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Table 4 Recommendations on system sustainability

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

Groundwork,Domains 1-7• Understand the existing context, including the technical capacity, for implementing an EIR prior to introduction of the system
• Strong government interest in electronic data is key to continued program support
• Piloting and software updates should be included in planning for scale; a phased roll-out approach can help accommodate changes
Partnerships, and
Financial Health
Technology and contingency planningDomains 8, 9, and 14• EIR data should be easily accessed and used to monitor errors occurring at the facilities
• Create mechanisms to ensure EIR security
• Plan for the number of servers needed to host data locally
Operations-trainingDomain 12• Training strategies should accommodate a variety of skill levels, be standardized across facilities, include multiple cadres of staff, and incorporate multiple on-site visits
• Ensure there are enough staff to perform high-quality training and leverage the use of mentors and champions at the facility-level
• Create training plans to accommodate staff turnover
Operations- supervision and technical supportDomain 12• Integrate supervision within existing structures and adequately budget for visits and incorporate capacity building
• Use standardized supervision checklists
• Develop technical support team to respond assist with troubleshooting and triage issues
Operations- personnel and outreachDomains 11 and 13• Incorporate all levels of EIR-users into program decision-making
• Use community mobilization/sensitization to increase buy-in for the system
• Consistently engage with partners at every step of the roll-out
• Understand existing user capacity and incorporate this into training strategies
• Plan for sustained use of the system from the beginning, including handover of activities from partner organizations to the government
Monitoring and evaluationDomains 15 and 16• Provide access to EIR data so supervisors can monitor the system remotely
• Use standard indicators, tools, and reporting mechanisms to monitor the system
• Develop plan for scale-up and indicators to track system maturity
Sustainability—otherNA• Create a data use culture among users and supervisors
• Identify partners that can support scale-up in other regions
• Plan for equipment and data bundle costs as well as system maintenance, monitoring, and supervision activity costs
• Encourage a high-level of government involvement and leadership
• Plan for scale-up alongside other health programs