Wednesday, 20 July 2011
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by Erida Nelaj, Albania Institute for Public Health and Jan Grevendonk, PATH In May 2011, the Albanian Institute for Public Health (IPH) launched a new web-based immunization registry and vaccine ordering system in the district of Skodra. Based on the acceptability and success of the system in Skodra, the government is deciding when and how to roll out the software nationwide. After an initial training with nurses, the system appears to be working well, and acceptability is high. [Click photo to enlarge] The project began in 2009 when IPH asked project Optimize to help develop a strategy for an electronic immunization registry and vaccine stock management system. Working with a local software developer, IPH and Optimize documented the key processes and requirements for the system and referred to them throughout the development process to ensure the project was on track. A year later, after several rounds of preliminary testing with users, the software and training materials are complete and have been deployed at 24 health centers in Skodra. In many ways Albania is a difficult place to deploy a web-based information system. Few health centers are equipped with computers, electricity is unreliable in many areas, Internet access is limited, and even mobile networks do not reach the more remote areas of the country. However, the system was designed to work around these issues by providing access through mobile phones and, when needed, paper-based reporting systems to complement online access. After a month of use in the district, IPH and Optimize staff checked in with nurses in health centers across the district to learn how they liked the new system. They found that nearly everyone understands the system and finds it highly functional. Despite some frustrations with Internet access and electricity, nurses clearly see the value in the system, noting that it will save them a tremendous amount of time creating their monthly plans and make it easier for them to track and monitor vaccinations, even among families that move to and from other districts. For now, nurses are simply playing with the system, and data are not being collected for use. In September, the system will be used for actual data collection, monitoring, and ordering. Over time, additional features and capabilities will be added to the system, including the mobile-phone component that will allow nurses to download immunization schedules for children associated with their health post, find any child in the database, and register the vaccinations they administer from any location with connection to a mobile SMS (short message service) network. Nurses have also requested that the system be expanded to include additional functionality such as adverse events reporting and disease reporting. As the Government of Albania prepares for nationwide introduction in the coming years, neighboring countries, too, are taking an interest in the system. In the fall, representatives from these countries will be invited to visit health centers in Skodra to understand how the system works. Optimize will monitor the system for up to a year and conduct multiple evaluations, including a functional evaluation of its use and acceptability, impact on supply chain performance, and cost. For IPH, the success of the pilot will be measured by how well it can improve the quality of the monitoring system for immunization coverage, increase ordering accuracy, and decrease the administrative burden on health workers. [Click photo to enlarge] For nurses who currently record each vaccination session on five different paper records, the benefits of the system are obvious. After completing the first training session, one nurse asked, “okay, just tell me when it is going to start.” For administrators, the system will also bring value. Not only will coverage data be more accurate, but the data are disaggregated, which means that district officers and nurses can see that not only do five percent of children need vaccination, but they can see the individual names and locations of children who are due or overdue for vaccination. Combined, these benefits will accrue to families whose children will receive all the vaccines they need right on schedule. To learn more about the software system or comment on its use in Albania, please click reply at the bottom of the page.
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