Applying lessons learned in the design of electronic immunization registries
Routine vaccination is one of the safest and most cost-effective methods to protect against life-threatening diseases in both children and adults. Despite the longstanding success of vaccines, low immunization levels persist. About 20 million children miss out on life-saving vaccines annually, with the poorest and most vulnerable among the least likely to be vaccinated. While many factors contribute to low vaccination rates, one major obstacle is a lack of timely, high-quality data to inform the delivery of immunization services. Without accurate information—such as current coverage rates, vaccine stock levels, and community demographics—health workers struggle to identify individuals who need vaccines. The use of electronic immunization registries (EIRs) is one intervention to help address these data use and quality challenges to improve immunization service delivery.
EIRs are replacing the paper-based systems of manual record keeping that have characterized most countries’ vaccination services until recently. EIRs are confidential, population-based, computerized information systems that record data on vaccine doses delivered. They are designed to capture individualized data, i.e., an individual’s vaccine record, on doses administered by one or more health workers. EIRs track critical information needed to ensure that a child is registered for vaccination from birth and receives all recommended vaccines from then on. In aggregate, these data can be used to inform vaccination program monitoring, planning, and forecasting.
Not only do EIRs have the benefit of storing information in an electronically accessible way, but a growing body of evidence shows that EIRs help to improve vaccine equity and coverage rates, and provide access to more timely, accurate, and complete immunization data. Other benefits include improvements in vaccine stock levels, reduction in vaccine wastage, and systemwide cost savings. Many people benefit from EIRs, whether they are individuals who may receive EIR-generated reminders about upcoming vaccines, or health system managers who are equipped with high-quality, timely data to support equitable immunization programs.
As more countries have introduced EIRS, the variety of EIR-related guidance and resources has expanded. However, about a year ago, it was evident that countries needed comprehensive and detailed guidance on the design of EIR systems—how to make them affordable, scalable, and interoperable with existing health information systems, and also functional in low resource settings. To address this, Digital Square and the United States Agency for International Development (USAID) partnered on an extensive research project to develop recommendations on system design to inform EIR investment decisions.
This exercise resulted in an EIR report centered on these three objectives:
Identify where EIRs have been implemented in low- and middle-income countries.
Summarize how and why EIRs can add value for vaccination programs.
Provide recommendations on the functional and nonfunctional requirements for EIR system design.
Ultimately, the goal of the report is to provide decision makers with a collection of best practices and lessons learned from previous EIR implementations to help them understand the added value that an EIR can bring to existing infrastructure, how to design a highly effective EIR, and what can be done to improve an existing EIR.
Along with the report are three short briefs that highlight different aspects of the report. The first brief describes how EIRs can be valuable for managing immunization programs during pandemics or other health system shocks, like COVID-19. The second brief provides an overview of what to consider when designing an EIR, and the final brief captures recommendations for stakeholders evaluating the possibility of implementing an EIR.
By leveraging the key considerations and lessons learned from a collection of countries, Digital Square and USAID have curated an information source to ensure that future EIR implementers will not need to recreate the wheel, and potentially, can adapt existing software tools. Amid the COVID-19 pandemic, EIRs can be even more valuable when used to track vaccinations for COVID-19 and beyond. Because integrating COVID-19 vaccination tracking into EIRs is a relatively new activity, there are many opportunities for learning as implementation of EIRs and COVID-19 vaccine delivery continues.
Report: Electronic Immunization Registries in Low- and Middle-Income Countries
Reference: UNICEF immunization webpage