Wednesday, 18 June 2014
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Dear Colleagues, Paper immunization registers and register books are critical components of health information systems (HIS) for immunization programs across the globe. Even as many HIS for immunization programs and other health domains move toward electronic and mobile data collection systems, paper registers continue to be relevant tools in many resource-constrained settings. Registers occupy a particularly unique space in HIS as they serve as an intermediary between individual patient records and aggregate data. For immunization programs, they can be used to track defaulters and to estimate coverage. Registers must meet both the needs of health providers and the needs of administrators and decision-makers. The Bill & Melinda Gates Foundation’s Vaccine Delivery Team engaged the University of Washington’s Global Health Strategic Analysis and Research Training (START) Program in the Paper Health Registers Project in September 2013. With the hypothesis that sub-optimal paper register systems likely detract from patient care and produce poor data quality, the START team investigated five case studies representing innovations in paper health register systems across various health domains and geographies. These cases include: [list] Ethiopia’s Family Folder (FF) is a non-standard register innovation. Developed in 2008, this folder contains key indicators at the household level and contains individual records for each family member, allowing health extension workers easy access to both individual and aggregate data. Ethiopia Case Study Ghana’s Simplified Registers (SR) are a set of five consolidated primary care registers, including maternal and child health and family planning. They were introduced in 2010 as part of the Mobile Technology for Community Health (MoTeCH) initiative. Ghana Case Study South Africa’s 3-Tiered Antiretroviral Treatment (ART) Monitoring Strategy gathers a reduced number of monthly and quarterly data elements to track ART services for all patients receiving HIV treatment in South Africa. This strategy was developed by researchers in South Africa in 2004, and includes a paper tier for facilities with fewer patients and less infrastructure, and non-networked and networked electronic tiers for facilities with many patients. South Africa Case Study Uganda’s Tuberculosis (TB) and Leprosy Program Registers were updated in 2005 to include a mechanism for monitoring TB/HIV cooperative activities. This link allows patients with TB/HIV co-infection to be monitored by the system more easily. This case study focuses on the TB register (rather than the leprosy register), and particularly emphasizes modifications made to record TB/HIV collaborative activities. Uganda Case Study Uruguay’s National Immunization Program Register (SNNI) is a mixed paper and electronic system, in which vaccinators at all public and private vaccination facilities fill out a paper form for each vaccination encounter and submit the form for data entry into an electronic database at the national level. This system was developed in 1987 and is the oldest nominal register in Latin America. Uruguay Case Study While the case studies represent a variety of health domains, many of the lessons learned are applicable to immunization program registers. The full project resulted in five individual case studies detailing each register innovation and a synthesis of the lessons learned from all five cases. The lessons learned demonstrate innovation in register design, human resource models, policymaking, and implementation strategies. This research demonstrates that many stakeholders – including funders, policymakers, public health officials, and health providers – can be a part of strengthening paper register systems to support evidence-based decision-making for improved patient care and accurate reporting. For further information about this work, please contact me at [email protected]. Best, Anna Rapp Vaccine Delivery Program Bill and Melinda Gates Foundation
9 years ago
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#2878
Thank you very much for sharing these case studies. I very strongly agree as similar intervention through offline tool brought in quick results in the PHC (Primary Health Centre Sampaje) attached to KVG Medical College, later replicated in 57 PHCs of Chikkaballapur district in Karnataka. The offline tool is now extended to improve Newborn Vaccination specially Hep-B birth dose, "raising the coverage" of this is considered as one of the challenging topics in the 67th WHA. For Hep-B birth dose 'vaccine delayed is vaccine denied'.
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