The Gambia launches digital immunization registry

A child about to be weighed during immunization sessions in Yorobawol, Upper River Region of The Gambia. Image by the Alkamba Times and used with permission.

This post first appeared in The Alkamba Times on June 21, 2022. This edited version is being republished on Global Voices under a content partnership agreement.

Six years ago, the journey to establish a new Health Management Information System (HMIS) in The Gambia began. This year, all 91 health service delivery points in the country, including public, private, and not-for-profit clinics shifted to using the Smart Paper Technology (SPT) solution. 

The new health information management system will aid the Ministry of Health (MoH) keep track digitally of all children under five with regard to vaccines, reduce the administrative time of health workers during service delivery, and allow decision-makers at the MoH to monitor the progress and performances of facilities based on key performance indicators. Additionally, the external evaluations of the project have shown that the solution is expandable to cover the whole primary health care whilst being sustainable to operate within existing government budgets. This empowers local health workers to contact and support families and allows ministries and other funders to see which regions are facing the biggest challenges with vaccine rollouts.

SPT has reduced the time spent by health workers looking through records, compiling data by hand. They can now spend this time doing more vaccinations, talking with mothers, and starting new health initiatives. In sum, it’s better for patients.

The journey to a digitalized registry

In 2016, The Gambian MoH signed a Memorandum of Understanding together with ActionAid International The Gambia and Shifo Foundation to establish a new form of Health Management Information System (HMIS) in The Gambia.

This intervention implemented a novel hybrid paper-digital solution that collects, shares, stores and distributes data for the Expanded Programme for Immunisation (EPI) using Smart Paper Technology. The data is digitized through the SPT engine and stored in an electronic register from which HMIS reports are generated and shared at a health facility, regional and national levels.

The key stakeholders in the implementation of the project are the Ministry of Health (MoH), ActionAid International The Gambia (AAITG), The Vaccine Alliance (GAVI), IKARE, Swedish Postcode Foundation (PKS), af Jochnick Foundation (af Jochnick) and Shifo Foundation (Shifo).

An external evaluation of data quality and operating costs of Smart Paper Technology (SPT) in The Gambia was conducted in 2018 when the solution was deployed in 4 fixed and 14 outreach health service delivery points in the West Coast Region of the West African country. Based on the findings, the external evaluators recommended the scale-up of the solution in the two regions, which was subsequently agreed on by the MoH, AAITG, and Shifo. 

In July 2018, the scale-up of SPT commenced in Western Regions 1 and 2 and the solution was scaled up in all health service delivery points. A second independent evaluation on the scale-up of the solution took place in 2019 and focused on the themes of data quality, data use, administrative time efficiency, the total cost of ownership and transition of work processes, and perceptions and experiences of health workers.

After the successful evaluation results, the MoH decided to scale-up SPT to the other remaining regions, starting from the Central River Region. The Smart Paper Technology (SPT) Solution has been successfully integrated with DHIS2 which is the world’s largest Health Management Information System (HMIS) to store and analyze health data. Through this platform, the Smart Paper Technology engine feeds data directly into DHIS2 to avoid the manual data entry processes which are prone to errors.

Smart immunization

Smart Paper Technology reduced administrative time spent by health workers during service delivery by at least 60 percent.

The technology “produced accurate data up to 99 percent compared to the previous manual system of data entry and reporting [and] facilitates system data analysis by generating all reports needed by health workers and their supervisors,” according to Yerro Cham, ActionAid International and The Gambia/Shifo Foundation's health innovation officer.

Furthermore, “Smart Paper Technology eliminated manual reporting and data entry at all levels, the perceptions of health workers showed that the solution was easy to use during service delivery, easy to make follow-ups on defaulting children,” Cham said.

At the community level, families with children and women of childbearing age receive SMS messages one day before their visit reminding them about their due date to visit the facility.

Health workers receive key performance indicators and develop strategies to improve vaccine coverage, equity, and quality of immunization services in the underperforming areas. Other benefits include ‍automatically generated request forms used by regional vaccination stores to deliver vaccines and other supplies to each health facility. In addition, decision-makers and planners at regional and national levels review the performance of each health facility/area using the integrated dashboard and reports. The insights help decision-makers identify and close the gaps in health service delivery points.

For health facilities with adequate infrastructure, health workers can capture patients’ health information using the MyShifo App. This results in real-time data being available at all levels of the health system, at any given time. Through the MyShifo App, health workers are also able to access up-to-date patient records to support service delivery, as well as monthly reports.

Whereas improving the quality of data collection is crucial, improving how data is used is vital in achieving efficient health services that deliver better health outcomes. Shifo’s Smart Actions platform enables the data generated by the SPT solution (and by other electronic information systems) to be used as effectively as possible.

Smart Actions facilitates the efficient and systematic continuous quality improvement of health services, making it easier to quickly identify low-performing health facilities and subsequently seek to understand the root causes of the underperformance. As a result, improvement plans are discussed, and actions are agreed to improve performance and maximize the efficiency of services.

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