Table 3 Perceptions of Facilitators and Barriers to Scale-Up of an Electronic Immunization Registry
Axis | Domain | Facilitators | Barriers |
|---|---|---|---|
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 planning | Domains 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-training | Domain 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 support | Domain 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 outreach | Domains 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 evaluation | Domains 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-other | NA | • 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 |