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Table 3 Perceptions of Facilitators and Barriers to Scale-Up of an Electronic Immunization Registry

From: Perceptions of factors influencing the introduction and adoption of electronic immunization registries in Tanzania and Zambia: a mixed methods study

AxisDomainFacilitatorsBarriers
Groundwork,Domains 1–7• Identification of a long-term strategy
• Conducted landscape analysis
• Pilot EIR in one region
• Support by MOH for electronic data
• Lack of electricity in facilities
Partnerships, and
Financial health
Technology and contingency planningDomains 8, 9, and 14• Accessibility of data at facility and district levels
• Secure access to EIR
• Use of data standards
• Interoperability of EIR with stock management system (TZ)
• Policies for lost or stolen tablets
• Delays with data synchronisation across the system
• Discrepancies in data across systems
• Inability to access data at provincial level
• Lack of interoperability of EIR with HMIS (ZA)
• Multiple versions of software used (ZA)
• Limited funding and delays with equipment procurement
Operations-trainingDomain 12• Completed multiple training visits per facility
• Trained HCWs and district staff to act as mentors and to provide technical support
• Use of training checklists
• Identified champions
• Trained multiple staff cadres
• Limited MOH staff capacity to conduct mentorship and training
• Limited time available for training
• Inability to scale training approach
• Accommodating varying skill levels and staff turnover
Operations-supervision and technical supportDomain 12• Support of partner organisations for conducting supervision
• Integration of supervision with existing structure
• Use of supervision checklist and plans
• Use of data to target problematic areas
• Trained district staff to provide technical support
• Creation of help desk
• Reliance on partner organisation for support
• Integrated supervision can limit time spent addressing EIR issues
• Limited funding to do EIR-specific supervision visits
• Need for data access and dashboards (ZA)
• Limited internet access
• Lack of a contingency plan (ZA)
Operations-personnel and outreachDomains 11 and 13• HCW and MOH buy-in to EIR use
• Supportive leadership
• Inclusion of MOH and local leaders with all decision-making
• Capacity to deploy program
• Community sensitization
• Support of partner organisation
• Multiple electronic systems deployed at facilities
• Lack HCW skill and confidence
• Limited staffing
• Lack of involvement of technocrats with planning
• Weakened leadership because of reliance on partner organisation
• Lack of focus on sustained use of the EIR
Monitoring and evaluationDomains 15 and 16• Tracking indicators of use
• Roll-out approach
• Planning and review meetings
• WhatsApp groups
• Monitoring visits
• Used monitoring visits of other programs to observe EIR (ZA)
• Few resources for monitoring
• Lack of system interoperability (ZA)
• Lack of indicators to track system maturity
Sustainability-otherNA• Improved ability to register and track children
• Creation of data use culture
• Identification of partners
• Continuity of internet connectivity
• Lack of support for data bundles, tablets, and system maintenance
• Limited mentorship and leadership
• High level of government involvement needed
• Need for planning for scale-up alongside other programs
  1. TZ Tanzania, ZA Zambia; the axes of groundwork, partnerships, and financial health were grouped, and operations was disaggregated by domain due to the amount of information collected