Table of Contents

List of tables.........................................................................................................................................2
List of figures.......................................................................................................................................2
1.0 Introduction...................................................................................................................................2
1.1 Background................................................................................................................................2
1.2 Scope of Work............................................................................................................................3
Problem Statement..............................................................................................................................3
Justification of Research.....................................................................................................................3
Objectives.............................................................................................................................................3
Key features.....................................................................................................................................3
2.0. Literature Review.........................................................................................................................4
2.1 Introduction................................................................................................................................4
Definition of an Immunization Registry System...............................................................................4
The need for an Immunization Registry System...............................................................................4
DHIS2 Immunization Tracker in Ghana.......................................................................................5
DHIS2 in Rwanda............................................................................................................................6
Methodology........................................................................................................................................6
Procedures............................................................................................................................................7
Data Collection................................................................................................................................7
Data Entry........................................................................................................................................7
Data Validation................................................................................................................................7
Data Storage.....................................................................................................................................7
Data Security....................................................................................................................................7
Data Sharing....................................................................................................................................7
Solutions...............................................................................................................................................7
Expected results...................................................................................................................................7
Limitations...........................................................................................................................................8
Parent concerns...............................................................................................................................8
Limited access for patients..............................................................................................................8
Data quality issues...........................................................................................................................8
List of tables
 Table 1: Project timeline
 Table 2: Budget Breakdown
 Table 3: Potential Risk assessment

List of figures
 Figure 1: IRIS system architecture
 Figure 2: User registration Use case/flow chart
 Figure 3: Immunization record creation process
 Figure 4: reminder notification workflow
 Figure 5: data analytics dashboard

Introduction
The evidence demonstrating the benefits of immunization is overwhelming. Immunization
has been proven as one of the most successful interventions in improving health outcomes. It
is one of the greatest public health achievements of the twentieth century.
Background
Since the launch of Extended Program of Immunization in Malawi in year 1979, child
immunization has remained a key preventive health priority area for GoM. Since then,
various vaccines have been introduced into the extended program of immunization. During
launch of the EPI in 1979, vaccines against six diseases were introduced. For many years,
Malawi has sustained a high coverage of immunization, with well above 80% of the
population having received the six basic vaccinations. Since 1996, periodic immunization
campaigns targeting polio and measles have been successfully conducted in accordance with
the WHO recommendation. These campaigns relished a massive gain in an average
vaccination coverage of 95%. Despite Malawi sustaining a high vaccination coverage,
shockingly, recent reports have indicated a decline in vaccination coverage for all the six
basic vaccinations. Studies from Malawi have reported that women’ low education, having
one or no antenatal visits, having no immunization card, having an immunization card but not
seen, residing in poor households, having a large number of children, and living in the central
region were the most significant factors associated with decreased odds of achieving
vaccination coverage and complete vaccination. The vaccination coverage gains in Malawi
were also greatly affected by COVID-19 pandemic. Misinformation and conspiracy theories
and beliefs among the general society largely affected vaccination coverage in Malawi. Most
of the parents were afraid that their children would be given COVID-19 vaccine without their
consent during a routine in immunization program.
Our Immunization registry system is going to play a critical role in public health by ensuring
that individuals receive necessary vaccinations and tracking vaccination coverage rates. The
system is going to help providers, families, and public health officials by consolidating
information into one reliable source. The information can then be used to guide patient care,
improve vaccination rates, and ultimately reduce vaccine-preventable diseases.
Scope of Work
The scope of work for this project encompasses the design, development, and implementation
of an advanced immunization data management system. Leveraging the modern technologies,
the project’s primary objectives include creating a secure, user-friendly, and centralized
database for immunization records. This scope extends to developing automated reminders
for timely vaccinations, providing comprehensive training and support for system users,
ensuring accurate migration of existing immunization data, conducting rigorous testing, and
hopefully, progressively deploying the system across all healthcare facilities within our
nation. The project aims to deliver a fully operational system that enhances immunization
data accuracy, public health monitoring, healthcare efficiency, while also empowering
individuals with access to their vaccination records. Specific deliverables and milestones will
be detailed in the project plan to guide the successful execution of this scope of work.

Problem Statement
The current registries are characterized by fragmented data, limited accessibility and outdated
technologies. This current situation of IRISs had led to healthcare providers to struggle with
managing immunization record effectively, and public health agencies face challenges in
tracking and reporting vaccination coverage rates and prevent vaccine preventable diseases
like Polio.

Justification of Research
The development of this project is justified for the following reasons:
 Public health impact: Immunization is a cornerstone of health. A robust
registry system can improve vaccination coverage rates, reduce vaccine-
preventable diseases and contribute to overall population health.
 Data accuracy: Current registries suffer from data discrepancies and
inaccuracies due to manual record-keeping. Our IRIS will ensure the accuracy
of immunization record, aiding healthcare providers in delivering timely
vaccines.
 Accessibilities: Our IRIS will provide easy access to immunization records
for healthcare professionals and individuals, enabling efficient vaccination
scheduling and monitoring.
 Data-security: with rising concerns about data security and privacy, IRIS will
prioritize robust security measure to protect sensitive immunization data.
 Efficiency: Automation of reminder notification and reporting management,
IRIS can reduce administrative cost associated with manual record keeping
and data entry.

Objectives
Key features
IRIS will include the following key features:
 User registration and authentication
 Immunization record creation, storage and retrieval
 Automated reminder notification for upcoming vaccination
 Reporting tools for healthcare providers and public health agencies
  Data analytics for monitoring immunization coverage

Literature Review
Introduction
Several organizations support development of Immunization Registry Systems. This chapter
summarizes the most relevant literatures concerning Immunization Registry systems and their
use in Ministry of Health.

Definition of an Immunization Registry System

The term Immunization or Immunisation, is the process by which an individual’s immune
system becomes fortified against an infectious agent. An IIS is an information system that
collects vaccination data about all persons within a geographic area. It consolidates the
immunization records from multiple sources for each person living in its jurisdiction. In
Vaccines (Fifth Edition), 2008 defines Immunization registries as confidential, population-
based, computerized information systems that collect vaccination data about all children
within a geographic area. Immunization information systems are an important tool to increase
and sustain high vaccination coverage by consolidating vaccination records of children and
adults from multiple providers, forecasting next doses past due, due and next due to support
generating reminder and recall vaccination notices for each individual, and providing official
vaccination forms and vaccination coverage assessments.
The need for an Immunization Registry System
Many countries across the globe are working towards developing immunization registries [1]
and can usefully share many lessons along the road [2]. In that context, the collection of
articles in this issue of Euro-surveillance, which follows on an earlier special issue on the
topic in 2012[3], illustrate the evolution and potential of immunization registries to impact on
health. Examples are provided on how an Immunization Information System (IIS) enables
better management of programmes as well as research and evaluation, all of which leads to
quality order to adapt to local particularities in immunization programme recommendations,
legal context, data availability and healthcare delivery systems, those working in the field can
still learn much from each other [4]. For example, while countries such as those in northern
Europe have data systems integrated through a unique personal identification number, data
linkage. Furthermore, many requirements, processes and principles are shared. For example,
‘No duplicate entry or collection’ is an excellent principle that underpins the system design in
Finland as by Baum et al. [5].
Malawi needs an Immunization Registry System to;
i. Improve the vaccine recipient’s experience
 Stores vaccine history
 Helps ensure the quality of vaccine administration
ii. Improve registry performance
 Improves immunization coverage through follow-up
 Reduces dropout rates
 Improves indicators of simultaneity in vaccine administration
iii. Improve registry management and efficiency
  Improves resources and activity planning processes
 Allows a greater focus on support for training and supervision
 Allows establishment of provider workload in terms of immunization
productivity
 Allows complete vaccine traceability
iv. Provide improved evidence for research
 Supports studies of vaccine effectiveness
 Supports vaccination safety studies

According to Desousa (2008), Web based application have four core benefits. These are the
following:
i. Compatibility: Web based applications are far more compatible across
platforms than traditional installed software like web browsers.
ii. Efficiency: Everyone hates to deal with piles of paper unless they do not have
alternatives. The benefit of web based solution makes services and
information available from any web-facilitated Personal Computer(PC).
iii. Security of live data: Normally in more complex systems data is moved about
separate systems and data sources. In web-based systems, these systems and
processes can often be merged by reducing the need to move the data around.
Web-based applications also provide an additional security by removing the
need for the user to have access to the data and back end servers.
iv. Cost Effective: Web-based applications can considerably lower the costs
because of reduced support and maintenance, lower requirements on the end
user system and simplified plans.
DHIS2 Immunization Tracker in Ghana
In 2016, Ghana deployed the DHIS2 Immunisation Tracker (e-Tracker), which is an
extension platform within DHIS2 that provides for collection, management and analysis of
transactional, case-based data at the individual level with built-in reminders for tracking and
following up defaulters. In Ghana, the immunisation tracker is integrated with maternal and
child health and TB services. In an effort to support its implementation at various levels,
Regional EPI coordinators, data managers and health workers were trained on how to use it.
The e-Tracker is currently deployed in seven out of sixteen regions in the country. Using the
approved standard operating procedures (SOPs) that guide different health programs on how
to have their indicators tracked within DHMIS2, the EPI team had a set of indicators
approved for tracking with its data parameters officially included in the immunisation
registers. These include absolute numbers of monthly and cumulative vaccination conducted
by type and level; monthly and cumulative coverage for selected antigens by all levels;
monthly and cumulative vaccine coverage and stock vaccines by health facility among others.
Regular onsite support is provided by the technical teams at the national and district level to
ensure good quality, timely and accurate data capture by the health workers at the health
facility level.
DHIS2 in Rwanda

In 2019, the Ministry of Health of Rwanda’s MCCH/EPI Program expressed the need to
improve the vaccination services in all Health Centres, integrate birth notification into the
child immunization program, and improve compliance with the immunization schedule. The
goal was not only better statistical and public health data, but also to ensure an increase in
immunization service coverage and improve monitoring of immunization dropout to facilitate
timely response.

Before the implementation of Rwanda’s EPI eRegistry, the management of all childhood
vaccination services relied on the use of vaccination cards to track vaccines received and set
the appointments for future vaccination dates. This information was manually recorded for
reporting purposes and program monitoring, with appointment reminders handled through
phone calls from community health workers to parents. Reminders were through phone calls
to CWHs to inform parents with children who missed out the appointment. This system was
slow. While 98% of all children in Rwanda are born in health facilities, birth
notification/registration rarely was reported within the 14-day window that Rwanda required.

In collaboration with HISP Rwanda, UNICEF/CO, UiO, and WHO/CO, the EPI Program
adopted the DHIS2 EPI Tracker module to address these issues. This system is now used in
all health facilities that offer vaccination services (505 in total, both public and private), and
the completeness rate for EPI services is 98% across the country. All the EPI supervisors and
data managers are trained to perform data entry and follow up with children through the EPI
Tracker system. The system also makes it easiest for the facilities to plan staffing and stock
levels based on the calendar of upcoming vaccination appointments. The system is also
configured to send out reminders to parents about upcoming appointments, and allows for the
transfer of patients and their records to another facility if needed. In the first half of this year
(January-June 2020), 234,579 children were newly enrolled in the EPI Tracker for various
vaccines.

While further work is required to achieve all the goals of EPI Tracker–the implementation of
which was partially disrupted due to the Covid-19 pandemic–stakeholders throughout the
MoH are already benefiting from it, and the introduction of the system has led to significant
improvements in vaccination activity management at all levels. For example, the EPI Tracker
helps the EPI program decision makers to plan and monitor the vaccination activities across
the country, early detection of mAPI, and generating aggregate or individual analysis for
advocacy or data dissemination. The EPI Tracker helps health facility managers improve
birth notification and vaccination schedule compliance, and improve vaccination coverage
overall through improved individual case management and monitoring of dropouts rates. The
EPI Tracker helps community health workers by sending them reminders of the next
vaccination sessions for all new-borns/infants with upcoming appointments in their villages.
Finally, the EPI Tracker helps parents and caregivers by providing them with timely
reminders of their child’s upcoming vaccination appointments

Methodology
The methodology chosen for this project is Traditional Systems Development Life Cycle
(SDLC) according Kendall terminology, which divides the methodology into seven phases,
namely;
 1) Investigation (Identifying problems and opportunities)
2) Requirement Determination
3) Analysis
4) Design
5) Develop Software
6) System Test
7) Implement and evaluate
The software process model used with this methodology is the Waterfall model. It is an
example of a plan-driven process in principle, you must plan and schedule all of the process
activities before starting work on them.

Procedures
Data Collection
Healthcare providers collect immunization data during vaccination appointments, including
the type of vaccine administered, the date of administration, the dosage, and the patient’s
demographic information. Data may also include information about the provider who
administered the vaccine and any adverse reactions.
Data Entry
Healthcare providers or their staff enter the collected immunization data into the registry
system.
Data Validation
The registry system will perform data validation checks to ensure the accuracy and
completeness of the entered data. This may include verifying vaccine lot numbers, patient
identifiers, and date formats.
Data Storage
The immunization data is securely stored in a central database.
Data Security
Robust security measures will be implemented to protect the confidentiality and integrity of
immunization records. Access to the registry is restricted to authorized personnel.
Data Sharing
Authorized healthcare providers and public health systems, such as state and national health
departments, to support to

Solutions
Data Quality Assurance: The system will implement data validation checks and quality
control measures to maintain accurate and complete immunization records. This includes
verifying data accuracy during data entry and addressing data discrepancies promptly.

Expected results
One of the primary expected outcomes is an increase in vaccination coverage rate as a result
better data management, reminders, and tracking within the system.
The project will result in improved data accuracy, reducing errors and discrepancies in
immunization records.
Increased use of immunization reminders and recall components will lead to more timely
vaccinations for individuals and better adherence to vaccination schedules and overtime it
will lead to a decrease in the incidence of vaccine-preventable diseases like Polio.

Limitations
Parent concerns
Parents may lack knowledge about childhood vaccinations, have unreasonable fears about
vaccine safety, or lack transportation. They may not be aware of the threat of vaccine-
preventable illness or that safe and effective vaccines are available against these diseases.
Limited access for patients
Individuals (patients) will not have direct access to their immunization records.
Data quality issues
Immunization registry data may suffer from inaccuracies, missing information, or data entry
errors.
Underreporting
Healthcare providers may not consistently report all administered vaccinations to the registry,
leading to underreporting and incomplete vaccination records.

Work Plan
1. Timeframe
The project is expected to be completed within time frame of the semester with
regular milestone reviews of presentation.

2. Timetable
3. Tentative Schedule

Project Budget
Item Cost (USD)
SMS outbound (TNM) / 1 SMS 0.257 * 50
SMS outbound (AIRTEL) / 1 SMS 0.257 * 50
Monthly internet Data pack 10.00
TOTAL : $ 35.7
Table 2

Risk Assessment
Potential risks
 Technical challenges during development
 Data security and privacy concerns
 User adoption and training
Conclusion
The Immunization Registry Information System project aims to address the pressing need for
an efficient, secure and user-friendly platform to manage immunization records. With the
immunization registry information system, we can strengthen public health efforts and
contribute to better immunization outcomes.
We request your approval and support for this project to proceed. Please find the detailed
project plan, and risk assessment attached. We look forward to the opportunity to discuss this
proposal further and answer any questions.
REFERENCES
https://en.wikipedia.org/wiki/Immunization
https://en.wikipedia.org/wiki/Immunization_registry
https://www.cdc.gov/vaccines/programs/iis/index.html#
https://dhis2.org/rwanda-vaccination-management/
https://www.ghspjournal.org/content/11/1/e2100804

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