Ensuring vaccines reach the people who need them most

November 8, 2021 by Celina Kareiva

Putting data-driven interventions into the hands of health workers is closing the immunization gap.

Digital health

Oliver Mlemeta is a nurse at Usa River Health Facility in Tanzania. Before the BID Initiative, Oliver had limited visibility into the communities she was serving. Photo: Bill & Melinda Gates Foundation/Riccardo Gangale

Stacks of immunization registry ledgers tower above the desks and medical supplies. Each ledger contains rows and rows of patient records—their name, date of birth, the last time they received a vaccine, and which antigen, among other information.

It’s a scene familiar to most health facilities across developing countries—particularly along “the last mile.” The term references the final challenges a country faces as it works to vaccinate its communities, and achieve full immunization coverage. At the root of this challenge are fragmented and weak information systems. Accurate, timely, and accessible data are critical to ensuring the right vaccines are administered to the right people, at the right times.

But by putting the power of data into the hands of health workers, this story is changing.

Towers of paper replaced by tablets

Between 2014 and 2021,the BID Initiative worked to increase immunization rates by improving data quality and fostering a culture of data use. The initiative, led by PATH, was a country-driven effort in Tanzania and Zambia to roll out a series of tools and interventions, including electronic immunization registries (EIRs), data-use campaigns, and barcodes or QR codes on child health cards.

Today, more than 2 million children have been entered into Tanzania's Electronic Immunization Registry (TImR) and there are plans to scale nationally. Zambia's Southern Province is also employing data interventions. More than 141,000 children have been entered into the Zambia Electronic Immunization Register (ZEIR).

Reuben Mwanza (right) of PATH enters vaccination data into a tablet computer during a vaccination service at the Mahatma Gandhi Clinic in Livingstone, Zambia.

Health workers in Arusha, Tanzania, are using tablets to pull up patient records. Photo: Bill & Melinda Gates Foundation/John Healey.

Susan Siatwiko is the nurse in charge at Siakapisa Health Facility in the Kazungula district of Zambia. She used to sift through cumbersome ledgers to figure out how many children were due for an upcoming immunization clinic. After tallying up each patient, she’d cross-check that information against Siakapisa’s vaccine stocks. The tedious task didn’t end there. Immunization day was usually followed by several weeks of manual reporting.

Through BID Initiative interventions, she was able to forecast the vaccines needed for an immunization clinic. When she realized her health facility would not have enough stock to meet demand, Susan used a WhatsApp group that BID established as a communication forum for health workers in neighboring facilities to locate more vaccines.

“We borrowed vaccines from a neighboring facility, and completed [our clinic],” says Susan.

“[Health workers] are used to collecting data, but there hasn't been a need for them to critically look at the numbers. Our desire is to transcribe that information into people and realize that every digit that goes on record is a human.”
— Mpoki Ulizubisya, former Permanent Secretary of Tanzania's MOH

Connecting health workers by connecting data

BID also changed the way health workers relate to the information they collect. They know that behind each number is a human life. But now health workers have a better understanding of how data can ease their workload and improve care, motivating them to use the data to make evidence-based decisions.

“[Health workers] are used to collecting data, but there hasn’t been a need for them to critically look at the numbers,” said Dr. Mpoki Ulizubisya, the former Permanent Secretary of Tanzania’s Ministry of Health, Community Development, Gender, Elderly, and Children. “Our desire is to transcribe that information into people and realize that every digit that goes on record is a human.”

A nurse gives a polio vaccine to a child.

For health workers, immunization information systems dramatically reduce time filling paperwork, tracking down patient records, and determining which patients have not shown up for their vaccines. Photo: Bill & Melinda Gates Foundation/Riccardo Gangale

An ambitious goal for us all

While clinics around the world leave dusty book ledgers and piles of folders behind, the systems in place in Tanzania and Zambia are upending traditional processes and revolutionizing health care. Pen and notepad are being replaced by tablets and smartphones.

Having just passed the ambitious global goal to achieve universal coverage by 2020, high-quality data is increasingly critical to vaccinating the last mile. These are the hardest to reach communities who typically have low access to health care, and for whom the financial burden of illness has a greater impact on health and happiness.