Electronic Immunization Registries in Tanzania and Zambia: Shaping a Minimum Viable Product for Scaled Solutions.

Henry Mwanyika,Dawn Seymour,Dykki Settle,Mandy Dube,Francis Dien Mwansa,Ngwegwe Bulula,Brian Taliesin,Laurie Werner

doi:10.3389/fpubh.2019.00218

Abstract

As part of the work the Better Immunization Data (BID) Initiative undertook starting in 2013 to improve countries' collection, quality, and use of immunization data, PATH partnered with countries to identify the critical requirements for an electronic immunization registry (EIR). An EIR became the core intervention to address the data challenges that countries faced but also presented complexities during the development process to ensure that it met the core needs of the users. The work began with collecting common system requirements from 10 sub-Saharan African countries; these requirements represented the countries' vision of an ideal system to track individual child vaccination schedules and elements of supply chain. Through iterative development processes in both Tanzania and Zambia, the common requirements were modified and adapted to better fit the country contexts and users' needs, as well as to be developed with the technology available at the time. This process happened across four different software platforms. This paper outlines the process undertaken and analyzes similarities and differences across the iterations of the EIR in both countries, culminating in the development of a registry in Zambia that includes the most critical aspects required for initially deploying the registry and embodies what could be considered the minimum viable product for an EIR.

Highlights

Led by PATH and funded by the Bill & Melinda Gates Foundation, the Better Immunization Data (BID) Initiative is grounded in the belief that better data plus better decisions lead to better health outcomes
Zambia has deployed the second version of its electronic immunization registry (EIR), Zambia Electronic Immunization Registry (ZEIR), in 291 facilities in Southern Province and is actively seeking funds to support maturing its use in the province, as well as scaling to other provinces
The 5 years of experience developing EIRs in Tanzania and Zambia under the BID Initiative contributed to important lessons in system development, which were documented and disseminated [13, 14]

Summary

Introduction

Led by PATH and funded by the Bill & Melinda Gates Foundation, the Better Immunization Data (BID) Initiative is grounded in the belief that better data plus better decisions lead to better health outcomes. Both countries formed user advisory groups made up of health workers from all levels of the health system (including community health workers, facility staff, district and provincial managers, and national-level staff) to develop a suite of interventions to address these data-related challenges. Evolutionary approach to developing the solutions was taken, building on existing systems when possible. Interventions were designed and tested in the regions identified for initial implementation, close collaboration with government employees and agencies at the national-level focused on creating solutions that would be sustainable, that could scale beyond the initial regions, and that could be used in multiple countries with little additional development effort. Among the solutions in the suite of interventions, the most intricate to develop was the electronic immunization registry (EIR), which gives health workers access to immunization data that can be used for decision-making to improve the effectiveness and efficiency of delivering immunization services

Methods

Results

Conclusion