👩‍💻 Open source helps reach millions of unvaccinated children

• Many countries relied on paper or Excel for data collection, causing delays and quality problems in reporting.
• An eight-year collaboration between the HISP Centre at the University of Oslo and Gavi has built digital vaccination systems in low- and middle-income countries, and today 40 countries use the DHIS2 platform as their main system for vaccination data.
• In Mozambique, 524,383 children who had never been vaccinated were identified and reached, and in Kenya 127,000 previously unvaccinated children were identified with vaccination coverage exceeding 95 percent in campaign areas.

From paper to digital systems

When the collaboration between the HISP Centre and Gavi began in 2018, national immunisation programmes were beset by serious data problems. Fragmented systems were common. Many countries relied on paper or Excel for data collection, causing delays and quality problems in reporting. Only 7 of 54 Gavi-supported countries had integrated their vaccination data into national health information systems.

The collaboration has centred on DHIS2, an open-source platform used in more than 75 low-income countries as a national health management information system. Today, 40 Gavi-supported countries use DHIS2 as their main system for vaccination data, fully integrated with national health information systems.

Concrete results in several countries

The change has produced measurable results. Countries now have access to detailed and timely data on their vaccination programmes, supporting decision-making. Using DHIS2 for disease surveillance has enabled countries to detect and respond to disease outbreaks more quickly and effectively. Integration of facility-level vaccine stock data has improved supply chain efficiency and reduced shortages of vaccines and other health commodities.

In Mozambique, DHIS2 helped identify and reach 524,383 children who had never been vaccinated and who lived in often overlooked settlements. In Kenya, the system supported three national vaccination campaigns reaching 4.3 million children. Digital microplanning tools were deployed in 12 high-priority counties. This helped identify 127,000 previously unvaccinated children, achieve vaccination coverage of more than 95 percent in campaign areas, and reduce data reconciliation time from three weeks to four days.

Digital vaccination records reduce administrative work

An important change that followed in the wake of the COVID-19 pandemic was the shift from aggregated reporting to systems that maintain digital vaccination records for each individual child. Countries such as Rwanda, Liberia, Sri Lanka and Laos introduced such electronic immunisation registers during the pandemic.

Research from Exemplars in Global Health shows that Rwanda's use of a DHIS2-based register led to an 82 percent reduction in the monthly hours health workers spent on administrative tasks. The time spent creating lists of patients who had missed vaccinations fell by 93 percent, freeing up more time for direct patient care.

In Laos, a study found that the large majority of users were positive about the new system, finding it faster and easier to use than their previous one. The researchers noted that the decision to build on an existing platform, DHIS2, was highlighted by key informants as crucial to the early success and as an important driver of acceptance and uptake among healthcare workers.

DHIS2 during the COVID-19 pandemic

During the COVID-19 pandemic, countries shared DHIS2 solutions with one another, helping 60 countries quickly deploy digital tools for disease surveillance and vaccine delivery. This illustrates how open source enables the rapid spread of working solutions between countries without each country having to start from scratch.

Africa CDC Director General Jean Kaseya is among those calling on all African countries to digitalise health data using DHIS2 tracking programmes, to collect person-centred health data at the community level. The goal is to improve healthcare delivery, disease surveillance, and supply chain efficiency and resilience.

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