Design, Development, and Deployment of an Electronic Immunization Registry: A Qualitative Cross-Case Comparison of Experiences from Vietnam, Tanzania, and Zambia

Abstract

Background: There is growing interest among low- and middle-income countries to introduce electronic immunization registries (EIRs) that capture individual-level vaccine data. While practical EIR guidance documents are available, the real-world implementation experience varies by country. There is an opportunity to learn from countries that have experience implementing EIRs to inform other countries considering the same. Methods: This qualitative study provides a cross-case comparison of the design, development, and deployment of EIRs in three countries: Vietnam, Tanzania, and Zambia. The countries were selected based on PATH’s role in providing technical support to the governments to introduce and scale their EIRs. Through desk review and thematic analyses, we consider findings related to four implementation factors: time, partnerships, financial costs, and technology and infrastructure.Results: The country cases highlight the multi-year timeline required to implement an EIR at scale. Of the 3 countries, only Vietnam has achieved nationwide scale of the EIR after implementing a series of iterative cycles to pilot and redesign the system over 7 years. In terms of partnerships, all three case countries established interdisciplinary national teams with experience in leadership, technology, and immunization, and incorporated end user perspectives from subnational levels in the EIR design and development. It was important for the national government to play an active role to ensure country ownership and sustainability. Financial investment was necessary for design and development, as well as to maintain the EIR beyond the initial deployment, including all recurring costs for system maintenance, updates, and end user support. Finally, technology and infrastructure were important considerations in the EIR design and choice of equipment in each country, and all 3 countries have a local partner to provide ongoing technical support.Conclusions: Comparing implementation factors across these cases highlights practical experience and recommendations that complement existing EIR guidance documents. The findings and recommendations from this study can inform other countries considering or in the process of implementing an EIR.