TechNet-21 - Forum

This forum provides a place for members to ask questions, share experiences, coordinate activities, and discuss recent developments in immunization.

Discussions tagged Data quality

Stemming the Tide of Counterfeit Proof of Vaccination

Recent reports [1] of counterfeit yellow fever vaccination certificates in Zambia follow reports of falsified proof of vaccination documents being used in other countries, including Ethiopia [2], India [3], Nigeria [4], Pakistan [5], Sudan [6], Uganda [7], Tanzania [8] and Zimbabwe [9]. While the World Health Organization (WHO) published guidelines in 1999 [10] to support countries in developing measures to combat counterfeit pharmaceutical products and issued a report in 2017 [11] highlighting the public health and socioeconomic impacts of falsified medical products, neither publication discussed the current problem of false or fraudulently obtained proof of vaccination documentation. Counterfeit proof of vaccination in home-based records (HBRs), particularly those issued to provide documented proof of vaccination against yellow fever virus or polio virus [12], presents a threat to the health and security of countries and their citizens and warrants further discussion and action. Given the imperative of preventing the spread of vaccine-preventable diseases at a time when increased air travel and globalization link communities worldwide as never before [13], efforts seem warranted to (1) understand the magnitude and impact of counterfeit proof of vaccination and (2) work with national health authorities to develop practical counterfeit-deterrent strategies as part of the Eliminate Yellow fever Epidemics (EYE) global strategy (2017–2026) [14] as well as ongoing WHO activity around protection of essential medicines and health products [15]. Efforts to combat counterfeiting are also timely and urgent as part of the Global Health Security Agenda [16] as the likelihood of deadly, cross-border epidemics increases [17] and as countries continue to require international travelers to provide proof of vaccination as a prerequisite for entry (or exit) as part of international health regulations recommended by WHO [18]. This directive combined with improved enforcement at ports of entry into a country and a global yellow fever vaccine shortage [19] could further drive the demand for counterfeit vaccination documents. As providing proof of vaccination for travelers is one of several important HBR functions [20], HBRs deserve particular attention. For many travelers, proof of vaccination status is provided through a duly completed version of the International Certificate of Vaccination or Other Prophylaxis [18] recommended by the World Health Organization. In June 2007, a revised international certificate of vaccination was adopted following the 2005 revision of the International Health Regulations [21]. The revised certificate replaced the International Certificate of Vaccination or Revaccination Against Yellow Fever but did not include any anti-counterfeit guidelines or recommendations. The prevalence and impact of counterfeit medical products highlighted in the 2017 WHO report [11] point to a very real public health problem: a counterfeit problem that is not limited to medicines [22]. In Nigeria counterfeit proof of yellow fever vaccination records have been noted since at least 2012 when travelers from the country holding alleged counterfeit documents were denied entry by officials on arrival in Ghana [23] and South Africa [24]. As a result, the Federal Ministry of Health has attempted to curb the problem by issuing documents that included additional security features; however, a November 2018 report from Lagos airport highlights opportunities for further improvement as the problem of counterfeit documentation may continue [25]. It is far too easy to dismiss HBR counterfeit incidents as a trivial matter. Such incidents are anything but trivial. More must be done to investigate HBR counterfeiting incidents with local authorities. Additionally, we must leverage existing knowledge and explore novel approaches to combat counterfeit proof of vaccination while also exploring design-related solutions to better ensure the integrity of HBRs. The risks of spread of vaccine-preventable diseases by international travelers is a public health concern [26], placing increased importance on safeguarding HBRs as a verified source of travelers’ vaccination status.   Acknowledgement The author acknowledges the editorial support of Ms Stacy Young of Applied Scientific Consulting in preparing this work.   References 1. “Fake Health Certificates Scam Exposed.” Zambia Daily Mail Limited. 29 December 2018. Available online at: http://www.daily-mail.co.zm/fake-health-certificates-scam-exposed/. Accessed 4 January 2019. 2. “Ethiopia to Launch Massive Yellow Fever Vaccination.” Ethio Dailypost. 26 June 2018. Available online at: http://ethiodailypost.com/2018/06/26/ethiopia-to-launch-massive-yellow-fever-vaccination. Accessed 4 January 2019. 3. “Fake Yellow Fever Vaccine Certificates Pose Risk to Whole Indian Population.” RESET. 19 Jul 2013. Available online at: https://reset.org/node/24435. Accessed 4 January 2019. 4. “Ghana denies Nigerians entry over yellow fever card.” Daily Post. 25 July 2012. Available online at: http://dailypost.ng/2012/07/25/ghana-denies-nigerians-entry-yellow-fever-card/. Accessed 4 January 2019. 5. “India warns against ‘fake polio certificates’.” DAWN. 9 October 2014. Available online at: https://www.dawn.com/news/1136759. Accessed 4 January 2019. 6. “Sudan’s Vaccination Card Black Market.” The Daily Beast. 31 August 2015. Available online at: https://www.thedailybeast.com/sudans-vaccination-card-black-market. Accessed 4 January 2019. 7. “Travellers Resort to Fake Yellow Fever Cards.” TravelSafe Clinic. 28 October 2016. Available online at: http://travelsafeclinic.com/travellers-resort-to-fake-yellow-fever-cards-uganda/. Accessed 4 January 2019. 8. “Seven in Trouble Over Fake Vaccination Cards.” Daily News. 28 January 2017. Available online at: https://www.dailynews.co.tz/news/seven-in-trouble-over-fake-vaccination-cards.aspx. Accessed 4 January 2019. 9. “Fake vaccination certs sold.” The Zimbabwean. 9 January 2013. Available online at: http://www.thezimbabwean.co/2013/01/fake-vaccination-certs-sold/. Accessed 4 January 2019. 10. World Health Organization. Counterfeit Drugs. Guidelines for the development of measures to combat counterfeit drugs. Geneva: World Health Organization, 1999. Available online at: http://apps.who.int/medicinedocs/en/d/Jh1456e/. Accessed 4 January 2019. 11. World Health Organization. A study on the public health and socioeconomic impact of substandard and falsified medical products. Geneva: World Health Organization; 2017. License: CC BY-NC-SA 3.0 IGO. Available online at: https://www.who.int/medicines/regulation/ssffc/publications/se-study-sf/en/. Accessed 4 January 2019. 12. Soghaier MA, Saeed KMI, Zaman KK. Public Health Emergency of International Concern (PHEIC) has Declared Twice in 2014; Polio and Ebola at the Top. AIMS Public Health. 2015;2(2):218-222. doi: 10.3934/publichealth.2015.2.218. 13. Brent SE, Watts A, Cetron M, German M, Kraemer MU, Bogoch II, Brady OJ, Hay SI, Creatore MI, Khan K. International travel between global urban centres vulnerable to yellow fever transmission. Bull World Health Organ. 2018;96(5):343-354B. doi: 10.2471/BLT.17.205658. 14. World Health Organization. Eliminate Yellow fever Epidemics (EYE): a global strategy, 2017–2026. Wkly Epidemiol Rec. 2017;92(16):193-204. 15. World Health Organization. Essential medicines and health products. Available online at: https://www.who.int/medicines/about/en/. Accessed 4 January 2019. 16. Katz R, Sorrell EM, Kornblet SA, Fischer JE. Global health security agenda and the international health regulations: moving forward. Biosecur Bioterror. 2014;12(5):231-8. doi: 10.1089/bsp.2014.0038. 17. Suk JE, Van Cangh T, Beauté J, Bartels C, Tsolova S, Pharris A, Ciotti M, Semenza JC. The interconnected and cross-border nature of risks posed by infectious diseases. Glob Health Action. 2014;7:25287. doi: 10.3402/gha.v7.25287. 18. World Health Organization. International Health Regulations (2005). Third Edition. Geneva: World Health Organization, 2005. Available online at: https://www.who.int/ith/en/. Accessed 4 January 2019. 19. “What is behind the global shortage in yellow fever vaccine?” VOA News. 5 May 2016. Available online at: https://www.voanews.com/a/what-is-behind-the-global-shortage-in-yellow-fever-vaccine/3316820.html. Accessed 4 January 2019. 20. World Health Organization. Practical Guide for the Design, Use and Promotion of Home-based Records in Immunization Programmes. Geneva: World Health Organization, 2015. Available online at: https://www.who.int/immunization/monitoring_surveillance/routine/homebasedrecords/en/. Accessed 4 January 2019. 21. Gostin LO, DeBartolo MC, Friedman EA. The International Health Regulations 10 years on: the governing framework for global health security. Lancet. 2015;386(10009):2222-6. 22. Hamisu Hassan, Kate Kolaczinski, and Angela Acosta. Preventing, identifying, and mitigating the impact of fraud, theft, and diversion of insecticide treated nets: A summary of experience and best practices from country programs. VectorWorks Project, Johns Hopkins University-Center for Communication Programs (JHU-CCP), and Tropical Health LLP. 2016. Available online at: https://www.continuousdistribution.org/wp-content/uploads/2017/05/Preventing-Identifying-and-Mitigating-the-Impact-of-Fraud-Theft_mi.pdf. Accessed 4 January 2019. 23. “Ghana denies Nigerians entry over yellow fever card.” Daily Post. 25 July 2012. Available online at: http://dailypost.ng/2012/07/25/ghana-denies-nigerians-entry-yellow-fever-card/. Accessed 4 January 2019. 24. “On Yellow Fever, Yellow Cards, Nigeria And South Africa.” Nigeria Health Watch. 6 March 2012. Available online at: https://nigeriahealthwatch.com/on-yellow-fever-yellow-cards-nigeria-and-south-africa/#.XDUAU1xKg2w. Accessed 4 January 2019. 25. “Investigation: Inside Nigerian airport where cleaners, touts issue fake yellow cards to travelers.” Premium Times. 10 November 2018. Available online at: https://www.premiumtimesng.com/news/headlines/294967-investigation-inside-nigerian-airport-where-cleaners-touts-issue-fake-yellow-cards-to-travelers-2.html. Accessed 4 January 2019. 26. Gautret P, Botelho-Nevers E, Brouqui P, Parola P. The spread of vaccine-preventable diseases by international travellers: a public-health concern. Clin Microbiol Infect. 2012;18 Suppl 5:77-84. doi: 10.1111/j.1469-0691.2012.03940.x.

New articles: The BID Initiative featured in MMS Bulletin #148 "Digital Health - A Blessing or Curse for Global Health?"

The BID Initiative is featured in the most recent issue (December 2018) of the MMS Bulletin #148 "Digital Health - A Blessing or Curse for Global Health." "Marrying engineering with health policy to bring digital health to scale," by Steven C. Uggowitzer, Sima C. Newell, Dykki Settle, Alice Liu and David J. Hagan.  Just as medical doctors take the Hippocratic Oath as they graduate into their profession, so do many engineers solemnly promise to carry out work to the highest quality, recognizing that any errors may put lives at stake. Given this sharing of fundamental values, engineering is a profession that could be leveraged even further towards public health information systems to address opportunities created by the fusion of the early and relatively informal eHealth and mHealth paradigms into the more mature and complex one that is Digital Health. Recently, the World Health Assembly (WHA) adopted a key resolution on Digital Health, urging member states to assess and prioritise the scale-up of the implementation of digital technologies towards the “universal access to health for all”(WHA 71.1, 2018). For the full article, visit the MMS Bulletin. "The challenges of implementing a data use culture," by Hassan Mtenga, Dr. Alex Mphuru, Dawn Seymour, and Laurie Werner.  To increase coverage and equity of routine immunization services, the government of Tanzania is strengthening the data use culture through the implementation of a package of data quality and use interventions, including an electronic immunization registry, for immunization service delivery. Three key phases for achieving scale as a government-owned model emerged during the implementation: user-centered design and testing, PATH-led implementation, and government-led implementation with scale-up. A combination of factors contributed to achieving a government-owned model of implementation and ultimately showed significant time and cost savings, as well as greater ownership and ability to sustain and scale the interventions. For the full article, visit the MMS Bulletin. Other articles in the MMS Bulletin #148 can be found here.  

JUST RELEASED: Rotavirus Surveillance, Safety and Economic Data before Vaccine Introduction: a Global Perspective from the World Health Organization Global Rotavirus Surveillance Network

A new issue of Vaccine is now available: Rotavirus Surveillance, Safety and Economic Data before Vaccine Introduction: a Global Perspective from the World Health Organization Global Rotavirus Surveillance Network 
Edited by Adam L. Cohen, Negar Aliabadi, Fatima Serhan, Jacqueline E. Tate, Patrick Zuber, Umesh D. Parashar This can be accessed from: https://www.sciencedirect.com/journal/vaccine/vol/36/issue/51?dgcid=raven_sd_via_email

New Article: Expenditures on vaccine-preventable disease surveillance: Analysis and evaluation of comprehensive multi-year plans (cMYPs) for immunization.

A new article Expenditures on vaccine-preventable disease surveillance: Analysis and evaluation of comprehensive multi-year plans (cMYPs) for immunization, recently published,  is available here: https://www.ncbi.nlm.nih.gov/pubmed/30236633

New article available on considerations for electronic immunization registries in Africa.

The article Considerations for the development and implementation of electronic immunization registries in Africa, published this year, can be found here: https://www.ncbi.nlm.nih.gov/pubmed/30344865

External evaluation results of the Smart Paper Technology Solution in The Gambia

Herein lies the external evaluation results of the Smart Paper Technology Solution (aka MyChild Solution) in The Gambia which has assessed data quality, efficiency gains, operational costs, and the users’ experiences and perceptions associated with the intervention. In 2017, Shifo Foundation (Shifo), the Ministry of Health & Social Welfare (MoH&SW) of The Gambia, Gavi, the Vaccine Alliance, Action Aid International The Gambia, IKARE, Swedish Postcode Foundation, and Jochnick Foundation started working together to implement The Smart Paper Technology Solution (SPT) in The Gambia. To date, the SPT is implemented in the Western Regions 1 and Western Region 2, two out of seven regions in The Gambia. The real-time progress of work in The Gambia can be seen here. Since the inception of the programme in The Gambia, partners have identified key criteria to evaluate the effects of the programme and make informed decisions. This article summarises the results of the external evaluation conducted by Umeå University in May of 2018. The goal of the external evaluation was to assess four main attributes of the SPT in The Gambia, including 1) the data quality, 2) the annual operating costs, 3) the time efficiency gains for frontline health workers and 4) the users’ experiences and perceptions associated with the intervention. Data Quality Assessment The WHO Data Quality Review Toolkit was used as the framework to asses the data quality of the SPT over the course of three months. Data quality dimensions including 1) completeness and timeliness, 2) internal consistency and 3) external consistency were measured with this toolkit. The results indicated that completeness and timeliness of health facility reports were at 100%. The data was found to be internally and externally consistent. Moreover, the consistency between the reported data and the original records was at 99,95%. Lastly, the recording errors were between 0.7% to 1.5%. Therefore, the SPT scored highly in all of the data quality dimensions and it was concluded to generate high-quality data. Administrative Time Efficiency With the SPT, the frontline health workers’ administration time was reduced by 60% for each child who was fully immunised, receiving Vitamin A and deworming supplements. Annual Operating Costs The operating costs were measured by comparing the annual national cost of the current HMIS forms with the SPT in two different scenarios: excluding and including the monetary value of reduced time which is achieved with the SPT. When the monetary value of reducing the administration time with the SPT was excluded, the SPT (11,675.95 USD) was more expensive than the current HMIS (8,792.54 USD). When the monetary value of reducing the administration time was included, the SPT (3,944.10 USD) was cheaper than the current HMIS (8,792.54 USD). Users’ Experiences and Perceptions Interviews were conducted with frontline health workers and the regional health directorate staff to assess their perceptions of the SPT. The interviewees expressed how the SPT was user-friendly, how this solution delivered benefits to their health facility, and how the workload was less with the SPT when it was compared to the current HMIS. The health workers acknowledged the value of SMS messages sent to parents which remind them of vaccination due dates. The health workers also confirmed the importance of improving data quality. However, the interviewees also expressed how the initial registration of patients was time-consuming during the introduction of the intervention. The health workers also recommended that other health facilities adopt the SPT. In conclusion, the participants’ perceptions of the SPT were overall positive except for the initial registration of patients. Conclusion The external evaluators provided a number of recommendations such as better planning and projection of the necessary human resources required for the initial registration of children. They also recommended the MoH&SW staff to work more closely with data verification. It may also be beneficial to return the Smart Paper Forms to health facilities after they have been scanned for the purposes of increased ownership. The evaluators expressed that scaling-up the SPT would be beneficial and they recommend it.   The full reports and additional information about the Smart Paper Technology Solution (aka MyChild Solution) can be accessed using these links below: Assessment of MyChild Solution in The Gambia: Data quality, administrative time efficiency, operation costs, and users’ experiences and perceptions:https://bit.ly/2U14OGq
About Smart Paper Technology Solution: https://shifo.org/en/solution/ Project progress in The Gambia: https://shifo.org/en/work/gambia/

Handbook on designing and implementing an immunisation information system - European Centre For Disease Prevention and Control

Hereby to share a new resource on IIS produced by the Vaccine-preventable diseases at ECDC in collaboration with partners globally: Designing and implementing an immunisation information system. A handbook for those involved in the design, implementation or management of immunisation information systems https://www.technet-21.org/en/library/explore/immunization-information-systems-coverage-monitoring/5027-handbook-designing-and-implementing-an-immunisation-information-system We would like to hereby acknowledge the contribution of a number of experts in contributing to this report and providing case-studies based on their experience in Immunisation information systems. We hope this document will prove relevant in further informing decisions and discussions at National Level. The handbook proposes strategies that build on the experiences of IIS experts; provides case studies from actual programmes to highlight particular aspects of IIS practice, including functionalities, benefits, challenges, and implementation. It aims to share experiences and explore ideas that IIS experts consider valuable for developing a new IIS or upgrading an existing system,.  The handbook is intended for all those involved in the design, implementation, management or continuous improvement of IIS, such as immunisation programme managers and operational IIS staff; and also public health experts and policymakers. For more information please contact Tarik Derrough, Senior Expert VPD team, ECDC tarik.derrough@ecdc.europa.eu 

Article reporting updated global coverage estimates recently published

New article on "Global Routine Vaccination Coverage - 2017" was recently published in the CDC MMWR. Article can be accessed here: https://www.cdc.gov/mmwr/volumes/67/wr/mm6745a2.htm?s_cid=mm6745a2_e

WHO Immunization Monitoring Academy Fall 2018 programme

The WHO Immunization Monitoring Academy is a learning and capacity-building initiative. The Academy is open to all immunization professionals with an interest in the use, collection, and improvement of immunization data. Starting in Fall 2018, the Academy will offer a WHO Scholar certificate programme to support competency development in national and sub-national staff. The Academy will offer:  Level 1 certificate course in developing a Data Improvement Plan (DIP) in both English and French. A series of workshops on key topics for immunization monitoring. WHO Survey Scholar modules in French. In 2019, the Academy will offer Level 2 certification, focusing on implementation of a Data Improvement Plan. To learn more see the Academy's information page: http://learning.foundation/ima-level1-en/?utm_source=WHO+Scholar+network+(English)&utm_campaign=e9e7e0da24-EMAIL_CAMPAIGN_2018_05_28_05_22_COPY_01&utm_medium=email&utm_term=0_55bba48b4a-e9e7e0da24-260659585

External evaluation results of MyChild Solution based on Smart Paper Technology in Afghanistan. Assessing data quality, operational costs, efficiency gains and transfer of work processes to the existing health system.

Dear colleagues,  The results of external evaluations assessing MyChild Solution based on Smart Paper Technology in Afghanistan are now available. These evaluations assessed the data quality, operational costs, efficiency gains as well as transfer of work processes to the existing health system in Afghanistan. In 2015, the Shifo Foundation, the Swedish Committee for Afghanistan (SCA), IKEA Foundation, and the Ministry of Public Health (MoPH) in Afghanistan started a joint collaboration to strengthen child health services in Afghanistan. Data and information are fundamental to inform decisions and assist key stakeholders to allocate appropriate resources to continuously improve the quality of health services. Therefore, one of the main objectives of the collaboration was to strengthen the quality of data and its utilisation in the Expanded Programme on Immunisation using an innovation based on Smart Paper Technology called MyChild Solution. MyChild Solution is an innovation developed by Shifo Foundation based on Smart Paper Technology. The solution was implemented and evaluated to inform evidence-based decisions on the scale up of the programme. MyChild Solution was implemented in 141 health service delivery points including fixed, outreached, and mobile clinics in the Mehterlam District of Laghman Province in Afghanistan. Currently, using MyChild Solution, more than 45,000 children have been registered, more than 9,000 children are fully vaccinated and more than 11,000 children are being followed up with SMS messages which inform parents about vaccination schedules. From the beginning of the programme, project stakeholders set several programme key success indicators which informed project development and external evaluations. These success indicators measured data quality such as completeness of data, timeliness, internal consistency, and external consistency and analysed if MyChild Solution could be integrated into the existing health system, thus sustained by the government. In June 2018, two external evaluations were conducted to assess data quality, operational costs, and efficiency gains as well as the transfer of work processes to the existing health system. This article summarises the results of these external evaluation reports. The data quality and review toolkit developed by World Health Organisation was used to evaluate the quality of data generated by MyChild Solution. The assessment showed high-quality data generated from MyChild Solution in every indicator, including completeness (100%), timeliness (91,66%), internal consistency (100%), and external consistency (99,4%). Moreover, the ratio of data recording error was low in the study and ranged from 0.05% to 1.7% for two selected data recording errors. The second evaluation investigated time efficiency. This evaluation assessed the time health workers spent on administrative tasks during and after delivery of care with MyChild Solution and compared the results with existing Health Management Information System(HMIS) tools. Results showed that 64% to 96% of time spent on administration could be reduced with MyChild Solution when compared to the current HMIS. Incremental cost analysis was done considering two scenarios. The first scenario took into account the monetary value of the reduced time for administration whereas the second scenario was conducted without the time reduction values. The evaluation also took into account two versions of the MyChild Solution. The first evaluation assessed MyChild Forms which is an innovation on facility-based data management tools. The second evaluation assessed MyChild Card which is an innovation modelled after the child health card. When adding the value of the reduced administration time, the total national cost of MyChild Card was 611,974 USD and the total national cost of MyChild Forms was 316,436 USD. Comparatively, the existing HMIS total national cost was 873,253 USD. Over a five-year period, MyChild Forms would save around 2,938,543 USD and MyChild Card would save around 1,378,875 USD compared to the existing HMIS system. When administration time is removed from the analysis, MyChild Card (501,622 USD) and MyChild Forms (206,126 USD) amounted to be more costly than HMIS forms (195,581 USD). It is noteworthy that when administration time is excluded from the analysis, MyChild Forms were 5% more expensive than HMIS. The second report displayed the results of the transfer of work processes to the existing health system. This is one of the key elements to evaluate the sustainability of the programme as well as how successful management was by the local stakeholders in Afghanistan. The results indicate that 95% of the processes essential to the management of MyChild Solution had been transferred to the local stakeholders in Mehterlam District. In most cases, these processes had been transferred in a way that is both accurate and sustainable. The remaining 5% of processes are planned to be fully transferred to Mehterlam by the end of 2018 to increase process accuracy. The external evaluation reports provide information on the effects of MyChild Solution from four different perspectives which give valuable insights to key stakeholders. These perspectives are data quality, costs, efficiency gains and transfer of work processes to the local level. Based on the findings derived from these external evaluations Shifo, SCA, and MoPH will collaborate to further expand and investigate the intervention on a larger level to inform decision making for the national implementation of the programme. The programme positively addressed all the key success metrics set in 2015 and brings opportunities to empower health and social workers at all levels of healthcare delivery who continuously work to improve quality of child health services across the country based on the reliable and relevant information. The full reports and additional information about MyChild Solution can be accessed using these links below: 1) Questing The MyChild Solution in Afghanistan- An external evaluation of Data Quality, Operational Cost and Efficiency: https://shifo.org/doc/rmnch/MyChildExternalEvaluationAfghanistan2018.pdf 2) MyChild Solution in Afghanistan: An External Evaluation — Transfer of Work Processes to Existing Health System: https://shifo.org/doc/rmnch/ShifoExternalEvaluationTransferProcessAfghanistan.pdf 3) About MyChild Solution based on Smart Paper Technology: https://shifo.org/en/solution/ 4) Project progress in Afghanistan: https://shifo.org/en/work/afghanistan/ 5) Link to the summary of the reports: https://medium.com/shifo-news/external-evaluation-results-313c92ddcb88    Looking forward to your follow up questions/discussions. Kind regards, Nargis  

New tools for data quality and use introduction, adapted from the BID Initiative in Tanzania and Zambia

Strategic reuse of appropriate tools is one of the core principles of the BID Initiative. Over the last five years, we have worked with the governments of Tanzania and Zambia to enhance immunization and overall health service delivery by improving data collection, quality, and use, with interventions such as electronic immunization registries. We have created several planning, implementation, and data strengthening tools for use in Tanzania and Zambia, and have taken the most frequently used tools from both countries and made them generic. We hope other countries will be able to reuse and modify them for their specific needs. To learn more about the tools and how each was used, visit the BID website. Thanks, Celina, on behalf of the BID Initiative team  

Tanzania and Vietnam forge South-South learning exchange to advance electronic immunization registries

As countries increasingly implement and scale electronic immunization registries (EIRs), it will be critical that they exchange lessons and best practices. The BID Initiative, which is led by PATH, in partnership with the governments of Tanzania and Zambia, recently hosted delegates in Tanzania from PATH's Vietnam office and the country's Ministry of Health. Despite their different health contexts and challenges, Vietnam and Tanzania have much to learn from each other. In Vietnam, PATH’s pilot EIR, called ImmReg, was first developed and tested in 2012, before expanding into the National Immunization Information System (NIIS), which was launched in 2017. Last month’s visit was a chance to deepen this partnership and trade lessons about the challenges and successes of securing government buy-in and building health system capacity for EIRs. Check out several of the takeaways from the recent study visit in this blog post.  

HLN releases Version 1.13.1 of its Award Winning Open Source Immunization Forecaster

A new release (v 1.13.1) of the Immunization Calculation Engine (ICE) is now available (download ICE version 1.13.1). ICE is a state-of-the-art open-source software system that provides clinical decision support (CDS) for immunizations for use in Immunization Information Systems (IIS), Electronic Health Record (EHR) and Personal Health Record (PHR) Systems. The release includes support Earliest Date and Overdue Date for additional vaccines: Pneumococcal and Hib. If enabled, ICE will output two additional forecast dates along with the Recommendation Date: the Earliest Date and Overdue Date. The Earliest Date is the soonest date that the vaccine can be given and still be considered valid. The Overdue Date is the date after which an immunization administered would be considered late. With this release, ICE returns the earliest and overdue dates for nine vaccine groups, and the remaining three vaccine groups will be completely supported in a future release of ICE this summer. In addition, this release includes an adjustment to the Pneumococcal catch-up schedule (see Exception 1B in the Pneumococcal Vaccine Group documentation for details). All changes are documented in the release notes. There were no changes to the ICE Implementation Guide (v2r20) which describes how implementers should update their installation and software to properly read the Earliest, Recommended, and Overdue dates. Feel free to e-mail us at ice@hln.com if you have any questions.

New WHO Vaccination Coverage Cluster Surveys Reference Manual available on Technet

WHO would like to announce that the new WHO Vaccination Coverage Cluster Surveys Reference Manual is available on the Technet website on the Coverage Surveys page. This document can be downloaded from here: https://www.technet-21.org/en/topics/vaccination-coverage-surveys under the section on "Current WHO reference manuals"      

A Failure to Communicate - When is Inventory not inventory?

As a relative newcomer to the EPI supply chain world, but not to healthcare supply chain I have always struggled with some of the terminology. One term in particular bugs me. And not just because I can be a bit pedantic but because its genuninely confusing: the term "inventory management" when used in EPI Supply Chain terminology. Now I always understood inventory to be something you or your organization/value chain/supply chain worked on, added value to, to ultimately resell or pass along to an end user. Medicines can be inventory (for a manufacturer or a supply chain). Widgets. Now in the EPI world inventory management is often used to refer to what I would refer to as "assets". To me refrigerators are only inventory if you are making them or are distributing them. If refrigerators are something you use to store vaccines, they are an asset (or a piece of hardware) but they are not inventory. So in meetings when people talk about inventory management, one half of the room thinks we are talking about managing vaccines, and the other half thinks we are talking about assets like fridges and freezers. Words matter, we need to speak the same language. A plea: can we talk about inventory management when we refer to managing medecines/vaccines/ etc and asset management when we talk about fridges, freezers (and indeed trucks and other hardware)? (And of course you could do an inventory on your assets - i.e. count your fridges - just to confuse things even further but I believe asset managmeent or "cold chain asset managment" is a better, more encompassing term)

OpenLMIS 3.3 Webinar en français

Dear TechNet-21 Colleagues, The OpenLMIS Community is hosting a French-language webinar this Thursday, May 24 at 6 AM PST / 13h00 UTC on the latest features in the OpenLMIS 3.3 release. Details for the meeting including the call-in number are below, and the event is listed in the TechNet-21 events calendar.  Hope to see you there!  Tenly Snow
OpenLMIS Community Manager   Invitation en français  Salutations chers collègues, La communauté OpenLMIS organise un webinar en français le 24 mai à 13h00 UTC (6h PST) pour présenter et discuter des dernières fonctionnalités d'OpenLMIS. Une invitation calendrier est jointe. Un webinar supplémentaire en portugais (7 juin) est prévu. Réjoignez l'appel sur Zoom en utilisant ce lien:  
Join from PC, Mac, Linux, iOS or Android: https://zoom.us/j/128422371 Meilleurs vœux dans votre travail,
Mme. Tenly SNOW
Responsable de la Communauté OpenLMIS   Invitation in English Dear colleagues, The OpenLMIS Community is hosting a webinar in French on May 24 at 13h00 UTC (6 AM PST) to present, demo, and discuss the latest features in the OpenLMIS software. A calendar invitation is attached.  An additional webinar in Portuguese is planned for June 7.  Join the call by using this link: 
Join from PC, Mac, Linux, iOS or Android: https://zoom.us/j/128422371      

Tools for monitoring the coverage of integrated public health interventions. Vaccination and deworming of soil-transmitted helminthiasis

PAHO is pleased to introduce a new resource publication that contains a set of modules aimed at improving the monitoring of coverage of integrated public health interventions.  To improve the well-being of the population and bridge gaps in health service delivery, it is necessary to guarantee access to various health interventions, including proven strategies such as vaccination and deworming. Meeting program coverage goals, however, depends on identifying and reaching target populations.This means, in turn, promoting universal access to health using integrated approaches and a more efficient use of resources. What’s more, health services must adopt monitoring and systematic analysis of coverage as indispensable activities. Immunization programs in the Americas have extensive experience with the methodologies and tools for monitoring vaccination coverage. Countries have adopted and improved these instruments, adapting them to a range of target populations and epidemiological contexts. Moreover, the accumulative experience gained in the area of vaccine-preventable diseases (VPDs) may be applied to other programs, like deworming, which uses very effective interventions to reduce the burden of disease caused by soil-transmitted helminths. Registries that generate data on administrative coverage are very useful for helping to control, monitor, and evaluate program evaluation. But the quality of numerators and denominators can affect the quality of coverage data. It is thus important to analyze and interpret administrative coverage indicators correctly, supplementing them with other field methodologies that health teams can use to monitor and evaluate health interventions. The Pan American Health Organization’s (PAHO) Comprehensive Family Immunization Unit and Regional Program on Neglected Infectious Diseases (NIDs) have highlighted the need to systematize and integrate methods for monitoring coverage of health interventions among preschool- and school-age populations and are offering strategies and opportunities for collaboration. Publication is also available in Spanish  

Electronic Immunization Registry: Practical Considerations for Planning, Development, Implementation and Evaluation

This document is designed to support EPI managers and their teams in the implementation of EIR-related information systems, using the various experiences compiled at the global level – and, especially, in the Region of the Americas – as a foundation. Within this context, the main objectives of this document are as follows: 1) To generate knowledge related to information systems and immunization registries for immunization program managers at the national and subnational levels; 2) To provide teams, EPI managers, and experts in health information systems with relevant background and experiences for development, implementation, maintenance, monitoring, and evaluation of EIR systems, so as to support planning of their implementation; 3) To provide technical, functional, and operational recommendations that can serve as a basis for discussion and analysis of the standard requirements needed for development and implementation of EIRs in countries of the Region of the Americas and other regions; 4) To serve as a platform for documentation and sharing of lessons learned and successful experiences in EIR implementation. This document is structured into three major sections: background; EIR planning and design; and EIR development and implementation, taking into account the relevant processes and their structure. The content of the chapters is supported by a literature review of aspects related to EIR requirements and summarizes the experiences of the countries of the Region of the Americas and other regions that already have EIRs in place or are at the development and implementation stage. Many of the experiences presented herein have been shared during the three editions of the “Regional Meeting to Share Lessons Learned in the Development and Implementation of Electronic Individualized Vaccination Registries,” held in 2011 in Bogotá (Colombia), in 2013 in Brasilia (Brazil), and in 2016 in San José (Costa Rica), in addition to ad hoc meetings held by the Pan American Health Organization/World Health Organization (PAHO/WHO), Member States, independent consultants and other agencies such as WHO, BMGF, CDC, PATH, ECDC, AIRA, among others. We appreciate the technical and financial support from the Bill and Melinda Gates Foundation. Publication is also available in Spanish and French 

Call for grey literature on immunization delivery costs in low- and middle-income countries

ThinkWell is currently accepting submissions of GREY LITERATURE about immunization delivery costs in low- and middle-income countries (LMICs). Resources need to be published between January 2005 and January 2018. Please upload your submissions directly to https://collaborativedev.egnyte.com/ul/pbf7fBiKXV. Submitted resources will be considered as part of a systematic review of the current evidence base on immunization delivery costs (IDC) in LMICs, conducted as part of the Immunization Costing Action Network (ICAN), led by ThinkWell and John Snow, Inc. (JSI) to increase the visibility, availability, understanding, and use of data on the cost of delivering vaccines. The three-year project includes this systematic review, country costing studies and a peer learning network and is supported by a grant from the Bill & Melinda Gates Foundation. To access systematic review findings already collected and analyzed, please visit www.immunizationeconomics.org/ican. This initial round of the review considered over 13,000 articles/reports published between January 2005 and January 2017 on the topic. Ultimately, ThinkWell drew from 54 articles/reports on immunization delivery costing data without restricting to a particular vaccine, delivery strategy, type of cost analysis, or setting. Resources available include a standardized and richly annotated Immunization Delivery Cost Catalogue (IDCC) (Excel workbook and web tool) of the data extracted, a summary reporting including immunization delivery unit cost estimates for vaccine delivery through a variety of strategies and in a variety of contexts. and companion interpretive products (e.g., detailed methodology note and user guides). To provide feedback or seek clarification on any of the ICAN resources, please contact ICAN@thinkwell.global.

SAVE THE DATE: OpenLMIS 3.3 Release Webinar

Greetings TechNet Colleagues, Please save the date on Thursday, May 10 at 13h00 UTC (6:00 AM PST) when the OpenLMIS Community will host a webinar presenting the latest features in the OpenLMIS software (webinar will be presented in English). Additional webinars will be presented in French (May 24) and Portuguese (June 7). Further details will be announced closer to the event time, but please feel free to contact us at info@openlmis.org if you would like to attend either of these additional webinars.  Please register for the English-language webinar in advance by clicking here.  Upon registering you will receive call-in details and a calendar invitation.  Contact us at info@openlmis.org or visit http://openlmis.org/ to learn more about the latest release and the OpenLMIS Initiative. Warm regards, Tenly Snow
Community Manager
OpenLMIS

OpenLMIS 3.3 - New Release Supporting Immunization Supply Chains

Greetings iSC Colleagues, The OpenLMIS Community is proud to announce the release of OpenLMIS version 3.3, the latest release in the version 3 series specifically supporting immunization supply chains (iSC). Immunization supply chains are facing a time of decreasing resources and increasing risk, underlining the importance of managing data at all levels. In response to consistent requests to add functionality to address the needs of iSC, OpenLMIS is proud to release the first set of vaccine-specific features in the core OpenLMIS software. New features allow for greater visibility, accountability, and efficiency in vaccine management. New features include:  Robust reporting and analytics Cold chain inventory management Integration with Nexleaf Analytics Remote Temperature Monitoring (RTM) platform Integration with OpenSRP for mobile vaccine stock management Other important announcements include the release of the first iteration of an Implementer Toolkit - a single resource to guide users in the process of implementing an electronic LMIS and many new videos available on the OpenLMIS YouTube channel. Find links to the Toolkit and videos in the OpenLMIS 3.3 Release Newsletter Read more about the release in the full blog post. Full software release details can be found in the 3.3 release notes. SAVE THE DATE: Please join the OpenLMIS Community on THURSDAY, MAY 10 at 6 AM PST for a webinar presenting the latest features in the OpenLMIS software (webinar will be presented in English). Additional webinars will be presented in French (May 24) and Portuguese (June 7). Please contact us at info@openlmis.org if you would like to attend either of these additional webinars. Further details will be announced closer to the event time.  Please register for the English-language webinar in advance by clicking here.  Contact us at info@openlmis.org or visit http://openlmis.org/ to learn more about the latest release and the OpenLMIS Initiative. Yours in good health, Tenly Snow
Community Manager
OpenLMIS  

Going beyond the aggregated: why we have better knowledge on immunisation dropouts with individual patient data

"There is no arguing that aggregate data is useful, but as with most things, it has its limitations."   Read the full article (5 minutes) here: https://medium.com/shifo-news/going-beyond-the-aggregated-why-we-have-better-knowledge-on-immunisation-dropouts-with-individual-efc8e11cf879     

HLN Adds Support for Earliest/Overdue Date in Latest Release of Open Source Immunization Forecaster

A new release (v 1.11.1) of the Immunization Calculation Engine (ICE) is now available (Download ICE version 1.11.1). ICE is a state-of-the-art open-source software system that provides clinical decision support for immunizations (CDSi) for use in Immunization Information Systems (IIS), Electronic Health Record (EHR) and Personal Health Record (PHR) Systems. The release includes support for Earliest Date and Overdue Date. If enabled, ICE will output two additional forecast dates along with the Recommendation Date: the Earliest Date and Overdue Date. The Earliest Date is the soonest date that the vaccine can be given and still be considered valid. The Overdue Date is the date after which an immunization administered would be considered late. In this release, ICE returns the earliest and overdue dates for 4 vaccine groups: Meningococcal ACWY, Polio, Rotavirus and Varicella. The ICE team expects the remaining vaccine groups will be completely supported in future releases of ICE in Spring 2018. In addition, this release includes a General Rule update which fixes an issue that resulted in the General Rule “Shots Administered Below Series Absolute Minimum Age for Dose 1” not being triggering when there are 2 or more invalid shots given below the absolute minimum age for Dose 1. The latest ICE Implementation Guide (v2r19) describes how implementers should update their installation and software to properly read the Earliest, Recommended, and Overdue dates. The relevant information starts on page 43. Note that a “track changes” version of this same guide is also available. The tracked changes are intended to make it easier for the reader to see what has changed in the Guide since the prior release of the ICE Implementation Guide (v2r18). You can determine which release of ICE you are using by viewing the README.HISTORY file that is included with each distribution. Please feel free to e-mail us at ice@hln.com if you have any questions.

Strong partnerships and flexible thinking- lessons from innovations to make data quality and use work in Afghanistan

Dear colleagues,  Wanted to share the recent article we wrote about the big pivot we made in Afghanistan and the story of perseverance and flexibility in partnerships.  It’s great to collaborate with partners, that persevere on the outcomes and are flexible to change the methods, which for us was shifting from high-tech to smart-tech to make data quality and use a reality in low resource settings. We are glad that we made that pivot, and 2 years since we started working in Mehterlam District in Afghanistan, almost all work processes have been transferred/integrated into existing health system structure. We are now in the third year in the project, and we are transferring remaining 10% of work processes.  And it looks like several innovations we developed in Afghanistan are making their way to be further expanded in Laghman Province and to other countries.    Here is a link to the article: https://medium.com/shifo-news/strong-partnerships-and-flexible-thinking-lessons-in-innovation-from-afghanistan-56f3ce0a2682 Enjoy reading and have a wonderful week! Nargis from Shifo Foundation

OpenLMIS Vaccine Module Webinar: November 30 at 8 AM PST

Dear TechNet-21 Members, Please join OpenLMIS on November 30th at 8 AM PST/ 5 PM CET/ 7 PM EAT for a webinar presenting details on the current roadmap and latest developments in the OpenLMIS v3 vaccine module. This webinar will serve as a refresher for those involved with the development of the vaccine module and a presentation of the roadmap and recently developed features for those interested in learning more about how OpenLMIS manages vaccines. Please register in advance for this webinar by visiting: https://zoom.us/meeting/register/9b1a18dcc87534aec5b9141539e44ee6 After registering, you will receive a confirmation email containing information about call-in details to join the meeting. We look forward to speaking with you soon! Please feel free to forward this invitation to your colleagues as well. Best regards, Tenly Snow, OpenLMIS Community Manager

BID Initiative's total cost of ownership study: The importance of costing data for building sustainable electronic immunization systems

Electronic immunization registries (EIRs) and other immunization information systems can be powerful tools, but in order to achieve their long-term sustainability, countries and governments must understand the financial investment to develop, implement, and sustain such tools as the BID Initiative's EIRs in Tanzania and Zambia. This sort of costing information helps countries budget for and plan for expansion.  Learn more about BID's total cost of ownership (TCO) tool in this recent Q&A with our Senior Health Economist, or reference our TCO factsheet. We hope it will benefit other countries interested in implementing their own digital health initiatives.   Sincerely, The BID Initiative

Interesting articles related to ICT and Data on PAHO newsletter

PAHO have released a few interesting articles on ICT and Data in their Immunization Newsletter. Please see attached for further reading.

Immunization Academy Update

This month several new data monitoring and supply videos have been added to www.immunizationacademy.com, including nine new training videos in Swahili. Anyone working in support of EPI can be notified when new videos are added via WhatsApp. Using WhatsApp, text "join" to +255 765 578 712 and you will be added to the Immunization Academy broadcast list. The Immunization Academy is a BMGF-sponsored initiative that provides health professionals with instant access to a comprehensive library of short, practical videos to support immunization training and delivery.

OpenLMIS 3.2 Release - Beta CCE Service

The OpenLMIS community has the pleasure to announce the milestone release of OpenLMIS version 3.2. In line with the version 3 series, 3.2 includes new features in stock management, new administrative screens, targeted performance improvements and a beta version of the Cold Chain Equipment (CCE) service. It also contains contributions from the Malawi implementation, a national implementation that is now live on OpenLMIS version 3. 3.2 represents the first milestone towards the Vaccines MVP feature set and after 3.2 there are further planned milestone releases and patch releases that will add more features to support Vaccine/EPI programs. These enhancements will continue development toward making OpenLMIS a full-featured electronic logistics management information system. Please reference the Living Product Roadmap for the upcoming release priorities. Patch releases will continue to include bug fixes, performance improvements, and pull requests are welcomed. New Features  Stock Management: Added a notification and new support for recording vaccine vial monitor (VVM) status Administrative Screens: View supply lines, geographic zones, requisition groups, and program settings Performance: Targeted improvements were made based on the first version 3 implementer’s usage and results. Improvements were made in server response times which impacts load time and memory utilization. In addition, new tooling was introduced to provide the ability to track performance improvements and bottlenecks Cold Chain Equipment (CCE) service (Beta): Includes support to upload a catalog of cold chain equipment, add equipment inventory (from the catalog) to facilities, and manually update the functional status of that equipment. Review the wiki for details on the upcoming features A full list of features, APIs, services, and tickets can be found in the 3.2.0 Release Notes. The OpenLMIS Initiative’s mission is to make powerful LMIS software available in low-resource environments – providing high-quality logistics management to improve health commodity distribution in low- and middle-income countries. OpenLMIS increases data visibility, helping supply chain managers identify and respond to commodity needs, particularly at health facilities where lack of data significantly impacts the availability of key medicines and vaccines. Learn more at openlmis.org, or by writing to info@openlmis.org

BID Initiatives launches new briefs -- recommendations and lessons learned!

Dear all, Routine immunizations and new vaccine introductions are two best buys in global health. But while immunization coverage has increased dramatically in the last decade, more must be done to ensure every child is reached. To bridge this gap, we need reliable, easily accessed and actionable data on the barriers impeding immunizations, coupled with trained data users at all levels of the health system. The BID Initiative is grounded in the belief that better data, plus better decisions will lead to better health outcomes. Partnering with Tanzania and Zambia, the BID Initiative developed, tested, and rolled out interventions that address some of the most pressing routine immunization service delivery challenges, such as poor visibility into vaccine supplies and difficulty identifying children who default on immunization schedules. These seven briefs summarize the BID Initiative’s approaches and interventions, and share recommendations and lessons learned for others interested in improving immunization data quality and use. We are thrilled to share them with you! Recommendations and Lessons Learned: Introduction to the Briefs Recommendations and Lessons Learned: Data Use Recommendations and Lessons Learned: Electronic Immunization Registries Recommendations and Lessons Learned: Software Development Cycle Recommendations and Lessons Learned: Rollout Strategy Recommendations and Lessons Learned: Change Management  Recommendations and Lessons Learned: Peer Learning Recommendations and Lessons Learned: Sustainability Take Care,
Celina & the BID Initiative Team
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