Evaluating the impact of eIR and eLMIS in four low- and middle-income countries

There is growing interest from governments, donors and implementing partners to introduce and scale-up digital health interventions to support immunization service delivery. A multi-country evaluation was performed with the aim of generating evidence to enable future decisions on the introduction and scale-up of electronic immunization registries (eIR) and electronic logistics management information systems (eLMIS) in low- and middle-income countries (LMICs) as well as on their effectiveness, affordability, and sustainability. The evaluation, supported by the Bill and Melinda Gates Foundation (BMGF), the World Health Organization (WHO) and Gavi, the Vaccine Alliance, was conducted in Guinea, Honduras, Rwanda, and Tanzania. Local research institutions and consultants planned, conducted, and managed the fieldwork, supported by the authors.  The research indicated that, by improving the quality and accessibility of data, eIR and eLMIS have the potential to optimize immunization program performance and to lower costs. A more integrated, cross-programmatic design and implementation of the tools may assist in better management of immunization programs. The systems might better support decision-making at the service delivery level if they were designed to better meet frontline HW needs. Use of the tools should result in HWs being more efficient, organized, proactive, and able to immediately use the data generated. Pre-conditions for success include establishing a favorable IT ecosystem, building local capacity, and planning for the early shift from paper to fully electronic systems at the outset. Joint operations with other PHC programs should build the foundation for their sustained use. Government ownership and support from implementation partners are critical to long-term success. Further investments are required to ensure an enabling environment for the continued use of the systems, all of which need to be considered by countries when deciding on the adoption of these solutions.