RT Journal Article SR Electronic T1 Design, Development, and Deployment of an Electronic Immunization Registry: Experiences From Vietnam, Tanzania, and Zambia JF Global Health: Science and Practice JO GLOB HEALTH SCI PRACT FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs SP e2100804 DO 10.9745/GHSP-D-21-00804 VO 11 IS 1 A1 Emily Carnahan A1 Linh Nguyen A1 Sang Dao A1 Masaina Bwakya A1 Hassan Mtenga A1 Hong Duong A1 Francis Dien Mwansa A1 Ngwegwe Bulula A1 Huyen Dang A1 Maya Rivera A1 Trung Nguyen A1 Tuan Ngo A1 Doan Nguyen A1 Laurie Werner A1 Nga Nguyen YR 2023 UL http://www.ghspjournal.org/content/11/1/e2100804.abstract AB Key FindingsElectronic immunization registry (EIR) development benefited from a phased scale-up approach, including multiple system iterations in each country. Although this lengthened the timeline, the process ultimately strengthened the system.The role of the software developer was a key difference in partnership approaches. Challenges resulting from working with international developers were addressed by also contracting a local software partner.Significant in-kind time contributed by the ministries of health and donor investment enabled these EIR implementations. Unanticipated costs resulted from system technical issues and the need to expand the server as new children are registered.The technological infrastructure in each country informed EIR design decisions, with adaptations made for level of computer literacy and Internet connectivity.Key ImplicationRecommendations to countries implementing an EIR include (1) plan for an iterative development process; (2) establish an interdisciplinary leadership team—including national government staff—with clear roles; (3) ensure funding to sustain and maintain the system; and (4) develop long-term plans for maintenance, updates, and end-user support.Introduction:There is growing interest among low- and middle-income countries to introduce electronic immunization registries (EIRs) that capture individual-level vaccine data. We compare the design, development, and deployment of EIRs in Vietnam, Tanzania, and Zambia. Through desk review and the authors’ firsthand implementation experiences, we describe experiences related to timeline, partnerships, financial costs, and technology and infrastructure.Implementation Experience:The country cases highlight the multi-year timeline required to implement an EIR at scale and the benefit of multiple iterative cycles to pilot and redesign the system before achieving scale. Of the 3 countries, only Vietnam has achieved nationwide scale of the EIR, which took 7 years. In all 3 countries, national government leadership as part of an interdisciplinary team (with experience in leadership, technology, and immunization) was important to ensure country ownership and sustainability. Where international software developers were contracted, partnering with a local software company helped improve responsiveness and sustainability. Across all 3 countries, governments contributed significant in-kind time in addition to investments from donors. Cost savings were observed in Tanzania and Zambia, largely driven by health worker time savings from using the EIR. All 3 case countries underscore the need to understand the local technology and infrastructure context and design the EIR to fit the context. In Vietnam, an initial landscape assessment was conducted to assess technology and infrastructure, whereas in Tanzania and Zambia, user advisory groups provided insights. Existing infrastructure informed EIR design decisions, such as choosing a system with offline functionality in Tanzania and Zambia. All 3 countries have a local partner to provide ongoing technical support.Conclusion: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.