As technology has become cheaper and more accessible, health programs are adopting digital health interventions (DHI) to improve the provision of and demand for health services. These interventions are complex and require strong coordination and support across different health system levels and government departments, and they need significant capacities in technology and information to be properly implemented. Electronic immunization registries (EIRs) are types of DHI used to capture, store, access, and share individual-level, longitudinal health information in digitized records. The BID Initiative worked in partnership with the governments of Tanzania and Zambia to introduce an EIR at the sub-national level in both countries within 5 years as part of a multi-component complex intervention package focusing on data use capacity-building. We aimed to gather and describe learnings from the BID experience by conducting a framework-based mixed methods study to describe perceptions of factors that influenced scale-up of the EIR. Read the full article in Implementation Science Communications.
Pakistan, Zambia, and Kenya are among a growing number of countries implementing electronic immunization registries (EIRs) to improve data quality and health facility performance. But EIRs can be costly to design and introduce. This case study explores the localization and adaptation of OpenSRP’s immunization module, the benefits of iterating on open-source software, and lessons learned during use in Pakistan, Zambia, and Kenya.
Between 2013 and 2018, BID designed, developed, and introduced an electronic immunization registry in three regions in Tanzania and one province in Zambia. The Initiative’s financial records were used to account for the financial costs of designing and developing the EIRs, BID staff time, expenditures for rolling out the EIR systems and the related suite of interventions to health facilities, and recurrent costs. Total financial costs, cost per facility and cost per child were calculated in 2018 US$. By documenting the costs associated with introducing an EIR, BID hopes to help other countries introduce more affordable platforms for their own health landscapes. Read the full article in BMJ Global Health.
Since 2016, the Government of Tanzania has been implementing TImR, an integrated Electronic Immunization registry-logistics management information system (EIR-LMIS) that includes stock notifications. Working in close partnership with the Government of Tanzania, PATH conducted a study to estimate the impact of this intervention on vaccine availability. The findings of this study were published in Vaccine.
The governments of Tanzania and Zambia identified key data-related challenges affecting immunization service delivery including identifying children due for vaccines, time-consuming data entry processes, and inadequate resources. To address these challenges, since 2014, the countries have partnered with PATH’s Better Immunization Data (BID) Initiative to design and deploy a suite of data quality and use interventions. Two key aspects of the interventions were an electronic immunization registry and tools and practices to strengthen a culture of data use. As both countries deployed the interventions, three distinct changes in data use emerged organically. This article provides a detailed summary of these three phases or waves, based mostly on qualitative data or observation: (1) strengthening data collection using new data collection tools and processes and increasing efficiency of health workers; (2) improving data quality regarding accuracy and completeness; and (3) increasing use of data to take action to strengthen their work and for programmatic decision making. These waves clearly demonstrated the growing ability of health workers to move from data collectors to data analyzers who began to focus on the data quality and then the value of using the data in their day-to-day activities. For the full article, visit Global Health: Science and Practice.
As part of the work the BID Initiative undertook starting in 2013 to improve countries’ collection, quality, and use of immunization data, PATH partnered with countries to identify the critical requirements for an electronic immunization registry (EIR). An EIR became the core intervention to address the data challenges that countries faced but also presented complexities during the development process to ensure that it met the core needs of the users. The work began with collecting common system requirements from 10 sub-Saharan African countries; these requirements represented the countries’ vision of an ideal system to track individual child vaccination schedules and elements of supply chain. Through iterative development processes in both Tanzania and Zambia, the common requirements were modified and adapted to better fit the country contexts and users’ needs, as well as to be developed with the technology available at the time. This process happened across four different software platforms. The BID Initiative recently published a paper to Frontiers in Public Health that outlines the process undertaken and analyzes similarities and differences across the iterations of the EIR in both countries, culminating in the development of a registry in Zambia that includes the most critical aspects required for initially deploying the registry and embodies what could be considered the minimum viable product for an EIR. Read the full article in Frontiers in Public Heath.
Vaccine coverage is routinely used as a performance indicator for immunization programs both at local and global levels. For many national immunization programs, there are challenges with accurately estimating vaccination coverage based on available data sources, however an increasing number of low- and middle-income countries (LMICs) have begun implementing electronic immunization registries to replace health facilities’ paper-based tools and aggregate reporting systems. These systems allow for more efficient capture and use of routinely reported individual-level data that can be used to calculate dose-specific and cohort vaccination coverage, replacing the commonly used aggregate routine health information system data. With these individual-level data immunization programs have the opportunity to redefine performance measures to enhance programmatic decision-making at all levels of the health system. In this commentary, we discuss how measures for assessing vaccination status and program performance can be redefined and recalculated using these data when generated at the health facility level and the implications of the use and availability of electronic individual-level data. Read the full article in Vaccine.
The BID Initiative is committed to sharing its learnings with others interested in improving immunization data quality and use. The following series of briefs summarizes our work alongside the governments of Tanzania and Zambia and our lessons and recommendations spanning seven key subject areas.
Mott MacDonald conducted an independent evaluation of the BID Initiative with the aim of verifying and explaining results and identifying lessons learnt. This report presents a synthesis of findings from successive milestone evaluations. Full reports for each of these evaluation exercises are included as annexes. This report also includes findings from a special study in Dodoma Region to assess the effectiveness of an alternative rollout strategy.
Mott MacDonald conducted an independent evaluation of the BID Initiative with the aim of verifying and explaining results and identifying lessons learnt. This presentation is a synthesis of key findings from successive milestone evaluations, including a special study from Dodoma Region.