On immunization day at Phu Hung Commune Health Center in southern Vietnam, the atmosphere is loud and sometimes boisterous. The sound of fifty women talking and babies crying reverberates off the concrete walls.
“Things are getting easier,” explains Ms. Linh, who is responsible for the Expanded Immunization Program (EPI) at the small clinic. “Before it took me more than a day to manually generate the list of who to invite to immunization day; now I do it with the computer in just 15 minutes.”
PATH’s Digital Immunization Registry System (DIR) is helping Ms. Linh and her colleagues across Ben Tre Province make the leap from a paper-based to a digital health care system. Earlier this month I made the two hour trek from Ho Chi Minh City to visit two Commune Health Centers engaged in this painstaking but ultimately rewarding transition.
I was accompanied by PATH project officer Sang Dao Dinh, who has been deeply engaged in this project since its inception in 2012 and who will see it to completion later this year.
Learning curve
“The goal is to get all 164 Commune Health Centers in this province proficient with the system, show government the value, and hope that they consider an action plan to scale it up nationwide,” he said.
Sang has been working with EPI officials to conduct dozens of Training of Trainers workshops for immunization program staff based at the clinics, some of whom have never used a computer before. Now they are entering data and running lists of who is due for vaccinations. In turn, the software automatically generates reports that higher-level health managers can see in real time and sends SMS text appointment reminders to patients.
Guest contributor Ingrid MacDonald looks over the shoulder of a health care worker during the launch. Photo: PATH/Sang Dao Dinh.
At times the transition to a new way of doing business has been tough. Sang remembers one staff member who had only a few years left until her retirement. “How I do it now works just fine. I don’t want to hassle with all of this,” the woman told Sang. Months later when Sang visited her clinic, he joked, “What do you think now? Shall we keep this system or is it time to take it away?” “No don’t stop it,” the woman replied, “I can generate lists and reports instantly. I’m not going back to laboring over the ledgers for hours.”
In addition to saving time, the new system is reducing errors by automatically aggregating data instead of relying on manual calculations and by employing built-in functions to check for accuracy.
Text messages provide parents with important reminders such as what immunizations their children need and appointment times. Photo: Mark Leong/WHO consultant.
Mobile reminders
The nearly 60,000 pregnant women, mothers, and children who use Ben Tre’s commune health centers are also seeing the benefits. Thanks to easy access to low-cost mobile phones, nearly all of the women are receiving text reminders to come to immunization day. These messages complement written invitations hand delivered to their homes by village health collaborators.
This interplay is important because, as one mother shared, the handwritten invitations “sometimes get lost, especially if my husband receives it. Texts are what really get my attention.” In the future, inexpensive digital communications might replace the old fashioned hand deliveries. For now the combination seems to be working well.
The new system is meeting people where they are: communicating with them through tools they love and enabling them to access important health care information even if they are on the move. In the past, if a migrant mother brought her child to immunization day at a commune health center far from her original community and she didn’t have her immunization card, her child might be turned away. Today, if she is from within Ben Tre Province, staff can easily look up her child in the DIR system, find out exactly what they are due for, and give them what they need.
Scaling up
PATH’s digital innovation in Ben Tre is saving time, reducing errors, and making it easier than ever for parents to ensure that their children are protected from vaccine-preventable diseases. I’m looking forward to coming back to see this system scaled up nationwide.
The DIRS project is made possible by the United Nations Innovation Working Group’s catalytic grant competition for maternal, newborn and child mobile health (mHealth), managed by the United Nations Foundation.