Closing gaps in vaccine coverage with electronic immunization registries

October 6, 2020

Every year, more than 10 million children go without lifesaving immunizations. To close the gaps, PATH helps countries turn paper immunization registries into dynamic digital platforms that provide high-quality data when and where it’s needed most.

Paper-based data systems take more time to manage and are often less accurate—resulting in children and families missing out
Digital immunization registries save time and improve accuracy, allowing health workers to focus on improving vaccine access.
Tanzania, Vietnam, Zambia
Gates Foundation; Gavi; governments of Tanzania, Vietnam, and Zambia; Viettel
Path Expertise Areas

Digital systems and tools

Human-Centered Design

Access to Immunization

Health System Strengthening


The Challenge

How can we ensure that every child is immunized? We start by improving the tools we use to manage and measure the process.

Paper-based data systems often fall short of countries’ data needs. For example, paper systems lack the flexibility required to guide decisions at the national level or to accurately identify children who have missed routine immunizations.

In many countries, health workers must manually transcribe data from one system to another, or use multiple overlapping data collection tools, increasing errors and taking valuable time away from patients.

“Digital dashboards let us see what’s happening in real time—instead of waiting for paper reports each month.”
— Dr. Dafrossa Lyimo, Tanzania’s Immunization Development Manager

The solution

To help close the gaps in vaccine coverage, PATH supported the design and introduction of electronic immunization registries (EIRs) in Tanzania, Zambia, and Vietnam.

Thanks to these EIRs, frontline health workers can now enter data directly into an electronic system that can automatically link to other health information systems.

EIRs have made a significant difference in the ability for frontline health workers to track individual children’s immunization statuses. They’ve also reduced the hours spent on data collection, giving time back to health workers to spend with patients. Additionally, EIRs provide health managers timely insights to prevent vaccine shortages, respond to disease outbreaks, and find new ways to improve or plan immunization strategies.

“Mothers see the change and they’re happy with the improvements to service delivery and the more time they have with nurses.”
— Aziza Ahmed Seif, nurse at the Mikanjuni Health Center in Tanzania

Why is PATH chosen to work on EIRs?

PATH’s work exemplifies key approaches to digital health and data systems:

  • Holistic perspective on digital and data systems.
    PATH looks beyond technology to ensure the policy, people, and funding are in place for successful digital health and data approaches.

  • Deep institutional knowledge and expertise.
    PATH is a leader in global digital health and data use, with expertise in supporting governments and partners in software design, implementation, and data analysis.

  • Starting and ending with government ownership.
    PATH partners directly with ministries of health and other government partners to design systems that can transition and scale long after our involvement.

  • Human-centered design approach.
    We design with end users to co-create systems and tools that work for them.
Photo: PATH/Trevor Snapp

In Tanzania, PATH’s BID Initiative helped design and introduce an electronic immunization registry. Photo: PATH/Trevor Snapp.

Our approach

PATH’s work on EIRs demonstrates key approaches to digital health and data systems.


PATH works with governments and partners to define the specific needs and requirements of a country’s EIR. This includes baseline assessments, stakeholder interviews, user testing, feature prioritization, and cost analysis.
For example, PATH’s Better Immunization Data (BID) Initiative created a product vision using a process called the Collaborative Requirements Development Methodology. Representatives from more than a dozen countries contributed to this starting point for designing EIR software.


Based on the information gathered during the design phase, PATH supports the selection, development, and testing of an EIR tailored to specific country needs. This includes working with technology partners and software developers, as well as reinforcing the government capacity to manage and implement the system.

In Tanzania, the BID Initiative supported the development and adaptation of electronic immunization registry software. Aligning existing open source platforms with Tanzania’s priorities and needs, PATH helped create a scalable and sustainable EIR.


PATH coordinates with governments and partners to roll out EIR systems, typically with a phased strategy—starting in a few regions and working toward national deployment. By developing a change management strategy, we also plan for the adoption of new technologies and build a culture of data use throughout the health system.

For example, in Vietnam, PATH supported the National Immunization Information System (NIIS)—a sustainably planned, government-run, nationwide EIR system—that was officially launched along with national mandates on system use in 2017.

Beyond the software

In Tanzania, Zambia, and Vietnam, PATH worked with governments on data governance, technological and data analysis capacity, health worker training, and change management. This allowed PATH to reinforce the enabling environment required for long-term success of EIRs.

PATH’s work on EIRs has also provided a platform for the creation of peer learning opportunities. The BID Learning Network brings together health managers and other country-based data and digital experts to collectively share experiences, problem solve, and learn. The Introducing Digital Immunization information systems: Exchange and Learning from Vietnam project, called IDEAL-Vietnam, is specifically designed to capture lessons from the development and implementation of the country’s EIR—providing lessons that can be applied in many other countries.

The results

Across Tanzania, Vietnam, and Zambia, PATH-supported EIRs increased on-time delivery and saved valuable time and money.

children entered into EIRs in Tanzania and Zambia
women and children in Vietnam’s EIR
hours saved by health workers each year in Tanzania
increase in on-time delivery of three routine vaccines in Vietnam
saved in annual costs per health facility in Tanzania



The BID Initiative is a partnership between PATH and the governments of Tanzania and Zambia with support from the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.

In Vietnam, PATH worked closely with the Vietnam Ministry of Health, General Department of Preventive Medicine; the Vietnam National Expanded Program on Immunization; and Viettel. This work was funded by the Bill & Melinda Gates Foundation.