive and child health nurse in Mikanjuni health center, one of the busiest clinics in Tanga municipal council, vaccinating about 370 children a month. Each month, Aziza used to spend more than 10 hours compiling and completing monthly immunization reports, and more or less the same number of hours compiling and completing child health monthly summary reports in the HMIS Book 7 to report to DHIS2. She often worked evenings and weekends to cross-reference stock ledgers, meticulously count opened vaccine vials, add tallies, and then carefully inscribe the information. It was a pain-staking process and just a few human errors from her miscalculations or the inaccurate recording of data might have serious consequences. This sometimes translated into insufficient vaccine stock and required that Aziza turn patients away for lifesaving vaccines.
So when Aziza’s was among the first health facilities in Tanzania to transition to a fully-digital immunization system, she was excited by the possibilities. Earlier this month, the government of Tanzania further cemented its leadership in digital health as it celebrated a historic milestone in its quest to improve health outcomes with better data. Eighty six health facilities in Tanga have shifted to a paperless immunization system since October 2018, with plans to transition all 332 health facilities in the region this July. While significant lessons and performance improvements have been seen in the 86 health facilities, the government felt the need to have a much bigger scope of experimentation, particularly when it came to integrating with DHIS2, to inform the paperless transition process and guidelines at scale.
Though data quality and use interventions were first rolled out in July 2017 in Tanga, facilities had been required to use both paper and digital systems side-by-side until recently. The dual systems allowed BID and the government to resolve system bugs, demonstrate the effectiveness of the Tanzania Immunization Registry (TImR), and develop a plan for the transition. The government of Tanzania, in partnership with BID, is experimenting with the process of going paperless in all 332 health facilities in Tanga Region for a full reporting quarter, or April through June. The government has chosen a three-month period to compare the performance of health facilities against preceding quarters in line with DHIS2 reporting requirements.
Tanzania is applying a phased approach to this historic milestone, and after June will compare a series of performance indicators from before and after the paperless process. Interviews will also be conducted with health workers about their experiences and recommendations for the transition process. This assessment will inform how other regions should approach the paperless transition process by helping to define guidelines and challenges that must be addressed through software enhancement, human resource capacities, implementation, and monitoring and evaluation.
Though too early to draw conclusions, it’s clear that those facilities that have shifted to paperless have so far performed better than those still maintaining the parallel reporting system.
“I feel more empowered. I can easily monitor my performance and have a more informed conversation with my boss in terms of vaccine needs, clients that I serve and those who missed the opportunity to be vaccinated. I no longer spend time compiling monthly reports, as the system helps me to do that,” says Aziza. “My role now is to make sure that I accurately record every child I serve so that at the end of the day the data in the system speaks to my actual performance.”
Health workers and caregivers are already taking notice. “Mothers see the change, they now receive SMS notifications if they do not bring their children to immunization on time” explains Aziza, “and they’re happy with the improvements to service delivery and the more time they have with nurses.”
This is another significant milestone for the government of Tanzania, says Hassan Mtenga, Country Lead Health System Strengthening Project.
“Normally the value of digital solutions are understated when operating in parallel with traditional reporting systems because of the opportunity cost of using digital over the paper system, in terms of performance evaluation,” explains Hassan.
This milestone will enable the government to see and evaluate digital transition at a much larger scale and will help the government understand the true value of adopting digital solutions to improve health delivery in the country.