How can information systems help us? Dr Richard MIHIGO WHO Regional Office for Africa Istanbul, 11 Nov 2014 © 2010 Bill & Melinda Gates Foundation

Great progress in immunization, but still challenging to reach “the fifth child”… Setting the context: programs have been very successful in introducing new vaccines. But we still don’t manage to reach the last communities. © 2010 Bill & Melinda Gates Foundation

… while challenges are multiplying… Changes in health financing Changes in service delivery (public - private) Decentralization More vaccines Population mobility Broader age groups EPI used to be a fairly simple program. Now, there are so many demands and complexity that we cannot necessarily manage with yesterday's tools. Integration Equity © 2010 Bill & Melinda Gates Foundation

… so maybe new solutions are needed. Can better management systems and information put program managers back in the driver’s seat? Haven't we been trying to drive our programs with only a rear-view window perspective? © 2010 Bill & Melinda Gates Foundation

Why are we here? © 2010 Bill & Melinda Gates Foundation

Objectives of an information system We have been doing this: But do we also do this enough? Collecting Checking Sending Receiving Analysing Deciding Managing Information systems are set up to collect data, report it and file it. We manage data, but do we manage with data? Why not?? © 2010 Bill & Melinda Gates Foundation

Systems, people and tools Objectives Increased program performance Better operational (day-to-day) decisions Management response based on real problems Better informed strategy and policy Data not available when needed Data not fit for purpose because not accurate, timely, complete Good data but not used for decision making Challenges Root causes: examples Are too cumbersome Don’t always collect the right data Not adequate to allow for easy data collection, reporting & analysis Are not sufficiently trained on data collection / reporting / usage Lack incentives to collect and use data Systems Tools and technology People Lack the knowledge and skills needed to improve systems Don’t always make it available where needed Don’t provide enough analytical support Paper tools for collection and reporting not always available Receive not enough feedback Systems, people and tools all need to be working together for data to be available, qualitative, and useful © 2010 Bill & Melinda Gates Foundation

Can information systems and technology make a difference? People and information technology paper-based as well as electronic information technology Information can empower people to do a better job Improve health outcomes by providing high-quality relevant data in a timely manner Technology is exciting but not sufficient to lead to sustained improvement by itself.

What information do you need to make better strategic decisions? Coverage and drop out rates by district / health center But also: coverage by community? Numbers of doses rather than coverage in certain cases? Root-causes for non-vaccination: Parental refusal? Vaccine availability? Health worker attitudes? Access? People like this EPI manager in Tunisia need a lot of good information to make the best strategic decisions. © 2010 Bill & Melinda Gates Foundation

What information do you need to make better management decisions? Stock availability at all levels % wastage and reasons % of fridges in disrepair Workload per vaccin²ator Vaccine consumption rates So does this pharmacist in Senegal © 2010 Bill & Melinda Gates Foundation

What information do you need to make better operational decisions? Children to be immunized this week / month? Lists of unvaccinated children. And can we remind them? How much vaccine do I need to order for next month? Or this nurse in Albania © 2010 Bill & Melinda Gates Foundation

Immunization Partners are working towards better country-level information systems. Many pilots and initiatives by a variety of immunization partners are showing potential: logistics management, immunization registries, remote temperature monitoring, geographic information systems… With or without use of information and communication technologies (ICT) Bringing innovations with merit to scale will require all immunization partners to play their role Stock Management Systems can track vaccines through supply chain Registry Systems can track individual children and their vaccinations Barcodes on vaccine packaging can improve traceability across the supply chain Remote temperature monitoring systems can track temperatures in fridges in real time

Let’s think about our roles in bringing innovation to scale Information Sharing Tools and systems Guidance Standards To implement and sustain tools and systems, we need some coordination and a common understanding of what is needed. We are here to define what guidance and standards are needed. But let’s not forget that we will also need the funding and people to sustain an effort like this. Workforce development will be crucial. Finally, let’s think how we can share information and experiences in a more structured way! © 2010 Bill & Melinda Gates Foundation

Not the main question in this meeting "What system or software should we use?"

But: What problems are we trying to solve? What results (outcomes) do we expect? How do we plan to sustain improvements?

This meeting: What kind of standards and guidance? Program standards, not e-health Key performance indicators: outcome and impact indicators well defined, but questions about quality Process indicators need work Vaccine availability Adequate supply Temperature alert rates Sessions held versus planned HR adequacy Funding flows Guidance Use of data for decision making Assessing and improving data quality Assessing and improving information systems Functional standards for electronic management and monitoring systems Workforce development Planning and managing ICT projects

Thank you – Tesekkurler - Merci - Gracias