by Dr. Nguyen Van Cuong, NEPI and Joanie Robertson, PATH Vietnam’s National Institute of Hygiene and Epidemiology is collaborating with project Optimize to demonstrate the benefits of a computerized immunization registry. In January 2012, a new computerized immunization registry was piloted by Vietnam’s National Institute of Hygiene and Epidemiology. Dr. Nguyen Van Cuong of Vietnam’s National Expanded Program on Immunization (NEPI) and Joanie Robertson of PATH provide an update on its performance. Think for a moment of the information associated with a child’s immunization. Who is the child? Where does she live? When was she born? Who are her parents? What vaccine will she receive? When and where will she be immunized? Did she actually receive the vaccine? And did she suffer any adverse reactions as a result? Now multiply this information by one and a half million—the number of children born in Vietnam every year. Next, add the five visits each child must make to fulfill the dozen-dose immunization schedule of Vietnam’s NEPI, administered at more than 11,000 commune health centers throughout the country. At this point, you begin to understand just how much data are captured and reported in the immunization program. In Vietnam, all of these data are meticulously recorded by hand in special notebooks. The country’s immunization registry is composed of thousands of such books, each containing a list of children born in the catchment area of a particular commune health center. Every child is recorded by name, along with their gender, date of birth, address, and the name of their parents. When a child receives an immunization, the date of that immunization is recorded in the book. Every month, health workers painstakingly flip through the pages of the book and count the immunizations delivered at the health center that month. This is the only way to obtain the aggregate number of immunizations delivered for each vaccine. Once these statistics have been gathered, they are passed on to the district health center, which aggregates the numbers for all of its communes. The district health center then passes these figures on to the province, which in turn aggregates the data and reports to the regional and national level. What if this information was digitized? If immunization data were kept in a database rather than a book, the computer could do all the counting and aggregating, leaving the health workers with more time to care for patients. And instead of waiting for the paper reports to come to them, the district, province, and national program staff could use a web-based interface to access the data at any time. This would help program staff to monitor, supervise, and plan immunization activities. Vietnam’s National Institute of Hygiene and Epidemiology is collaborating with project Optimize to start making this happen. In November 2010, an experienced local software developer was hired to build the system. It was important to work with a local developer who could speak the language of the NEPI administrators and commune health workers to understand their requirements, processes, and priorities. Working closely with NEPI and Optimize, the developer built the four components of the digital immunization registry: -A database to securely hold information on each child. -A mobile phone application that can download and upload data to/from the database, such as information about immunizations administered and aggregated report information on key indicators. -A desktop PC application that Expanded Programme on Immunization officers at district, regional, and national levels can use to generate reports from the database. -A short message service (SMS) feature to send text messages to parents of children with scheduled immunizations. In January 2012, the new immunization registry was piloted in Mo Cay Nam district in Ben Tre province. Health workers from all 17 communes in Mo Cay Nam came to the provincial health center for two days of training. The software performed well, but some health workers unfamiliar with computer programs and mobile phone applications found it difficult to use. And with only one day a month to practice (immunization days occur only once a month in Vietnamese communes), it was noted that becoming proficient in the new tool would present a challenge to such health workers. With further support, users are now beginning to enjoy the benefits of the new system. Assessment data are still incomplete, but it is already clear that in communes where health workers are successfully mastering the immunization registry, the system is helping to increase data availability. It is also helping to reduce the time needed not only for reporting, but also for immunization day planning and preparation. In particular, the new system has shortened the time needed to screen patients prior to vaccination because health workers have access to more information about each child. Additionally, the relationships between health workers and children’s parents have benefitted, since the parents are impressed with the reminder SMS they receive from the system prior to immunization day. All of these things are having a positive effect on the immunization program in the community. A small pilot such as this cannot answer every question that needs to be asked when designing a national immunization registry. However, the findings add further weight to the case for harnessing the power of digital technologies to track and store immunization data. The lessons learned in this demonstration will help to increase the strength and robustness of future computerized registry systems. Optimize will publish an evaluation of the immunization registry demonstration in Vietnam later this year. For more information, please email [firstname.lastname@example.org]Joanie Robertson[/email]. To comment, make sure you are logged in and click Reply.
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