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Improving National Immunization Program Impact with DHIS2

The World Health Organization (WHO), UNICEF, and Gavi, the Vaccine Alliance have partnered with DHIS2 to improve national immunization program coverage through better data collection, analysis and use

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    Overview of DHIS2 toolkit for immunization

    Since 2017, UiO has partnered with the WHO as a Collaborating Centre for Innovation and Implementation Research on HIS strengthening. Through this partnership, UiO has developed a suite of DHIS2 tools and metadata packages that support countries to adopt WHO immunization program standards into national HMIS.

    More than 30 countries in Africa and Asia have installed the WHO recommended DHIS2 dashboard packages into their national HMIS. Along with the WHO Immunization Analysis App and WHO Data Quality Tool for DHIS2, these dashboard packages empower EPI program managers and district staff to  identify gaps in immunization coverage, reduce stock wastage and monitor cold chain metrics and follow up on facility reports. Thanks in part to the use of DHIS2 analytics and data quality tools, some countries have achieved more than 98% completeness of their immunization data. Increasingly, countries are adopting DHIS2 tracker as an Electronic Immunization Registry (EIR) to improve adherence to the national vaccination schedule and reduce drop-out rates. These tools are designed with integration and sustainability at the forefront, underpinned by WHO recommendations to strengthen national HMIS through integration of immunization, health service delivery and other program data.

    Components of the DHIS2 Toolkit

    The DHIS2 toolkit for immunization includes the following apps and metadata packages, designed for modular implementation and adaptable to local program needs.

    EPI dashboard & analytics package

    Includes WHO-recommended dashboards and indicators for analysis of routine immunization data reported from facilities. Dashboard package can be installed in a country’s existing DHIS2 and indicators mapped to existing data elements. Designed to accompany the WHO’s Analysis and Use of Facility Data Toolkit for EPI.

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    Aggregate EPI metadata package

    Includes standard metadata (data elements, indicators) and dashboards for routine reporting and analysis of immunization data, with a special focus on facility-level data. The package can be installed in a country’s HMIS and ensures alignment with WHO’s indicator framework.

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    Immunization Analysis app

    An installable web app providing enhanced data visualizations to support the analysis and use of WHO-EPI programme data.

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    Bottleneck Analysis (BNA) app

    An installable web app for performing bottlneck analysis on your programs to identify, analyze, and resolve bottlenecks.

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    Scorecard app

    An installable web app for creating scorecards for immunization programs or other health interventions. Can be used alone, or in conjunction with the BNA app.

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    Action Tracker app

    An installable web app that works in conjunction with the BNA and Scorecard apps, for tracking actions taken to address the root causes of bottlenecks.

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    Electronic Immunization Registry (EIR) tracker metadata package:

    Designed for clinicians and staff at health facilities. Enables tracking a child’s immunization history and provides decision support. Incorporates the WHO-recommended immunization schedule and can be adapted according to national policies / schedules. Includes program indicators that are autogenerated and pre-mapped to monthly facility reporting indicators included in the aggregate package.

    Adverse Events Following Immunization (AEFI) tracker metadata package

    Facilitates the reporting of AEFI events and data collection during the investigation of an adverse event. The package can be installed as standalone or as an add-on to the Immunization Registry package. AEFI Training material is available for this package.

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    Birth notification tracker metadata package

    Facilitates notification of births from health facilities with the goal of improving the completeness of birth registration in national CRVS systems. The package can be installed as standalone or as an add-on to the Immunization Registry package.

    VPD (Vaccine Preventable Diseases) aggregate package

    Supports weekly IDSR (Integrated Disease Surveillance and Response) reporting for notifiable diseases. VPD aggregate is similar to the weekly IDSR that many countries in Africa already use with DHIS2. The package helps standardize using WHO definitions.

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    VPD case-based surveillance package (Tracker)

    Enables longitudinal capture of case data, linking clinical, laboratory and case outcome data to a case. The tracker currently supports 9 diseases and can be expanded to capture additional diseases.

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    Mass Campaign package (Coming soon)

    Supports the planning and execution of large-scale immunization / vaccination campaigns.

    Additional metadata packages are being developed for mapping of cold-chain logistics and integrated analytics between health service data and supply chain information.

    Download: Metadata files are available on the WHO package downloads page.

    DHIS2 COVID-19 Vaccine Delivery Toolkit

    The DHIS2 toolkit for COVID-19 vaccine delivery expands field-tested designs and tools from the WHO DHIS2 immunization data toolkit — including aggregate reporting and analysis, EIR Tracker, AEFI Tracker, and vaccine stock management components — to enable countries to rapidly update existing DHIS2 systems to support the equitable delivery of lifesaving COVID-19 vaccines at scale.

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    DHIS2 covax toolkit

    Guide to DHIS2 and Immunization Evidence and Resources

    With support from Gavi, WHO AFRO, and UiO, HealthEnabled produced a guide to support countries that intend to use DHIS2 for immunization-related activities. This guide presents relevant information that can inform the implementation of DHIS2 for immunization through learning from other country experiences, by providing a review of published literature on the use of DHIS2 for immunization program management, as well as a listing of helpful resources on facility-based data, data quality, interoperability, electronic registry using DHIS2, case-based surveillance and reporting on VPDs, vaccine supply chain information systems, bottleneck analysis and scorecards, DHIS2 and birth notifications, Adverse Events Following Immunization (AEFI), immunization campaign monitoring and other general DHIS2 resources.

    Learn more: The Guide to DHIS2 and Immunization Evidence and Resources is available in PDF format. Download the Guide

    Impact stories: Countries using DHIS2 for immunization

    Here are just a few examples from a selection of countries that show how DHIS2 can make an impact in management of immunization programs.

    Rwanda Immunization impact story

    More effective vaccination program management in Rwanda

    Rwanda uses the DHIS2 EPI Tracker to help the EPI program decision makers to plan and monitor the vaccination activities across the country, improve birth notification and vaccination schedule compliance, and improve vaccination coverage overall.

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    Using DHIS2 to manage MR vaccination of 35+ million children in Bangladesh

    The Government of Bangladesh and UNICEF exceeded vaccination targets and streamlined processes using DHIS2 for planning, monitoring, and follow-up for their MR mass campaign, including supervision with the DHIS2 Android Capture App.

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    Coordinating a mass immunization campaign in Uganda

    Uganda used DHIS2 dashboards at a national command center, using real-time data visualization to coordinate a country-wide Measles-Rubella and Polio mass immunization campaign that targeted vaccination of 18 million children for measles-rubella and and 8 million for polio.

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    Harmonizing immunization data across programs and improving data quality in Nigeria

    DHIS2 has been effectively used to manage immunization data in Nigeria since 2014, which has helped make it easier to compare indicators across counties, improved reporting completeness rates, and contributed to data-driven decision making.

    Read the full report

    Improvements in Ghana's EPI program with DHIS2 Immunization e-Tracker and Dashboards

    Ghana first deployed the DHIS2 Immunization e-Tracker in 2016, and uses the DHIS2 Immunization Dashboards at the national, district and sub district levels. This has resulted in more effective data use in managing immunization programs, helped guide decision making and aided in planning.

    Read the case study

    Improving EPI reporting rates and timeliness with DHIS2

    The transition to the DHIS2 for EPI reporting in Togo resulted in large improvements in EPI reporting timeliness–from only 38.2% of reports submitted on time in 2019 to 83% in 2019–as well as improvements in reporting completeness.

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    Read, share, and discuss on the DHIS2 Community of Practice

    The Community of Practice (CoP) is the primary forum for DHIS2 discussion and support. There, you can read, discuss, and share user stories and best practices, raise and help resolve questions and issues, and connect with other members of the global DHIS2 immunization community. Visit the CoP Immunization forum to join the conversation.

    Developed with global support

    Work on DHIS2 immunization packages and resources has been done in collaboration with–and with the financial support of–our international partners: The World Health Organization, UNICEF, and Gavi, the Vaccine Alliance.

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