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Using electronic immunization registry data to demonstrate the value of digital systems

By Emily Carnahan, Monitoring, Evaluation, and Learning Manager and Hassan Mtenga, Country Lead, BID Initiative Tanzania

Sep 23, 2020

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Photo: Bill & Melinda Gates Foundation/Riccardo Gangale. Clinical officer Caroline Agade advises mothers on vaccinating their children at the Green Hope Sispensary in Arusha, Tanzania.

This is the second in a two-part blog series about the BID Analytics portfolio, which will use electronic immunization registry data to consider how the data captured by these digital systems can help address immunization program barriers.

A growing number of countries have embraced electronic immunization registries (EIRs) that enable data-driven decision-making. To better shape the value proposition for countries using or considering using EIRs, the BID Initiative has started a new scope of work led by a global BID Analytics team that will use data from the digital systems in Tanzania. The work builds on previous landscaping and stakeholder conversations held in late 2019 and early 2020, to summarize common immunization barriers and the EIR features that help respond to these challenges.

“After landscaping many potential ways EIRs can add value for immunization programs, we solicited input from immunization leaders and ministries of health to prioritize a subset of topic areas for further research,” explained Emily Carnahan, a PATH Monitoring, Evaluation and Learning (MEL) manager leading this new portfolio of work. “Using EIR data, we’ll analyze the individual-level data from these systems to better understand how they can be used to improve immunization outcomes. These analyses could inform other data dashboards, performance indicators, and features of EIRs.”

Based on a prioritization exercise that included key informant interviews and surveys with key stakeholders, the BID team arrived at four topic areas:

Denominators and population movement: Accurate denominator data is critical for immunization programs to understand how many patients they must serve in their catchment areas. Health workers must also understand how children move between health facilities. This information can help to prevent children from being lost to follow-up and better plan for outreach. BID will conduct analyses to better understand how many children receive immunization services at multiple health facilities, what factors are associated with children moving between facilities, and how these movements affect immunization coverage calculations by facilities, as well as how they can be factored into vaccine stock requests more accurately.

Missed opportunities for vaccination: Missed opportunities for vaccination (MOV) refers to a patient, who is eligible or overdue for a vaccine, who has made contact with health services but not received the vaccine he or she is eligible for. Understanding and addressing the root causes for MOVs can enable immunization programs to increase vaccination coverage by making better use of existing vaccination sites. BID will analyze data about where MOVs occur, how frequently, and what types of facilities, providers, and patients are associated with these missed opportunities. The results will help to inform strategies for preventing future MOVs.

Continuum of care: A successful immunization program ensures that children receive their full course of vaccines without delays or dropping out. But there are still many unknowns about what factors contribute to children defaulting. Understanding these variables has taken on renewed importance under COVID-19. BID will conduct analyses about how many children default, when they do, and if there are certain patient characteristics or geographic factors associated with defaulters.

Continuous quality improvement: In this context, continuous quality improvement (CQI) refers to an iterative, data-driven process of empowering health care workers to improve health service delivery. Data captured within an EIR can support CQI approaches. BID will analyze data from Tanzania’s EIR to identify issues or challenges that can inform a CQI approach. For example, BID will explore trends, consistencies, or outliers in coverage and dropout rates by facility, and whether data quality and service delivery challenges are concentrated in certain facilities. EIR data can then be used to provide more targeted supervisory support and quality improvement for health facilities struggling to adopt the new system.

BID is collaborating with immunization program leaders in Tanzania on the design of the analyses. Throughout the analyses, BID will apply an equity lens, for example to understand if there is an inequitable distribution of MOVs, or if some children are more likely to experience a MOV. BID will also consider the impacts of COVID-19 on service delivery to understand, for example, whether population movement between facilities has changed during the pandemic.

After conducting the analyses, BID will share results with immunization program leaders in Tanzania so they can collaboratively learn from the findings. The results of these research priorities have important implications beyond Tanzania, to help immunization leaders understand how the digital platforms may solve remaining service delivery challenges. Learnings will be shared through a BID Learning Network webinar and published in a journal article to contribute to the global learning agenda for EIRs.

Are there specific questions you have related to the above research topics? What would help you understand the value of EIRs? We’d love to hear from you! Comment below or email bidinitiative@path.org with your questions or ideas.

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