Three Waves of Data Use Among Health Workers: The Experience of the Better Immunization Data Initiative in Tanzania and Zambia

Werner, Laurie; Seymour, Dawn; Puta, Chilunga; Gilbert, Skye S.

doi:10.9745/ghsp-d-19-00024

Cited by 13 publications

(9 citation statements)

References 5 publications

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“…21 The package of solutions included the development of a standards-based EIR with automated, simplified reports; web-based dashboards; and supply chain system tools, 12 and the introduction of data use mentors, peer networking communication forums between health workers, and data use guides to build capacity and motivation for data use. 22 Interventions were designed according to the principles of user-centered design to address each country's identified challenges. 23,24 For example, in both countries, the MOHs codesigned requirements for the EIRs with the project team, and user advisory groups (comprised of HCWs from facility, district, and regional levels) tested iterations of the EIRs to provide feedback on the functionality and user interface.…”

Section: Complex Data Collection Toolsmentioning

confidence: 99%

Determinants of Facility-Level Use of Electronic Immunization Registries in Tanzania and Zambia: An Observational Analysis

Carnahan¹,

Ferriss

Beylerian³

et al. 2020

Glob Health Sci Pract

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Section: Complex Data Collection Toolsmentioning

confidence: 99%

Determinants of Facility-Level Use of Electronic Immunization Registries in Tanzania and Zambia: An Observational Analysis

Carnahan¹,

Ferriss

Beylerian³

et al. 2020

Glob Health Sci Pract

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“…However, effective use of EIR data for decision-making will require health care workers and administrators at all levels to have the skills, motivation, and autonomy to understand and act on the data [ 16 , 17 ]. Leadership at the national and regional levels should prioritize capacity building to enable the health system to make use of EIR data [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Added Value of Electronic Immunization Registries in Low- and Middle-Income Countries: Observational Case Study in Tanzania

Secor¹,

Mtenga²,

Richard³

et al. 2022

JMIR Public Health Surveill

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Background There is growing interest and investment in electronic immunization registries (EIRs) in low- and middle-income countries. EIRs provide ready access to patient- and aggregate-level service delivery data that can be used to improve patient care, identify spatiotemporal trends in vaccination coverage and dropout, inform resource allocation and program operations, and target quality improvement measures. The Government of Tanzania introduced the Tanzania Immunization Registry (TImR) in 2017, and the system has since been rolled out in 3736 facilities in 15 regions. Objective The aims of this study are to conceptualize the additional ways in which EIRs can add value to immunization programs (beyond measuring vaccine coverage) and assess the potential value-add using EIR data from Tanzania as a case study. Methods This study comprised 2 sequential phases. First, a comprehensive list of ways EIRs can potentially add value to immunization programs was developed through stakeholder interviews. Second, the added value was evaluated using descriptive and regression analyses of TImR data for a prioritized subset of program needs. Results The analysis areas prioritized through stakeholder interviews were population movement, missed opportunities for vaccination (MOVs), continuum of care, and continuous quality improvement. The included TImR data comprised 958,870 visits for 559,542 patients from 2359 health facilities. Our analyses revealed that few patients sought care outside their assigned facility (44,733/810,568, 5.52% of applicable visits); however, this varied by region; facility urbanicity, type, ownership, patient volume, and duration of TImR system use; density of facilities in the immediate area; and patient age. Analyses further showed that MOVs were highest among children aged <12 months (215,576/831,018, 25.94% of visits included an MOV and were applicable visits); however, there were few significant differences based on other individual or facility characteristics. Nearly half (133,337/294,464, 45.28%) of the children aged 12 to 35 months were fully vaccinated or had received all doses except measles-containing vaccine–1 of the 14-dose under-12-month schedule (ie, through measles-containing vaccine–1), and facility and patient characteristics associated with dropout varied by vaccine. The continuous quality improvement analysis showed that most quality issues (eg, MOVs) were concentrated in <10% of facilities, indicating the potential for EIRs to target quality improvement efforts. Conclusions EIRs have the potential to add value to immunization stakeholders at all levels of the health system. Individual-level electronic data can enable new analyses to understand service delivery or care-seeking patterns, potential risk factors for underimmunization, and where challenges occur. However, to achieve this potential, country programs need to leverage and strengthen the capacity to collect, analyze, interpret, and act on the data. As EIRs are introduced and scaled in low- and middle-income countries, implementers and researchers should continue to share real-world examples and build an evidence base for how EIRs can add value to immunization programs, particularly for innovative uses.

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“…During the visits, health workers in the immunisation programme were introduced and trained on the EIR and related suite of interventions, which included targeted supportive supervision for facilities, peer support networks, data use guides and posters, and simplified and visualised reporting. This training was done in the context of the clinical care workflows and procedures and aimed to ensure that health workers were equipped to strengthen data collection, improve the quality of data available and increase the use of the data for decision-making 12. Each visit typically lasted about 6 hours with an average of four visits per facility.…”

Section: Methodsmentioning

confidence: 99%

“…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 the immunisation 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 5 12. Among the solutions, the most intricate to develop was the electronic immunisation registry (EIR),13 which now gives health workers access to child-level as well as aggregated facility-level data that can be used for decision-making to improve the effectiveness and efficiency of immunisation services.…”

Section: Introductionmentioning

confidence: 99%

The costs of developing, deploying and maintaining electronic immunisation registries in Tanzania and Zambia

et al. 2019

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ObjectiveTo determine the costs to develop, roll out and maintain electronic immunisation registries (EIRs) and a related suite of data use interventions.MethodsThe Better Immunisation Data (BID) Initiative conducted the activities from 2013 to 2018 in three regions in Tanzania and one province in Zambia. The Initiative’s financial records were used to account for the financial costs of designing and developing the EIRs, BID staff time, expenditures for rolling out the EIR systems and the related suite of interventions to health facilities, and recurrent costs. Total financial costs, cost per facility and cost per child were calculated in 2018 US$.FindingsTotal expenditures were ~US$4.2 million in Tanzania and US$3.6 million in Zambia. System design and development costs accounted for ~33% and 26% of the expenditures in each country, respectively, while BID staff costs accounted for 39% and 52%, respectively. Average expenditures per health facility for rolling out the EIR system were between US$709 and US$1320 for the Tanzania regions and US$2591 for Zambia. The annualised average expenditure per child was estimated to be between US$3.30 and US$3.81 for the regions in Tanzania and US$8.46 in Zambia. Expenditures per child were higher in Zambia partly because of a much smaller birth cohort compared with Tanzania.ConclusionOther countries may benefit from the investments made and lessons learnt in Tanzania and Zambia by leveraging these now existing EIR platforms and rollout strategies, and hence may be able to implement EIRs at lower costs than reported here.

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Three Waves of Data Use Among Health Workers: The Experience of the Better Immunization Data Initiative in Tanzania and Zambia

Abstract: Data quality and use rollout in Tanzania's and Zambia's immunization programs progressed along 3 phases—from strengthening data collection, to improving data quality, to increasing data use for programmatic decision making cultivating a culture of data use.

Cited by 13 publications

References 5 publications

Determinants of Facility-Level Use of Electronic Immunization Registries in Tanzania and Zambia: An Observational Analysis

Determinants of Facility-Level Use of Electronic Immunization Registries in Tanzania and Zambia: An Observational Analysis

Added Value of Electronic Immunization Registries in Low- and Middle-Income Countries: Observational Case Study in Tanzania

The costs of developing, deploying and maintaining electronic immunisation registries in Tanzania and Zambia

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