PATH s Digital Immunization Registry System: Improving quality of immunization data and coverage in Vietnam. Presentation Overview

Transcription

1 PATH s Digital Immunization Registry System: Improving quality of immunization data and coverage in Vietnam Nguyen Tuyet Nga, MD, PhD Vietnam Program Team Leader Mekong Regional Program Phone: ntnguyen@path.org Presentation Overview Background & Rationale Goals and Objectives Overview of Immreg Final evaluation Lessons Learned Recommendations Page 2 Background National Immunization Program Birth cohort annually: ~1.6 million 9 vaccines included in national immunization program Most vaccines are given at commune health center during monthly immunization days Overall rate of full immunization coverage is relatively high at 91.4%. However, there are geographic inequalities, with lower rates in hard toreach areas. Hepatitis B birth dose coverage is low in response to adverse events 1

2 Rationale: moving beyond paper based systems is critical for continued improvement. Current paper based systems are time consuming prone to errors and causes delays They leave children and pregnant women at greater risk of contracting vaccine preventable diseases. They cause data inaccuracies which result in poor planning and management of vaccine. Page 4 PATH s nearly 20 year partnership with Vietnam s National Expanded Program on Immunization (NEPI) Improving quality, safety and efficiency across the value chain Page 5 Previous work: Optimize project ( ) Immunization registry Successfully developed and implemented immunization registry software in Mo Cay Nam district, Ben Tre province. VaxTrak Piloted a computerized logistics management information system in 4 provinces to help health workers track vaccine stock as it is received and dispatched throughout the system and that facilitates monthly reporting on immunizations given. NEPI has since scaled up VaxTrak to all provinces nationally, with their own resources. Page 6 2

3 IWG: Expanding Reach Of Immunization Registration In Vietnam ( ) Goals and Objectives To provide the Government of Vietnam with a digital immunization registry model that improves timeliness, efficiency and accuracy of immunization data To increase the rate of on time immunizations and protect women and children from vaccine preventable disease To generate evidence to inform scale up of the model and eventual nationwide adoption Page 7 Immreg How it works Page 8 Immreg At a glance 3

4 Continuous Improvements Mobile interface for smartphone developed Additional immunization indicators for pregnant women to track their tetanus toxoid vaccination Generation of additional reports on vaccine use and immunization of pregnant women and children 18 months Key Partners National Expanded Program on Immunization Southern Expanded Program on Immunziation Ben Tre Health Department Ben Tre Preventive Medicine Center Software Developer Page 11 SMS provider Final Evaluation Design Sites Ben Tre PPMC, and 4 DHCs, and 8 CHCs. Time of evaluation Baseline assessment conducted in June 2014 before project launched End line evaluation completed in July 2015 after seven months of software operation Methods Qualitative method used to gather information about perception of health workers at different levels on the acceptability and feasibility of the software through in depth interview. Quantitative method used to compare indicators before and after intervention and to estimate costs for setting up and maintaining the system in a given setting (commune, district and province, and nationwide). Page 12 4

5 Final Evaluation Results Acceptability Feasibility Helps planning more accurate, and Most communes have meeting the vaccine demands more computers and internet access quickly with a good connection Helps reduce time to record and The software is easy to use report with friendly platform ImmReg sends reminder SMS Most commune health workers instead of invitation letter and have good computer skills makes it easier to track Number people using mobile immunization clients phone in Vietnam is increasing quickly All of interviewees respond absolutely acceptable or acceptable and absolutely feasible or feasible Page 13 Final Evaluation Results: Time to prepare immunization reports Level Report content Before (min.) After (min.) Commune Monthly immunization report for children under 1 year old and women District Province Monthly immunization report for children under 1 year old and women Monthly immunization report for children under 1 year old and women Page 14 Final Evaluation Results Percentage of On time vaccination of DPT HepB Hib 80.0% 78.0% 76.0% 74.0% 72.0% 70.0% 68.0% 66.0% 64.0% Full immunization coverage of children 1 year 70.0% Pre intervention 78.1% Post intervention DPT HepB Hib1 DPT HepB Hib2 DPT HepB Hib3 Pre intervention (Jan 2013 Dec 2013) Post intervention (Jan 2015 Aug2015) Page 15 5

6 ImmReg Implementation Cost Breakdown of total cost for ImmReg implementation in Ben Tre ( ) End user Training 34% TOT training 8% Monitoring 100% Monitoring (2014) 18% Monitoring (2015) 31% Software development 9% Software development TOT training End user Training Monitoring (2014) Monitoring (2015) Estimate cost per province for five year expansion to forty provinces in Vietnam $18, $16, $14, $12, $10, $8, $6, $4, $2, $ Page 16 $16, $13, $13, $12, $9, Year 1 Year 2 Year 3 Year 4 Year 5 Top Three Lessons Learned Involve and engage government partners at every stage of the process. Anticipate low levels of digital literacy at commune level and employ different approaches to supporting behavior change. The value of SMS text reminders as a patient centric and costeffective approach to maximizing on time immunization rates needs further exploration. Page 17 Recommendations Project life should be longer than two years to allow for unexpected delays, and realistic time for transition from paperbased to computer based system. To ensure the immunization registry runs well at the beginning, immunization data in paper based system should be standardized and validated prior to entering into the software. Software update should be done regularly to meet the requirements and changes in NEPI reporting system. Thus, it is important to keep the software developer team in close contact with NEPI. NEPI and MOH should allocate regular budget for provinces as well as technical support and supervisions. Page 18 6

7 ACKNOWLEDGEMENT Project Optimize (WHO PATH) United Nations Foundation WHO Global mhealth Initiative Johns Hopkins University Vietnam National EPI Ben Tre Health Department and Provincial PMC Ben Tre District PMCs and CHCs Page 19 THANK YOU! Page 20 7