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

2. 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

3. … 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

4. … 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

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

6. 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

7. 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

8. 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.

9. 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

10. 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

11. 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

12. 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

13. 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

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

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

16. 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

17. Thank you – Tesekkurler - Merci - Gracias