Investment in Immunization Information: A Sure Shot at Impact
By Dr Orin Levine
I recently traveled to Tanzania to see how health workers use data to boost child vaccination rates. These facts and figures—often captured via hasty penciling in a thick register by overburdened health workers—do not inherently feel life-saving. They don’t even sound like they would make for an interesting travel story.
But, in global health, these registers track the journey of a vaccine across a country (or countries) to a rural village. They measure a vaccine’s temperature, carefully monitoring whether it gets too hot or too cold to remain effective. And in the form of names scribbled down or boxes checked, they mark the key moment when a child receives a lifetime of protection against a deadly disease.
Once we consider the vital details it contains, data does not feel as dry or boring. We come to appreciate it as pivotal to addressing Africa’s stubbornly flat immunization rate of around 77 percent. Better record-keeping helps us find children who have not been reached or reach those who “dropped out” between doses, and ensures we have the right number of vaccines at the right time in the right place. This formula is the basis for the Better Immunization Data (BID) Initiative, a new partnership from the Seattle-based organization PATH that empowers countries to improve the collection, quality and use of immunization information.
Tanzania’s program has improved steadily under the leadership of EPI manager Dr. Dafrossa. She explained to me how in recent years Tanzania had increased vaccine coverage to over 90 percent, introduced many new vaccines, and now with the BID Initiative, she wants to increase the efficiency of the program and help her health care workers do their jobs more effectively. So I went to the Arusha region of Tanzania to see the BID Initiative in action.
In both Tanzania and Zambia, the BID Initiative is working with government officials toward exactly that goal. Here are three themes I observed in health centers across the Arusha region:
1. Country-owned, country-led solutions will lead to long-term improvements.
In BID the solutions come from frontline workers, not international experts. Health workers know what takes up their time and what would help them work more efficiently. So, the BID Initiative establishes User Advisory Groups comprised of members from all levels of the country’s health system to inform decision-making and solution design. Their input drives the overall effort as they choose, modify, prioritize and eventually roll out interventions across the country.
2. BID emphasizes process innovation, not technology innovation.
BID is not about testing out the next “killer app”, it’s about improving the processes to find and vaccinate every child. To ensure sustainability, health system improvement efforts can’t rely on expensive technology to succeed. Rather, appropriate technology products should only be one part of a coordinated approach that connects policies, practices and people.
In Tanzania, the User Advisory Group implemented an inexpensive technology-driven intervention that is enabling process-level change. Using a peer-support communication forum on WhatsApp, health workers help each other complete reports and ensure vaccine supply levels are adequate at facilities across the region. By proactively communicating with one another, they can avoid experiencing stock-outs in one clinic and surpluses in others.
Another example is the launch of Tanzania’s national electronic immunization registry, where every child in the country will be registered from birth. The system works both with tablets and paper forms. Depending on their facility’s infrastructure, health workers can register children’s vaccinations via an online form or they can use paper forms with barcodes that are compatible with the electronic system. Either way they save time and get better information.
The immunization registry can solve numerous problems for health workers. Instead of spending hours searching through a dense paper register to track down which children didn’t show up, health workers will quickly determine who missed a vaccination, where they are located and how to reach their parent. In the end, it’s about better processes that let health workers have more time to care for kids, it’s not about the app.
3. Improvements that enable better immunization data can improve other health programs. Tools like Tanzania’s peer-support forum and national electronic registry have been designed to be inter-operable. In the future, these platforms can be used to support not only vaccination, but to collect and share information to help reduce the spread of malaria, HIV and TB and to increase the use and availability of family planning supplies.
Africa’s immunizations rates have been stubbornly flat for too long, leaving too many children vulnerable to vaccine preventable diseases like pneumonia, meningitis, and measles. Lessons from BID Initiative countries like Tanzania are informing a “how-to” guide for other countries to overhaul their own immunization record-keeping systems in ways that will help Africa bend the curve downwards and protect millions more children.