Determinants of Scale-up From a Small Pilot to a National Electronic Immunization Registry in Vietnam: Qualitative Evaluation

Dang, Huyen; Dao, Sang; Carnahan, Emily; Kawakyu, Nami; Duong, Hong Thi; Nguyen, Trung; Nguyen, Doan; Nguyen, Linh; Rivera, Maya; Ngo, Tuan; Werner, Laurie; Nguyen, Nga

doi:10.2196/19923

Cited by 16 publications

(32 citation statements)

References 21 publications

(36 reference statements)

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“…The unit of implementation also is likely to influence the speed of translation. For example, a set of evidence-based interventions to promote vaccination uptake is likely to be implemented more quickly in a small number of clinics compared with a larger, diverse set of clinics across a state (Dang et al, 2020 ; Dearing & Cox, 2018 ).…”

Section: A Research Agenda On Speedmentioning

confidence: 99%

FAST: A Framework to Assess Speed of Translation of Health Innovations to Practice and Policy

Proctor

Ramsey

Saldana

et al. 2022

Glob Implement Res Appl

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The 17-year time span between discovery and application of evidence in practice has become a unifying challenge for implementation science and translational science more broadly. Further, global pandemics and social crises demand timely implementation of rapidly accruing evidence to reduce morbidity and mortality. Yet speed remains an understudied metric in implementation science. Prevailing evaluations of implementation lack a temporal aspect, and current approaches have not yielded rapid implementation. In this paper, we address speed as an important conceptual and methodological gap in implementation science. We aim to untangle the complexities of studying implementation speed, offer a framework to assess speed of translation (FAST), and provide guidance to measure speed in evaluating implementation. To facilitate specification and reporting on metrics of speed, we encourage consideration of stakeholder perspectives (e.g., comparison of varying priorities), referents (e.g., speed in attaining outcomes, transitioning between implementation phases), and observation windows (e.g., time from intervention development to first patient treated) in its measurement. The FAST framework identifies factors that may influence speed of implementation and potential effects of implementation speed. We propose a research agenda to advance understanding of the pace of implementation, including identifying accelerators and inhibitors to speed.

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Section: A Research Agenda On Speedmentioning

confidence: 99%

FAST: A Framework to Assess Speed of Translation of Health Innovations to Practice and Policy

Proctor

Ramsey

Saldana

et al. 2022

Glob Implement Res Appl

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“…Finally, the lens used in this study was the assessment of the potential added value of EIRs. This study does not attempt to highlight the challenges associated with implementing or maintaining EIRs, although many such challenges have been identified elsewhere [ 1 , 3 , 8 , 9 , 17 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Added Value of Electronic Immunization Registries in Low- and Middle-Income Countries: Observational Case Study in Tanzania

Secor¹,

Mtenga²,

Richard³

et al. 2022

JMIR Public Health Surveill

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Background There is growing interest and investment in electronic immunization registries (EIRs) in low- and middle-income countries. EIRs provide ready access to patient- and aggregate-level service delivery data that can be used to improve patient care, identify spatiotemporal trends in vaccination coverage and dropout, inform resource allocation and program operations, and target quality improvement measures. The Government of Tanzania introduced the Tanzania Immunization Registry (TImR) in 2017, and the system has since been rolled out in 3736 facilities in 15 regions. Objective The aims of this study are to conceptualize the additional ways in which EIRs can add value to immunization programs (beyond measuring vaccine coverage) and assess the potential value-add using EIR data from Tanzania as a case study. Methods This study comprised 2 sequential phases. First, a comprehensive list of ways EIRs can potentially add value to immunization programs was developed through stakeholder interviews. Second, the added value was evaluated using descriptive and regression analyses of TImR data for a prioritized subset of program needs. Results The analysis areas prioritized through stakeholder interviews were population movement, missed opportunities for vaccination (MOVs), continuum of care, and continuous quality improvement. The included TImR data comprised 958,870 visits for 559,542 patients from 2359 health facilities. Our analyses revealed that few patients sought care outside their assigned facility (44,733/810,568, 5.52% of applicable visits); however, this varied by region; facility urbanicity, type, ownership, patient volume, and duration of TImR system use; density of facilities in the immediate area; and patient age. Analyses further showed that MOVs were highest among children aged <12 months (215,576/831,018, 25.94% of visits included an MOV and were applicable visits); however, there were few significant differences based on other individual or facility characteristics. Nearly half (133,337/294,464, 45.28%) of the children aged 12 to 35 months were fully vaccinated or had received all doses except measles-containing vaccine–1 of the 14-dose under-12-month schedule (ie, through measles-containing vaccine–1), and facility and patient characteristics associated with dropout varied by vaccine. The continuous quality improvement analysis showed that most quality issues (eg, MOVs) were concentrated in <10% of facilities, indicating the potential for EIRs to target quality improvement efforts. Conclusions EIRs have the potential to add value to immunization stakeholders at all levels of the health system. Individual-level electronic data can enable new analyses to understand service delivery or care-seeking patterns, potential risk factors for underimmunization, and where challenges occur. However, to achieve this potential, country programs need to leverage and strengthen the capacity to collect, analyze, interpret, and act on the data. As EIRs are introduced and scaled in low- and middle-income countries, implementers and researchers should continue to share real-world examples and build an evidence base for how EIRs can add value to immunization programs, particularly for innovative uses.

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“…For example, Al Awaidy et al used the WHO M&E framework for hepatitis B in reviewing vaccination in several Gulf countries [15]. Dang et al used the mHealth Assessment and Planning for Scale (MAPS) toolkit to assess scale-up of an electronic immunisation registry in Viet Nam [18]. Hutubessy et al used the Cervical Cancer Prevention and Control Costing (C4P) tool to determine costeffectiveness of HPV vaccination in Tanzania [19].…”

Section: Frameworkmentioning

confidence: 99%

Monitoring and Evaluation of National Vaccination Implementation: A Scoping Review of How Frameworks and Indicators Are Used in the Public Health Literature

et al. 2022

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An effective Monitoring and Evaluation (M&E) framework helps vaccination programme managers determine progress and effectiveness for agreed indicators against clear benchmarks and targets. We aimed to identify the literature on M&E frameworks and indicators used in national vaccination programmes and synthesise approaches and lessons to inform development of future frameworks. We conducted a scoping review using Arksey and O’Malley’s six-stage framework to identify and synthesise sources on monitoring or evaluation of national vaccination implementation that described a framework or indicators. The findings were summarised thematically. We included 43 eligible sources of 4291 screened. Most (95%) were in English and discussed high-income (51%) or middle-income (30%) settings, with 13 in Europe (30%), 10 in Asia-Pacific (23%), nine in Africa (21%), and eight in the Americas (19%), respectively, while three crossed regions. Only five (12%) specified the use of an M&E framework. Most (32/43; 74%) explicitly or implicitly included vaccine coverage indicators, followed by 12 including operational (28%), five including clinical (12%), and two including cost indicators (5%). The use of M&E frameworks was seldom explicit or clearly defined in our sources, with indicators rarely fully defined or benchmarked against targets. Sources focused on ways to improve vaccination programmes without explicitly considering ways to improve assessment. Literature on M&E framework and indicator use in national vaccination programmes is limited and focused on routine childhood vaccination. Therefore, documentation of more experiences and lessons is needed to better inform vaccination M&E beyond childhood.

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Determinants of Scale-up From a Small Pilot to a National Electronic Immunization Registry in Vietnam: Qualitative Evaluation

Cited by 16 publications

References 21 publications

FAST: A Framework to Assess Speed of Translation of Health Innovations to Practice and Policy

FAST: A Framework to Assess Speed of Translation of Health Innovations to Practice and Policy

Added Value of Electronic Immunization Registries in Low- and Middle-Income Countries: Observational Case Study in Tanzania

Monitoring and Evaluation of National Vaccination Implementation: A Scoping Review of How Frameworks and Indicators Are Used in the Public Health Literature

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