Figures & Tables
Figures
- FIGURE 1
Electronic Immunization Registry Implementation Timelines in Vietnam
Abbreviation: NIIS: National Immunization Information System.
- FIGURE 2
Electronic Immunization Registry Implementation Timelines in Tanzania and Zambia
Abbreviations: DHIS2, District Health Information Software 2; TIIS, Tanzania Immunization Information System; TImR, Tanzania Immunization Registry; ZEIR, Zambia Electronic Immunization Registry.
Tables
Vietnam Tanzania Zambia Health system Vietnam’s health system consists of 5 main levels: national, regional, provincial, district, and commune. The MOH establishes policies, manages national and regional hospitals/institutes, and provides general oversight of the health system. Tanzania’s health sector operates under the MOHCDGEC, and the President’s Office - Regional Administration and Local Government plays a prominent role in implementations. Zambia’s MOH provides national policy and technical guidance, which is then interpreted at a provincial level to support hospital and district health management teams. Immunization program The NEPI was established in 1985 to provide free immunization services to protect children from the most common infectious diseases.
Despite high vaccination coverage, the country faced vaccine data quality challenges, and increasing urbanization and immigration made it challenging to ensure every child received all lifesaving vaccines.The Immunization and Vaccine Development Program of the MOHCDGEC focuses on administration, M&E, cold chain and logistics, routine immunization, and training.23
Despite high vaccination coverage, the country faces challenges related to subnational inequalities in coverage, low uptake of new vaccines, inaccurate target populations, and insufficient data use.24Since the mid-1990s, Zambia has decentralized many health services, including immunization, to its 9 provinces and 72 districts. In recent years, Zambia has improved its immunization service delivery and sustained high coverage rates.
However, the country still faces service delivery challenges, including highly mobile populations, vaccine-preventable disease outbreaks, subnational coverage inequalities, and data quality challenges.25Immunization data and reporting Before nationwide scale-up of Vietnam’s EIR in 2017, most health facilities across the country used paper-based forms to record, manage, and manually plan for immunization delivery, stock management, and reporting. The paper-based forms were often missing data, time consuming and laborious to complete, and a barrier to complete reporting and efficient vaccine stock management.26 Now all immunization facilities capture data in the National Immunization Information System. Some facilities have transitioned to paperless reporting (using only the EIR), but most use parallel paper-based and electronic systems. Before the launch of its EIR in 2016, Tanzania’s immunization information system was paper-based at the facility level and digital from the district level up. At the facility level, health workers recorded monthly reports on paper before submitting them to district managers who entered digital reports into the DHIS2 system. In addition to the DHIS2, the Excel-based District Vaccine Management Tool and the Stock Management Tool supported immunization service delivery.10 Where the Tanzania Immunization Registry has been introduced, most facilities are using it in parallel to these paper-based tools. Facilities in 2 regions have transitioned to paperless reporting. In Zambia, facility health care workers capture immunization data using paper-based forms and submit a monthly report of aggregate data to the district using the HIA2 form.11 At the district, data are entered into the DHIS2, the country’s primary health information system.27 The facility paper-based forms continue to be the standard and are used in parallel to the Zambia EIR where it has been introduced. Vaccination coverage of childrena BCG 88% 75% 92% Third dose of DTP 83% 81% 91% Birth cohort 1.4 million (2022)29 2.3 million (2022)30 683,355 (2022)31 National digital health market maturityb 2 2 2 Abbreviations: BCG, bacille Calmette-Guerin; DHIS2, District Health Information Software 2; DTP, diptheria-tetanus-pertussis; EIR, electronic immunization registry; HIA2, Health Information Aggregation 2; M&E, monitoring and evaluation; MOH, Ministry of Health; MOHCDGEC, Ministry of Health, Community Development, Gender, Elderly and Children; NEPI, National Expanded Program on Immunization.
↵a World Health Organization/UNICEF estimates from 2021.28
↵b Based on a 5-point scale where 1 is the lowest maturity and 5 is the highest maturity.32
- TABLE 2.
Comparison of Electronic Immunization Registries Across Vietnam, Tanzania, and Zambia
Vietnam Tanzania Zambia System name National Immunization Information System Tanzania Immunization Registry Zambia Electronic Immunization Registry Technology platform Bespoke system developed by Viettel OpenIZ platform (now known as SanteDB, SanteSuite), an open-source immunization management system33 OpenSRP, an open-source mobile digital global goods platform34 System functions Registration of individuals, including demographic information X X X Registration of vaccination events, including information on administered vaccine X X X Growth monitoring data X Individual monitoring X X X Aggregate reports X X X Stock management X (from national to commune level) X (facility) X Health worker decision support X X X SMS reminders for clients X X Automated scheduling and reminders X Interoperability/data exchange Vietnam developed an API based on HL7/FHIR to enable the NIIS to exchange data with other systems since many fee-based immunization facilities and private hospitals have their own systems to track their clients (covering multiple health areas beyond vaccination).
The NIIS is also interoperable with a mobile phone application, known as the e-immunization card, that allows parents/clients to access their individual NIIS data.TImR is integrated with the VIMS, an electronic logistics management information system that tracks vaccine supplies from national level down to district level.
An attempt to integrate TImR with the national birth registry compromised the TImR system performance; this challenge is currently being addressed.ZEIR is in the process of being integrated with DHIS2, the country’s national HIS. ZEIR reports are currently pushed to a cloned version of DHIS2, mirroring the official HIS.
ZEIR is integrated with mVacc (mobile vaccination), a community-level RapidPro system that community health workers use to send SMS messages to remind families to bring their children for immunization.Workflows Individuals are registered from birth using a unique ID, which is generated by the NIIS.
Data are entered by immunization health workers at health facilities, often using computers shared across health areas.
Aggregate data reports are generated for users at all levels of the health system to view.Individuals are registered from birth. A barcode sticker is applied to the child’s health card and scanned as the TImR unique ID. The caregiver’s ID captured in TImR is linked with the national civil registration and vital statistics system.
Immunization providers at health facilities enter data using tablets. Data can be captured in offline mode and later synced.
Aggregate data reports are generated for users at all levels of the health system to view.Individuals are registered from birth using a unique ID generated by ZEIR.
Immunization providers at health facilities enter data using Android-based tablets. Data can be captured in offline mode and later synced.
Aggregate data reports are generated for users at all levels of the health system to view.Abbreviations: API, application programming interface; DHIS2, District Health Information Software 2; HIS, health information system; HL7/FHIR, Health Level 7/Fast Healthcare Interoperability Resources; ID, identifier; NIIS, National Immunization Information System; SMS, short message service; TImR, Tanzania Immunization Registry; VIMS, Vaccine Information Management System; ZEIR, Zambia Electronic Immunization Registry.
