Developing What Works Best
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The BID Initiative Story


Dr. Tove Ryman

Funder perspective

“For me, it always comes back to the experiences of the health care workers. They’re on the front lines, vaccinating children day in and day out. So, I always ask myself and others: How can we ensure that they’re empowered to do their best job, and positioned to succeed?”

With the tap of her finger, Neema Temu can easily toggle between two estimates of immunization coverage within her catchment area. A health worker at Monduli Hospital in Arusha, Tanzania, she cheerfully demonstrates her new electronic immunization registry to Dr. Tove Ryman—Senior Program Officer at the Bill & Melinda Gates Foundation and technical lead of the BID Initiative.

Where Neema could once only estimate the number of children in her area using outdated census data, thanks to BID, she can now also evaluate immunization coverage based on the number of children registered at birth in her catchment area. The result: a much more accurate picture of her progress as a vaccinator. And, as she stated during Dr. Ryman’s February 2017 visit, the two coverage estimates paint divergent pictures of her progress. One gives her the false impression that she’s doing a great job, missing very few kids. The more accurate BID data provide a more sober assessment, with still too many kids going unimmunized.

For Dr. Ryman, this interaction marked a pivotal moment—one where her work to bring better immunization data to low-resource settings started to materialize in a tangible way. And it proved that, not only were the data quality and use interventions spearheaded by BID and country governments feasible, health workers had begun to embrace them as well.

“Despite having only used the electronic immunization registry for a few weeks, Neema was comfortable with it and the data it generated,” Dr. Ryman recalls. “It’s evidence of what’s possible.”

Helping health workers on the front lines

Events in the past year have only furthered that notion. The success of BID’s early interventions demonstrated that they may be ready for large-scale implementation in Tanzania, and likely Zambia in the not-too-distant future. The partnerships that have developed with JSI, UNICEF, and Gavi are further driving the enthusiasm and ownership of the initiative. And Dr. Ryman has had even more conversations with frontline health workers learning to apply the data quality and use interventions. While some workers were initially skeptical, and others struggled with the technology, most were excited by its potential to ease their workload and improve immunization service delivery.

Dr. Ryman stated, “For me, it always comes back to the experiences of the health care workers. They’re on the front lines, vaccinating children day in and day out. So, I always ask myself and others: How can we ensure that they’re empowered to do their best job, and positioned to succeed?”

In July 2017, Dr. Ryman had the opportunity to accompany Bill Gates to Ngamiani Health Centre in Tanga, where health care workers were using the BID interventions. There, she encountered another inspirational vaccinator named Millen Simon, who demonstrated her use of the Tanzania Immunization Registry (TImR) with such competence and enthusiasm that she was asked to do the same for local media in the capital of Dar es Salaam.

Despite the relatively quick uptake of BID interventions by health care workers, Dr. Ryman admits that it has not always been an easy journey.

“The development of the electronic immunization registries in both Tanzania and Zambia presented more challenges than we initially anticipated. We thought the technology would be the easy part. However, we came to appreciate that transitioning to an electronic system was a complex process. Thankfully, our team and network of partners persevered through the challenges and made sure we course-corrected where necessary to meet the needs of both frontline health workers and government stakeholders.”

Dr. Ryman continued, “With implementation well underway, I’m optimistic that Tanzania is on the path to scale and that Zambia could soon follow. Many health workers using TImR are currently facing an increased workload while also using the duplicative paper system. The transition to a paperless system in Tanzania is a huge milestone and an exciting opportunity to realize the potential benefits of a fully digital system.”

Looking ahead: A data revolution for the not-too-distant future

Without question, BID’s successes to date are worthy of celebration. But bigger successes are yet to come. The initiative is opening new possibilities for how Expanded Programme on Immunization (EPI) managers can think about data quality and use, and how better use of data can inform immunization program management. And the initiative is using the BID Learning Network (BLN)—an Africa-led, member-owned and peer-to-peer network—to provide opportunities for other countries with ambitions to improve their immunization data. The BLN has already helped countries like The Gambia to determine a best-fit electronic immunization system.

In the meantime, Dr. Ryman has already begun to train her sights on how the initiative can further expand to other countries, integrate into other programs and serve as a catalyst to boost equity measurement work. With a smile, she said “We’re just starting to see the potential.”