Vietnam’s Digital Immunization Registry: Important lessons and parallels to BID Initiative
By Nguyen Tuyet Nga, Vietnam Program Director and Celina Kareiva, Communications Associate, BID Initiative
Apr 20, 2017
It used to take Ms. Linh more than a day to generate a list of immunization patients at the Phu Hung Commune Health center in southern Vietnam. Ms. Linh was responsible for manually entering each name and record into paper registers before personally delivering invitation letters for the upcoming clinic. These days, it takes a fraction of that time – just 15 minutes on the computer.
“It was costly and time-consuming for health workers,” remembers Dr. Nguyen Tuyet Nga, Vietnam program director at PATH. “And sometimes these paper letters never reached parents, or the parents would forget they were due for a clinic visit.”
By 2008, Vietnam had reached national immunization coverage rates of over 95 percent for all EPI vaccines except Hepatitis B birth dose, but many health facilities faced stock shortages, reporting errors, and challenges with on-time vaccination. Without an accurate understanding of its target population, calculations were often based on estimates and disguised important inequities in rural and poor parts of the countryside.
Fortunately those trends are reversing, thanks to an ambitious system that greatly reduces the time and costs associated with local routine immunization programs.
In 2012, PATH began working with Vietnam’s National Expanded Immunization Program (NEPI) to improve coverage rates by developing and testing a digital registry called ImmReg, a software application to track the vaccine status of women and children in Vietnam’s Ben Tre Province, and a vaccine tracking tool, VaxTrak. In five years, ImmReg and VaxTrak, grew from a district-level pilot to a central piece of the country’s health system, as part of the National Immunization Information System (NIIS) launched last month by the Deputy Prime Minister. Its success demonstrates the demand and potential for quality, accurate data to improve health outcomes. It also presents telling parallels to the BID Initiative’s efforts in Tanzania and Zambia.
“ImmReg and VaxTrak showed how comprehensive digital systems could not only reduce the burden for community health workers,” says Nga, “but also increase immunization coverage, especially for the on-time delivery of essential vaccinations for children under one year of age.”
Despite the different health contexts and thousands of miles separating the two initiatives, ImmReg has lessons directly applicable to the BID Initiative:
- Country-owned, country-led: Support at the national level was critical to the success and expansion of ImmReg. Like BID, ImmReg prioritized country ownership, allowing the MOH to establish the timeline and scope of the program, and to define system requirements so that ImmReg was relevant and usable to health care workers (HCWs) at all levels of Vietnam’s health structure, as part of the NIIS.
- Ensuring health leader buy-in: The idea of a digital registry was initially met by skepticism and, in some cases, resistance by health workers. Older HCWs, many of whom had never used a computer before, were anxious to leave behind a paper system they depended on their entire careers. Anticipating their fears, PATH identified local health leaders, who could advocate on behalf of ImmReg. Their buy-in helped ensure support for the digital registry.
- Building a foundation for sustainability: Staff turnover is high among Vietnam’s health workforce and PATH knew that training was integral to the scale-up of ImmReg. At least two staff were trained from each commune or township, one of whom was required to have had past experience with computers. Rather than training huge swaths of end users, this training-the-trainer method, built local technical support.
- Vaccines and beyond: Like BID, immunization may be a point of entry for ImmReg and the NIIS, but the MOH has ambitious plans to scale to other parts of the health sector. Later this year, PATH will support the MOH and Viettel to incorporate nutritional indicators into the NIIS. Since health workers are also responsible for weighing and measuring children at the same time that they administer vaccines, incorporating these metrics presents a natural extension of the system.
The potential of ImmReg to have impact throughout Vietnam’s health system was clearly apparent. ImmReg was demonstrated to lead to significant time-savings, transforming report generation from a 20-minute process to a 2-minute task. In a final evaluation of the project, on-time delivery of vaccines was shown to increase by 20 percent across 164 health centers in Ben Tre Province. Early registration also improved. Newborns are now registered an average of 8.5 days after birth, compared to 33.4 days before the rollout of the digital registry. PATH estimates that switching to a system of SMS text message reminders, instead of paper invitations, could save the Vietnamese government USD 673,000 annually if scaled up nationally. This evidence led to the MOH integrating ImmReg and VaxTrak into the NIIS, through a collaboration with Viettel, one of the biggest telecommunications companies in Vietnam.
As the BID Initiative enters its final year, Vietnam offers a case study in how data can revolutionize primary health care. Like BID, ImmReg, as it has evolved into the NIIS, prides itself on being entirely owned and championed by local government and its recent expansion positions Vietnam as a global leader in digital health.