Three Waves of Data Use Among Health Workers: The Experience of the Better Immunization Data Initiative in Tanzania and Zambia.

The governments of Tanzania and Zambia identified key data-related challenges affecting immunization service delivery including identifying children due for vaccines, time-consuming data entry processes, and inadequate resources. To address these challenges, since 2014, the countries have partnered with PATH's Better Immunization Data Initiative to design and deploy a suite of data quality and use interventions. Two key aspects of the interventions were an electronic immunization registry and tools and practices to strengthen a culture of data use. As both countries deployed the interventions, 3 distinct changes in data use emerged organically. This article provides a detailed summary of these 3 phases or waves, based mostly on qualitative data or observation: (1) strengthening data collection using new data collection tools and processes and increasing efficiency of health workers; (2) improving data quality regarding accuracy and completeness; and (3) increasing use of data to take action to strengthen their work and for programmatic decision making. These waves clearly demonstrated the growing ability of health workers to move from data collectors to data analyzers who began to focus on the data quality and then the value of using the data in their day-to-day activities.

Electronic Immunization Registries in Tanzania and Zambia: Shaping a Minimum Viable Product for Scaled Solutions.

As part of the work the Better Immunization Data (BID) Initiative undertook starting in 2013 to improve countries' collection, quality, and use of immunization data, PATH partnered with countries to identify the critical requirements for an electronic immunization registry (EIR). An EIR became the core intervention to address the data challenges that countries faced but also presented complexities during the development process to ensure that it met the core needs of the users. The work began with collecting common system requirements from 10 sub-Saharan African countries; these requirements represented the countries' vision of an ideal system to track individual child vaccination schedules and elements of supply chain. Through iterative development processes in both Tanzania and Zambia, the common requirements were modified and adapted to better fit the country contexts and users' needs, as well as to be developed with the technology available at the time. This process happened across four different software platforms. This paper outlines the process undertaken and analyzes similarities and differences across the iterations of the EIR in both countries, culminating in the development of a registry in Zambia that includes the most critical aspects required for initially deploying the registry and embodies what could be considered the minimum viable product for an EIR.