Improving routine immunization data quality using daily short message system reporting platform: An experience from Nasarawa state, Nigeria.

Routine immunization (RI) delivery was declared a public health concern in Nigeria in 2017 because of persistently low immunization coverage rates reported in independent surveys. However, administrative coverage rates remain high, suggesting serious data quality issues. We posit that a shorter timespan between service provision and data reporting can improve the monitoring of RI data, and developed a short message system (SMS) text reporting strategy to generate daily RI data points from health facilities (HFs). The goal was to assess whether daily data collection produces complete, reliable and internally consistent data points. The SMS reporting platform was piloted between December 2017 and April 2018 in two Local Government Areas (LGAs, equivalent to districts) of Nasarawa state, Nigeria. The 145 healthcare workers from 55 HFs received one mobile phone and pre-configured SIM card, and were trained to send data through predefined codes. Healthcare workers compiled the data after each vaccination session and transmitted them via SMS. We analyzed completeness, number of weekly sessions, and supportive supervision conducted. During the pilot phase, we received data from 85% (n = 47) of the 55 HFs. We expected 66 fixed-post sessions and 30 outreach sessions per week, but received data for 33 fixed-post and 8 outreach weekly session on average. More HFs reported on Tuesdays compared to other days of the week. When assessing internal consistency, we observed that the reported number of children vaccinated was sometimes higher than the number of doses available from opening a given number of vaccine vials. When found, this discrepancy was noted for all antigens during fixed-post and outreach vaccination sessions. Despite these initial discrepancies, transmitting RI data sessions via texting is feasible and can provide real-time updates to the performance of the RI services at the HF level.

Targeted Short Message Service-Based Intervention to Improve Routine Immunization Reporting in Bauchi State, Nigeria, 2016.

Introduction: High quality, timely and complete immunization data are essential for program planning and decision-making. In Nigeria, the National Health Management Information System (NHMIS) Routine Immunization (RI) module and dashboard (on the District Health Information System version 2 (DHIS2) platform) support the use of real time RI data. We deployed an automated short message service (SMS) notification system that works with the existing RI module to facilitate improvements in RI data in the DHIS2. Methods: A pilot project was performed using intervention and control local government areas (LGAs). A mixed methods approach using both qualitative and quantitative methods was used to evaluate the system. We assessed changes in reporting rates across different reports. The evaluation also included baseline and post-intervention surveys of health facility (HF) staff. Results: Reporting timeliness (76% pre and 99% post intervention) and completeness (83% pre and 99% post intervention) were consistently higher during the post-intervention than the pre-intervention period for facilities in the intervention LGA while reporting timeliness (65% pre and 66% post intervention) and completeness (71% and 77% post intervention) for facilities in the control LGA showed no change. Users reported that the SMS system was easy to understand and helped to facilitate improvements in consistency of data and timeliness of reporting. Inability of health care workers to effect changes at the HF level and the lack of immediate feedback were reported as key challenges to timeliness and quality of reports. Conclusion: An SMS-based intervention improved timeliness and completeness of health data reporting. However, the intervention should be evaluated on a larger scale over a longer time period before considering a national implementation.