Developing What Works Best
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The BID Initiative Story

Scale-up & Sustainability

Scale-up & Sustainability
2017 - 2018

Driving scale-up and ensuring sustainability

As the BID Initiative draws to a close, there is still far more work ahead than behind. We’re expanding our efforts in Tanzania and Zambia through government and global partnerships and engaging the BLN regional work by sharing tools and approaches that will be useful for improving data quality and use around the world.

In Tanzania, rollout was completed by mid-2018 in the Arusha, Tanga, Kilimanjaro and Dodoma regions, and data on more than 400,000 children were entered into the immunization registry since BID began. Each subsequent rollout presented different health landscapes, demographic compositions, and challenges, and implementation across the three regions represented significant progress toward the goal of nationwide scale-up and country ownership.

In Zambia’s Southern Province, the BID Initiative successfully introduced and quickly scaled up ZEIR, thanks to the enthusiasm of health workers across the province. Data on more than 96,000 children have been entered in ZEIR.

From the earliest days, BID has been committed to seeing data quality and use interventions applied to other health areas and countries. BID will continue to support the scale-up of interventions in Tanzania and Zambia and plans to help other countries as they deploy similar data use interventions to improve health outcomes.

Defining and building a data use culture

Transitioning to a fully digital system in Tanzania

In October 2017, the government of Tanzania announced their commitment to the BID Initiative with plans to transition to a paperless immunization information system. Through a phased approach, health facilities will eliminate the use of paper tools, such as child register books and monthly report forms, and shift to a fully digital system. Previously, health workers used traditional paper records in parallel with the new electronic registry, increasing their workload and making it difficult for them to really feel the impact of the interventions.

Tanzania has also committed Gavi funds for health system strengthening to scale up data quality and use interventions to the equivalent of ten additional regions in 2018 and then national scale in 2019. Gavi funding for targeted country assistance will enable PATH to provide technical support for these regions and continue to build national capacity for long-term sustainability.

“I’m very optimistic that we can achieve a greater benefit when the [electronic immunization] system is used countrywide, rather than just pockets of the country.  The burden of data collection, accessing, analyzing, and reporting has gone down drastically in the regions using the systems and we believe we can still achieve more if we put more efforts into it. That is why the ministry has committed to scale the interventions using its own resources and resources from our development partners. No child should be deprived from the gift of vaccine and no health care worker should be deprived of her/his personal or family time just because of the need to do data entry or compile monthly reports.”

- Dr. Dafrossa Lyimo, Program Manager for Immunization and Vaccine Development, Tanzania

Expanding interventions with country partners

Data quality and use interventions must be scalable and able to be implemented long after the BID Initiative draws to a close. We are pleased to see these partnerships already taking shape with, for instance, John Snow, Inc. (JSI). BID is partnering with JSI to roll out TImR in Dodoma Region in 2018.

In 2017, the BID team forged a partnership with the Catholic Mission Medical Board (CMMB) to expand interventions in Zambia. We subsequently trained CMMB staff so they could deploy the BID data quality and use interventions, including ZEIR, to Zambia’s Western Province. By the end of 2017, nine facilities in Western Province were using the system. The BID team provided remote support and system monitoring for introduction.

With anticipated support from global funders, PATH will provide additional technical support to Southern Province and build capacity at the national level for long-term sustainability and for further work to optimize immunization systems. Additional interventions include the connection to a UNICEF mobile app for collecting home birth information and sending vaccination reminders, the potential for links to a tool for managing vaccine stock, and supply chain delivery redesign.

Adapting BID tools for use in Kenya

The BID Initiative represents a radical shift away from the current paradigm for many digital health interventions—data streams that don’t communicate with the existing health system, software codes hidden behind proprietary black boxes, and technologies that repeat the missteps that came before them. To avoid duplicating efforts, BID is committed to sharing its learnings with other countries interested in implementing data quality and use interventions.

In this spirit, BID and the International Training and Education Center for Health (I-TECH) began collaborating in December 2016. I-TECH localized ZEIR for use in Siaya County, Kenya, and then introduced the tool. The partnership demonstrated that, despite differing health landscapes and immunization programs, data quality and use solutions could be easily and cost-effectively adapted for use in other countries and contexts in sub-Saharan Africa.

Recommendations and lessons learned: Sustainability

Total cost of ownership

“[Our partnership with I-TECH] is the core of the BID Initiative’s theory. Effective electronic immunization registries have to be adapted to a country’s context and specific needs. Each time you do that, it becomes less and less of a financial investment for future countries.”

– Laurie Werner, Global Director, BID Initiative

Planning and costing guide for digital interventions

In 2018, the BID team, in partnership with the WHO, is disseminating a new toolkit for ministerial program managers, decision-makers, and implementers. This toolkit will function as a practical, comprehensive, step-by-step guide on how to select, plan for, cost, and implement digital health interventions aligned with specified health needs, appropriate to the country context and state of maturity, and linked to the broader architecture of existing digital health systems.

Available in both print and digital versions, the toolkit links to WHO’s classification of digital health interventions and associated guidelines, integrated with BID best practices and case studies. It allows users to support a facilitated planning process resulting in a costed proposal that can be submitted to a funder or Ministry of Finance.

Building on the work of the BID Initiative

We continue to build on the BID Initiative work through projects such as Immunization Data: Evidence for Action (IDEA). PATH, in partnership with the Pan American Health Organization (PAHO), is working with several global partners, including representatives from the Government of Tanzania and Zambia, CDC, WHO, AFRO, UNICEF, Gavi, and others, to collect, synthesize, frame, and share evidence-informed learnings and best practices to improve immunization outcomes through improved data quality and use.

The IDEA project is already underway and the learnings and best practices will be available in 2018.