Developing What Works Best
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The BID Initiative Story


Aziza Ahmed Seif

Health Worker Perspective

“Mothers see the change and they’re happy with the improvements to service delivery and the more time they have with nurses.”

In March 2018, Aziza Ahmed Seif and her fellow nurses at the Mikanjuni Health Center in Tanga, Tanzania, made history. They, along with workers at 32 other health facilities in Tanga, retired the thick paper immunization registers they had spent their entire nursing careers using and embraced a digital system that places a universe of data at their fingertips. They traded pen and paper for a tablet framed by colorful data visualizations, swapped crowded tally sheets for a simplified stock management module, and replaced the long evenings of record-keeping that used to characterize immunization clinics with a series of automated reports.

Going paperless

Mikanjuni is one of more than a thousand health facilities in Tanzania that have embraced data quality and use interventions, ranging from the Tanzania Immunization Registry (TImR) to behavior change campaigns focused on a culture of data use and bar codes on child health cards to uniquely identify patients.

Mikanjuni sees between 20 and 24 children each day, or approximately 100 children each week. This can lead to long queues, with patients sometimes waiting several hours before seeing a nurse. Adding to their workload, health workers have historically relied on paper records to determine which vaccines patients have received, and when. But the dizzying array of data—birth dates, the number of vaccine vials on hand, and projected patient volumes—was overwhelming. If a patient missed a vaccine, it was often lost in this sea of numbers.

“Sometimes you’d forget to tally everything, because there were so many registers,” remembers Aziza. “Missing a record used to lead to a reporting disaster at the end of the month. The burden was too great when the nurse at the clinic didn’t know how the registers were filled, or if she misplaced the record.”

Several missed tallies might result in incorrect reporting and lower stock estimates, resulting in stockouts and a child potentially missing a lifesaving vaccine.

“Mothers see the change”

Today, Aziza has mastered TImR and can adeptly navigate its different dashboard functions.

At the beginning of each work day, she checks to make sure her tablet is fully charged, consults her vaccine stock balance and the number of patients she expects to see that day, and then turns her attention to the mothers and infants who often trek miles for a check-up or vaccine.

“Mothers see the change,” explains Aziza, “and they’re happy with the improvements to service delivery and the more time they have with nurses.”

Aziza no longer feels like she’s at the mercy of this complex and unwieldly data. If, for instance, a patient doesn’t show up for an expected vaccine, she can pull up their caregiver’s mobile number in TImR and call them directly. If Aziza enters a patient’s weight and finds that they are underweight, a pop-up message appears on her tablet screen.

“It immediately tells you if the child is normal, under or overweight, which then [helps me] to start a discussion with the parent,” she explains.

Because she can pull up patient records in seconds and update them in real time, Aziza can now slow down. She takes her time with patients—carefully reviewing each child’s growth chart and tracing their progress, as she explains their nutritional status to their mothers, and when they are next due for a vaccine.

In short, Aziza now has more time for what she loves most—caring for the patients who pass through her clinic.