An interview with Silvia Bino, Albania Institute of Public Health The Institute of Public Health in Albania recently developed an online immunization registry to replace their existing paper-based system. In May 2011, the new system—named IIS—was piloted in Shkoder district. One year later, Op.ti.mize talks to Silvia Bino about how it has transformed the way vaccinations are scheduled and recorded. Before IIS was launched, how were immunizations scheduled? Nurses and the district head of vaccinators worked together using a paper-based system to make sure that all children received the vaccinations they required. Each month, the nurse made a list of all the children due to be vaccinated that month in her health center by carefully going through the health center’s immunization and cohort registries. She used this list to schedule each vaccination, notify parents, and work out how much vaccine to order. She did all this using pen and paper. Were immunization records kept in the same way? Yes. The nurse had to record the details of every child vaccinated on up to six forms and registers. At the end of each quarterly period, she had to review this information to produce a vaccination coverage report. This report was compiled by hand and compared the number of children scheduled for vaccination with the actual number of children vaccinated. The nurse would then send this report to the district head of vaccinators, who would review and aggregate the figures. What problems did nurses have with this system? The nurses spent a lot of time recording and reviewing immunization data. And despite their hard work, some errors in data collection and reporting were inevitable. We needed to automate as much of this administrative work as possible and help them get on with the more important parts of their jobs. Were there any other problems? The lack of detailed data was another big problem. At the national level, we only received aggregated data that wasn’t helpful to manage or improve the program. For example, we only received coverage estimates by district, when we needed to know the vaccination coverage by community, who the unvaccinated children were, where they lived, and why they had not been vaccinated. The old system could not give us this information. Other problems were that we could not control the distribution of vaccines in the way we needed to and that there was no easy way to keep track of children who moved to another part of the country. How has the work of health staff changed? A lot of the nurses’ work has been automated. For example, as soon as children are born, the maternity nurse enters their data into a central database. A schedule of their future immunization appointments is then automatically generated. When the appointments are due, the children are automatically included in their local health center’s monthly plan. The nurses no longer need to go through the immunization registries to find the children who need to be vaccinated. Instead, they use the monthly plan to organize their vaccination schedules. The monthly plan also calculates the total number of vaccine doses required, and this information helps nurses to determine the exact vaccine quantities to order. I have to say that IIS has also improved the quality of nurses’ work. For example, they can spend more time with parents and caregivers to answer questions or address any concerns they may have. And with IIS they are now better able to access and share information. Has the new system improved stock management? Absolutely. As children are vaccinated, nurses with access to a computer can update their immunization status directly into the monthly plan by entering the vaccination date and the vaccine lot they used. Because IIS is used for stock management, the system can show which vaccine lots are stored at every health center and can deduct their balance every time a nurse uses a certain lot for immunization. With IIS, the district head of vaccinators prints out a monthly plan for every health center and health post and distributes them to nurses together with the vaccines. In this way, he can easily make sure that the requested amounts are correct. Village health nurses who don’t have access to a computer can use the paper plan to organize their work and report back on the vaccinations they have administered by taking note of the vaccination date and the lot they used in the columns provided on the form. What are the main benefits? IIS simplifies the monthly planning and reporting that nurses need to do. But there are other benefits to tracking individual children. Firstly, IIS doesn’t just generate coverage reports automatically by comparing actual vaccinations with planned vaccinations, it can also show exactly which children have not been vaccinated—those who have been registered but have not received all their doses yet. This enables nurses to quickly identify any defaulters and to check that access to vaccination is equitable across communities. IIS also manages the stock of vaccines and consumables which allows the Institute for Public Health to monitor the expiry date, distribution, and usage of ever more expensive vaccines. By linking the vaccine lots to the individual child records, lots can be traced through the stores and eventually to any children who have received a dose from a particular lot. This is essential for vaccine safety. Are there any benefits for parents? Parents will shortly be able to access IIS themselves to view their child’s vaccination history and download a vaccination certificate for their child, required for school and visa applications. Are there plans to scale up the pilot? Yes. We plan to start using the system in other districts in Albania later this year. If all goes well, we will be able to implement IIS nationwide by the end of 2014. In the meantime, we are also adding new features to IIS, such as the tracking and reporting of adverse events following immunization. In May this year, we also hosted a workshop for the countries of the South East European Health Network. We hope to collaborate further with these countries in the future as we are all looking to improve our health information systems. For more information on Albania’s implementation of IIS, please contact Silvia Bino. Note: Optimize will provide a full report on the implementation of IIS in 2013. To comment, make sure you are logged in and click Reply.
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