BID Initiative Briefs: Recommendations Based on Lessons Learned

Partnering with Tanzania and Zambia, the PATH-led BID Initiative developed, tested, and rolled out interventions that address pressing routine immunisation service delivery challenges, such as poor visibility into vaccine supplies and difficulty identifying children who default on immunisation schedules. In addition, through the BID Learning Network, many countries across sub-Saharan Africa participated in the design and testing of tools to help ensure that solutions are relevant for and can be adopted by other countries interested in improving their health programmes through better data. This series of 4-page briefs summarises the BID Initiative's approaches and interventions and shares recommendations and lessons learned for others interested in improving immunisation data quality and use.

• Overview [PDF] - Outlines the challenge BID was created to address - i.e., a major obstacle to improving health and optimising immunisation service delivery is that decision-makers at all levels of the health system are not effectively using data to inform decisions in planning, performance management, and the delivery of services. The Data Use Culture conceptual framework (Figure 1 in the brief) illustrates the interplay between the various elements of a health system and how the information cycle contributes to a culture where data and evidence-based decision-making are prioritised, encouraged, and ultimately expected. The various stages of the information cycle include: collect, transform, act.
• Data Use [PDF] - In Tanzania and Zambia, specific interventions such as data use guides, readiness assessments, and guidelines on supportive supervision complemented the use of the electronic immunisation registry (EIR) to strengthen a culture of data use. As a result of these and other data use interventions, health workers can plan outreach activities to vaccinate specific children in their known catchment area; trace defaulters to a specific village and caregiver, to help increase vaccination rates; and identify patterns or trends in data, such as geographical differences, late vaccinations, and the number of children projected to attend upcoming immunisation clinics. Five recommendations are offered based on lessons learned - e.g., use targeted, supportive supervision and tools such as job aids and dashboards for data visualisation to identify low-performing facilities.
• Electronic Immunization Registries [PDF] - A national EIR can address many of the critical data-related challenges facing immunisation programmes by ensuring that all children are registered at birth and do not miss a potentially lifesaving vaccine and that the necessary stock is on hand when needed. Eight recommendations are offered based on lessons learned - e.g., ensure a user-centred design methodology to provide timely testing and input throughout system development.
• Software Development Cycle [PDF] - The creation of a national-level immunisation registry requires an intense software development process and in-depth knowledge of clinical care, routine immunisation services, and vaccine schedules, as well as an understanding of the data that will feed into the EIR. The software development process can be divided into a number of standard steps, which are outlined in the brief. Seven recommendations are offered based on lessons learned - e.g., design devices and apps for multi-user environments where data are shared offline between users.
• Rollout Strategy [PDF] - Developed in September 2014, the BID Initiative's rollout strategy builds health workers' awareness, access to information, motivation, and empowerment to act, as well as the skills they need to improve data quality and use across the health system. District Immunization Mentors, later known as Data Use Mentors, were identified from among local government staff to lead the rollout of interventions and encourage buy-in. Five recommendations are offered based on lessons learned - e.g., engage mothers so they understand the changes they see at the facility and what those changes mean for the health services they receive.
• Change Management [PDF] - One aspect of change management has been analysing and advising on priority areas that will facilitate implementation of the registry. The initiative has also promoted a coordinated approach to strategies and activities across both demonstration countries of Tanzania and Zambia. This will ultimately enable effective communication and knowledge transfer of successful strategies between policymakers and implementers and across the 2 demonstration countries. Dr. John Kotter's 8-step change model is depicted and applied to BID's strategy. Five recommendations are offered based on lessons learned - e.g., express the urgent need for change in a way that beneficiaries can appreciate and embrace.
• Peer Learning [PDF] - The BID Learning Network (BLN) features 3 tiers of country participation: discussion countries, design countries, and the 2 demonstration countries. The BLN is intended to be a member-owned platform where participants set the agenda, actively participate, contribute ideas, and share experiences. Seven recommendations are offered based on lessons learned - e.g., organise participating countries into a formal collaborative and limit participation to 15 to 20 people who can form close bonds and communicate openly and honestly about real-world issues.
• Sustainability [PDF] - Planning for sustainability focuses on 4 key areas: policy, institutional factors, technical issues, and financial considerations. Five recommendations are offered based on lessons learned - e.g., create a realistic, shared vision among partners and the government from the start.