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Public-private partnership in immunization data strengthening: Lessons learned from deployment of Vietnam’s electronic immunization registry
Public-private partnerships in health care have been used widely in higher income countries as well as in lower-middle-income countries, such as Vietnam.1 The partnerships tend to bundle together multiple phases or functions of the health care system infrastructure—such as design, build, finance, maintain, operate, and service delivery.1 Such health care system infrastructure can be effectively building on the experience and resourcing strategies of partnerships.2
Vietnam's National Immunization Information System (NIIS) is an ongoing story of a sustainably planned, government-run, nationwide electronic immunization registry (EIR) and vaccine tracking system that demonstrates a public-private partnership that both built the infrastructure and provided the service delivery. The NIIS is the product of a partnership between the Vietnam Ministry of Health and one of the country's largest mobile network operators (MNOs), Viettel Business Solutions Corporation. Nationwide implementation of the NIIS entails essential engagement of private, fee-based immunization facilities that help to expand the reach of immunization services to the population.
Throughout the decade-long evolution of the EIR in Vietnam, PATH has played the role of a catalyst to accelerate coordination and bridge the gap between the two sectors. The IDEAL Vietnam project (Introducing Digital Immunization information systems–Exchange And Learning from Vietnam, funded by the Bill & Melinda Gates Foundation), in collaboration with the National Expanded Program on Immunization, has captured the essence of challenges and lessons learned from two different public-private partnerships. Those are described in the following two case studies summarized here.
To launch an EIR and vaccine tracking system in Vietnam, it was necessary to select an MNO with the largest resources and capabilities in the country. This ensured that the necessary technology, core connectivity, and support and business infrastructure would meet the high demand of large datasets, nationwide application, and sustainable transition from paperless to digital. Trust also played a key role: Viettel is not only one of the largest MNOs in the country, it also has a long-standing working relationship with the Ministry of Health and other governmental agencies. Benefits for the MNO in regard to the EIR partnership included expansion of areas of expertise, recognition, and increased relationships and credibility.
There are key challenges that need to be considered in partnership development and maintenance of an EIR application. In Vietnam, these included learning curves for both parties in regard to technical content and areas of expertise, differing business models between the MNO and Ministry of Health, and the importance of planned formal agreements from the beginning.
Fee-based immunization services in Vietnam follow the same standards, guidelines, and regulations as Expanded Program on Immunization services, including the mandate to utilize the NIIS to document immunization service delivery since its launch in 2017. The status of NIIS data entry, quality, and usage at fee-based immunization facilities (FIFs) varies depending on (1) the interoperability between the NIIS and the FIF's own existing immunization information system, (2) human resources available for data entry into both systems, (3) willingness to comply with regulations, and (4) an understanding of the benefits of the NIIS in immunization coverage for the population.
The government is emphasizing effort in private-sector engagement as the number of FIFs continues to grow in Vietnam, especially in large urban areas like Hanoi and Ho Chi Minh City. Barriers to their engagement were identified and solutions proposed, including developing a strict legal framework for NIIS uptake, providing training for immunization staff at FIFs on the benefit of the NIIS, enhancing data use and data quality, and creating standard operating procedures for data transfer between systems via an application platform interface.
These case studies provide valuable insight for other countries or government bodies in their efforts to collaborate with the private sector in building and scaling up an EIR system.
PATH is a global organization that works to accelerate health equity by bringing together public institutions, businesses, social enterprises, and investors to solve the world's most pressing health challenges. With expertise in science, health, economics, technology, advocacy, and dozens of other specialties, PATH develops and scales solutions—including vaccines, drugs, devices, diagnostics, and innovative approaches to strengthening health systems worldwide. Learn more: at www.path.org.
For more information as well as publications on IDEAL Vietnam, please visit our landing page at https://www.technet-21.org/ideal/index-medical.html