Mekita Merita, a midwife at the University of Kampala, sits on a bench in the small immunization room at Mukono General Hospital, patiently flipping through the thick Ministry of Health registers.
Around her, two other health workers were tending to patients – giving injections to thighs or dripping vaccines into babies’ mouths. But Merita’s task for the day is paperwork: making sure every adult who gets the hepatitis B vaccine is properly registered.
Unlike traditional registers where data must be read manually and then manually entered into DHIS2, SPT is scannable and details such as the child’s name, parent’s identity and phone number are automatically uploaded to the system.
It’s important work, although not exciting. The hospital’s medical records office will then collect the data she records and enter it into the District Health Information System 2 (DHIS2), a tool used by Uganda to compile data on disease, immunization and other medical interventions performed by health workers across the region. nation.
Image source: Dicta Asiimwe
Because the hepatitis B vaccine is not a routine vaccine for adults in Uganda, it is one of the few vaccines still recorded manually in the register. It takes Merita no less than three minutes to find and enter information for a single vaccination: a patient’s second dose in late September.
paper cutting
If scaled up, those three minutes amount to a health system gridlock. “For someone who was admitted just a month ago, the time it takes to look up a name is going to be a problem when there are no interns to do that kind of work,” said Dr. Anthony Kkonde, the principal and Mukono city health officer.
Mukono General’s medical records show the hospital vaccinates an average of 100 clients each working day. This means that if the three minutes it takes Merita to register a vaccination are standard for all vaccines, recording a day’s worth of immunizations would take health workers five hours.
Dr. Kkonde noted that friction caused by registration management has the potential to reduce vaccination rates. He said Mukono General Hospital usually assigns two health workers to administer immunizations. With only one person handling books, there is likely to be a long queue, resulting in long wait times. This, in turn, is likely to deter some parents from returning to vaccinate their children.
Image source: Dicta Asiimwe
Additionally, data quality will suffer. “As this is a high-traffic hospital, it would be very cumbersome for such a small workforce to take the time to correctly register the details of children for vaccination, so nurses often overlook this part of the job,” he said.
In practice, this oversight may mean that the ledger about vaccine stocks is updated, but a child’s status is skipped, creating a gap in the health system’s oversight of who has or has not been vaccinated.
Scan records for rescue
Dr. Kkonde therefore expresses deep appreciation for the Department of Biomedical Engineering at Karolinska Institutet and Makerere University in Sweden. The two agencies jointly proposed and refined Smart Paper Technology (SPT), which is now in use at health facilities in Mukono to register the details of children and some adults seeking immunization services.
Albert Besigye, monitoring and evaluation expert for Uganda’s National Expanded Program on Immunization (UNEPI), said SPT has been piloted in 14 districts so far, including Mukono. “SPT, as a system, is helping us uniquely identify a child,” Besigye explained.
Image source: Dicta Asiimwe
Unlike traditional registers where data must be read manually and then manually entered into DHIS2, SPT is scannable and details such as the child’s name, parent’s identity and phone number are automatically uploaded to the system.
“It helps provide us with an electronic register of children,” he said.
Customers who register on smart paper receive a unique identification number. Besigye said these make it easy to update vaccination details, as health workers no longer have to dig through reams of ledgers to find clients before entering information for the day’s new vaccines.
Health workers simply write down the SPT number, mark the vaccine administered, then scan the data and automatically upload it to the system.
“With all these details, we are even able to (automatically) generate and send phone messages to remind parents not to default on their children’s vaccinations,” Dr. Kkonde said.
Johnson Mbabu, Medical Records Officer at Mukono General Hospital, added that smart paper is helping to streamline the ongoing COVID-19 vaccination exercise.
Mbambu said using the SPT system, they can quickly upload data to EPIVAC, a portal that hosts COVID-19 vaccination details, so that the public can print vaccination cards for international travel or access to restricted public places.
storage issues
Besigye said one challenge facing SPT – and the reason it has yet to be rolled out across the country – is that it requires a lot of data storage space, which Uganda does not yet have.
“It didn’t work as we expected because according to Uganda’s data policy, the data has to be hosted on domestic servers, but this SPT system is hosted on the cloud,” he said.
Since a solution to the storage space issue has yet to be found, Besigye said they are now trying alternative systems to easily digitize immunity data.
One of the tools currently under development is the National Electronic Community Health Information System (eCHIS). Besigye said under this system, the Ministry of Health registers every child in the community to identify those who have not been vaccinated or have not completed their vaccinations.
However, Mbambu said implementation of the electronic community health information system has been suspended.
Village Health Team (VHT) Member vaccine work People interviewed for this report said the government provided phones to obtain and update details of different people, especially children under five and pregnant women. The government also trained VHT members in August, but at the time of writing, the system was not yet widely operational.