In a world with dynamic population movements, outbreaks with cross-border implications, and increasingly politicized health issues, linear and inflexible approaches to global health programs are ineffective. Adaptive management has emerged as one possible approach that embodies iteration and adaptability in program design and implementation to help with navigating complex and dynamic environments. Real-time data systems can strengthen adaptive management by generating data that can more rapidly inform tactical adaptations, changes, and future planning. This white paper challenges traditional project management in the global development sector. It encourages donors, policymakers, implementers, and ministries of health to set a new precedent of adaptive programming.
Digital health innovations can improve health system performance, yet previous experience has shown that many innovations do not advance beyond the pilot stage to achieve scale. Vietnam’s National Immunization Information System (NIIS) began as a series of digital health pilots, first initiated in 2010, and was officially launched nationwide in 2017. The NIIS is one of the few examples of an electronic immunization registry (EIR) at national scale in low- and middle-income countries. This qualitative study explored the facilitators and barriers to national scale-up of the EIR in Vietnam. Qualitative data were collected in 2019 through in-depth key informant interviews and desk review. The results highlight the importance of the measured, iterative approach that was taken to gradually expand a series of small pilots to nationwide scale. The findings from this study can be used to inform other countries considering, introducing, or in the process of scaling an EIR or other digital health innovations.
As more countries transition from paper-based to electronic immunization registries (EIRs) to collect and track individual immunization data, guidance is needed for successful adoption and use of these systems. Little research is available on the determinants of EIR use soon after introduction. The BID Initiative published an observational study assessing the determinants of facility health care workers’ use of new EIRs in Tanzania and Zambia. The results highlight the importance of organizational and behavioral factors in explaining sustained EIR use. Read the full manuscript in Global Health: Science and Practice.
Poor data quality and use negatively impact immunization programs in low- and middle-income countries (LMICs). In addition, many LMICs have a shortage of health personnel, and staff available have demanding workloads across several health programs. In order to address these challenges, the BID Initiative introduced a comprehensive suite of interventions, including an electronic immunization registry aimed at improving the quality, reliability, and use of immunization data in Tanzania and Zambia. BID conducted a micro-costing study to estimate the economic costs of service delivery and logistics for the immunization programs with and without the BID interventions in a sample of health facilities and district program offices in each country. The full article can be found in the Pan African Medical Journal.
Vietnam’s immunization registry system prior to 2009 was a paper-based logbook that was prone to errors, time-consuming, and burdensome for health workers. Starting in 2009, the Vietnam National Expanded Program on Immunization (NEPI) and their partner PATH began visualizing the possibilities and benefits that a national-scale electronic immunization registry (EIR) and vaccine-stock-management system could bring to
Vietnam. In 2017, the National Immunization Information System (NIIS)—a sustainably planned, government-run, nationwide EIR system—was officially launched along with national mandates on system use. Much of the success of the scale-up of the Vietnam EIR can be attributed to three key factors: (a) planning for scale from the beginning, (b) commitment from the government, and (c) technical partnerships. The story of scaling up, however, did not come without challenges and hurdles. This case study reviews Vietnam’s journey from district pilot to national-level EIR.
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.