Implementing large-scale immunization tracker: Sri Lankan Experience

Part of the Scaling up COVID-19 Vaccine Delivery Solutions DAC2021 Session: Tuesday 22nd June 14:00

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Introduction & Objectives

COVID-19 pandemic created significant unforeseen challenges to countries during last 17 months. Towards the end of last year, the focus of countries all across the world shifted to COVID vaccination which was different to routine vaccination campaigns currently operational. Sri Lanka already used DHIS2 for COVID-19 surveillance since early 2020. The Ministry of Health required incorporation of information tracking of the large-scale, population-based COVID-19 vaccination in to the existing DHIS2 based surveillance system. The objective of the study is to explore the challenges in implementing a large-scale immunization tracker and identify recommendation of best practices to overcome them.

Methods

Case study approach was used to study the implementation of national level immunization tracker in Sri Lanka. Several qualitative data collection methods were devised which included in-depth interviews, experience of the implementers, observations and analysis of documents. Interviews were conducted from key implementers at national and district level, health administrators and development partners. The experience of authors who were involved as key implementers in attending meetings, customization and development of the platform, experiences at various levels of engagements were documented. Study of documents involved documents related to vaccination campaigns and guidelines of smart vaccination certificate. The collected data were transcribed and thematically analysed to identify challenges and recommendations.

Results

The main challenge identified at inception was to find proper guidance on developing a digital vaccination tracker. Training of end users and provision of support were challenges frequently encountered during the implementation phase. There were number of challenges encountered related to the platform and technology. These included pre-registration of the entire population, addressing performance issues related issues in tracker, issue of digital vaccination certificate based on WHO guidelines, handling of DHIS2 analytics in large-scale tracker and to support import of data captured offline. The analysis of data also revealed number of strategies that could be recommended to address the challenges. The country addressed the challenge of obtaining expertise on designing the immunization campaign by resorting to directives of local epidemiologists and international guidelines of vaccination. Addressing challenges related to user support and training were addressed by revamping traditional approach to designing user manuals, conducting online training programmes and provision of multiple user support mechanisms including remote desktop solutions. The technology and platform-related challenges were mostly overcome by collaborating with DHIS2 community and other stakeholders at the national level. In addition, building advanced capacity on the platform over time contributed to identifying the issues and communicating with experts. Integration with existing public goods to extend the functionality was another approach noted in building the system.

Conclusion

DHIS2 could be rapidly established as a large-scale immunization tracker for common vaccination requirements. However, proper identification of requirements, existing capacity on the platform, integration with existing solutions, and multisector collaborations are crucial for the establishment of a successful implementation.

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