The shift from manual to digital management of vaccine information will support the efforts of Government and Health workers in following up every child for all routine vaccine doses, to ensure no child is left behind.
WHO Maldives, Ministry of Health together with UNICEF Maldives unveiled and launched Maldives’s ‘Electronic Immunization Registry’. WHO has been continuously providing support to roll out the Electronic Immunization Registry based on the District Health Information System (DHIS2) platform as a critical instrument to improve data quality, availability, useability and to further strengthen the National Immunization Programme of the Maldives.
Routine immunization strengthening has been one of major priorities for both the Republic of Maldives and WHO South-East Asia Region. Maldives has reached many milestones in its immunization coverage and disease eliminations over the past few decades. However, with the paper-based recordkeeping system in place, Health Protection Agency and Ministry of Health have continued to face many difficulties in generating vaccination-related information of children and indicators for the country. Also, the highly mobile population of Maldives present unusual challenges in terms of calculation of indicators to assess immunization programme performance at subnational level (atoll and island level)
One of the key recommendations of WHO and UNICEF’s joint National/International Expanded Programme on Immunization and Vaccine Preventable Disease Surveillance Review (EPI Review 2019) and COVID-19 and HPV Vaccine Post-Introduction Evaluation (2021) was to accelerate roll out of an Electronic Immunization Registry.
To overcome the challenges in recording and reporting, it was important to have a tracking system to be able to monitor every child. At the same time, systems needed to be put in place to capture Vaccine Preventable Disease Surveillance data to monitor and detect outbreaks and to monitor any Adverse Events Following Immunization (AEFI) to ensure trust and confidence from the community. The Electronic Immunization Registry is developed based on DHIS which is health information management platform used in more than 60 countries around the world. It is an open-source software platform for reporting, analysis, and dissemination of data for all health programs; developed by the Health Information Systems Programme at University of Oslo and supported by WHO.
WHO and Ministry of Health commenced their collaborative work on the District Health Information Software (DHIS2) years ago. The introduction of DHIS2 to Maldives has been carried out in a phased approach. Since 2017, several trainings have been conducted to all health facilities focal points, in addition to international exposure visits, participation in DHIS2 Academy trainings and annual conferences to build capacity of the core team at Ministry of Health in preparation of this milestone event. From 2019, DHIS2 Routine Health Information module has also been rolled out at a national level.
‘The Electronic Immunization Registry’, will contain confidential, population-based, computerized database that records all vaccination doses administered by healthcare providers. Health staff will no longer need to manage paper-based registries and will be able to record and review vaccination information of a child easily and consolidate vaccination events in determining appropriate vaccinations for people. Health facility managers can access timely and accurate data which will allow for better planning and decision making. In addition to individual tracking, the Immunization Information System provides aggregate data on vaccination for monitoring coverage and program operations, guiding public health action. Though initially designed to capture routine childhood immunization, the system has now evolved into a comprehensive immunization registry including recording of optional vaccines, pregnancy vaccination, travelers’ vaccination, and health worker vaccines. The digital tool will capture individual level information of all vaccines delivered in Maldives and will create a complete longitudinal record of all the vaccines received throughout the entire lifecycle of a person.
“This system will also contribute to planning, monitoring and evaluation by providing accurate, timely and complete information. It has been envisaged that EIR would assist in better data management, analysis, monitoring and evaluation of key immunization indicators for informed and evidence-based decision making.” said Dr Nazneen Anwar, WHO Representative, “It is commendable to note that more than 6000 children have already been registered on the portal and more than 50,000 vaccination events have been entered during the initial phase. I take the opportunity to congratulate His Excellency Minister of Health and his team including officers from Health Protection Agency, nodal officers from hospitals, focal persons from atolls and islands for introducing and implementing this digital technology.”
During the ceremony, the Ministry of Health also announced that a beneficiary portal is being developed and will be rolled out in due course. This will help parents to track the vaccination status of their children and download one’s own digital vaccination record with accessibility to QR-code verification.
WHO Maldives has utilized the support of partners such as Health Information Systems Programme (HISP) Sri Lanka and technical experts from the Region to support the country team in the development and implementation of the system. Gavi, the vaccine Alliance has supported the EIR implementation as a funding partner through WHO. The commitment remains to support development of the country’s capacity to ensure system maintenance and sustainability. WHO looks forward to providing support in scaling up the system by integrating other public health programs into this digital health system. This state of the art system has the capability of evolving into a personal health record system for all citizens, and is sure to be an integral part of the digital health architecture in Maldives.
“Digital technologies are now integral to daily life, and the world’s population has never been more interconnected.” said Dr Nazneen Anwar, “WHO is committed to bringing in the required technology and transferring this technology to build the country capacity, ensuring the sustainability of this system.”