Friday, 10 February 2023
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Dear all


The report “Investigating the use of digital solutions in the COVID-19 pandemic: an exploratory analysis of eIR and eLMIS in Guinea, Honduras, India, Rwanda and Tanzania” – commissioned by the Gates Foundation and done by Bocconi University and MMGH – is now available in French and Spanish. I attach the original plus the translations; feel free to share. 

The executive summary is pasted here:

This report presents a series of brief case studies supported by the existing literature on the deployment of digital solutions during the COVID-19 pandemic. It specifically describes how electronic Immunization Registries (eIR) and electronic Logistics Management Information Systems (eLMIS) have been newly developed and/or repurposed in Guinea, Honduras, India, Rwanda, and Tanzania. Importantly, the findings are influenced by the state of the implementation which, because of the delayed availability of COVID-19 vaccines in the LMICs, is still in its early phase. 

Overall, Tanzania and India relied on their existing eLMIS solutions to roll-out the COVID-19 vaccines, however, resorted to the de novo development of complementary eIR solutions for tracking of beneficiaries. The latter are to be integrated in the future with the digital infrastructure and systems that currently support routine immunization efforts in these countries, including Civil Registry and Vital Statistics (CRVS) systems. Conversely, Rwanda implemented a separate COVID-19 EIR Tracker as an additional module to its District Health Information Software (DHIS2) platform which also hosts the eIR for routine immunization. Finally, Honduras and Guinea attempted to use the existing eIR and eLMIS systems, respectively, but succeeded only partially in adapting them and did not ensure deployment of all the required functionality across the country, resulting in the need for implementation of multiple parallel solutions. 

Several key lessons have emerged from the countries analysed, with support from the literature. The findings in this report clearly highlight the value of simplicity and flexibility in the design of the digital solutions, as well as the need to support local capacity to develop and adapt the tools to the specific context. The roll-out of many concurrent systems to fill gaps in the existing implemented solutions should be avoided as a source of unnecessary complexity. Building local competencies – that is, not continuing to reply upon expensive and time-bound external resources – also emerged as a clear success factor necessary to ensure real ownership and sustainability, as well as the need to strengthen the workforce with extended training and involvement of community health workers in the data collection process to reach zero-dose children. Finally, the need for a strong political commitment and a clear vision for the use of these digital solutions is essential to secure the domestic financing required for sustainable investments. 

This report serves as a call to “keep it simple and keep it local.” Development partners should invest in existing systems and human resources avoiding duplications and ensuring consistency and streamlined processes, wherever possible. Critical observations about the further roll-out of digital solutions over the next six months of the pandemic, coupled with the completion of the broader evaluation on the impact of these solutions, will provide additional information to guide the emerging learning agenda in this area which can further inform future investment decisions on the sustainable scale-up of eIRs and eLMIS as part of integrated health management information systems.


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