Framework for Action

Countries: Costa Rica, Colombia, Brazil

Electronic immunization registries (EIRs) are computerized information systems that record individualized data on vaccine doses delivered. More than 50 LMICs are at some stage of implementing EIRs and an increasing number of countries in Africa are considering an EIR to replace paper-based systems of manual recording¹. Immunization programs in countries such as Costa Rica, Colombia, Brazil, and others are adding value to PHC by linking their EIR with the national birth registration system. By linking the two systems through interoperable software, health workers can compare data across systems, identify discrepancies, and reduce duplicative data entry.

PHC levers: Enabling Factors: Digital (leveraging technology and interoperability between systems to facilitate immunization record keeping and birth registration); M&E (generating higher quality data for service delivery planning and monitoring); political commitment and leadership (coordination across programs and sectors); governance and policy frameworks (digital strategies and plans); PHC workforce (training HCWs on data collection and entry).

Constraining Factors: M&E (lack of unique identifiers, i.e. patient ideas, to facilitate interoperability between systems; many countries (low income countries particularly) have weak or non-existent civil registration and vital statists (CRVS).

Added Value:
Contribution to RI: Cross-checking immunization records with the birth registry can identify children who have never been vaccinated and improve data quality. Also, health worker time spent recording immunizations can be reduced if a new patient’s details are already captured in the CRVS.

Contribution to PHC: In many countries, national birth registration falls behind childhood immunization rates². By strengthening collaboration between immunization and maternal health service programs, birth registration could be improved, providing population statistics that are necessary for effective and efficient planning and monitoring of health services.

In Costa Rica, the EIR and birth registration system are designed to be interoperable in real time. When a patient’s national ID number is entered, the EIR automatically connects to the national registry and fills in details, such as the person’s name, date of birth, calculated age, and sex.

In Colombia, the records in the EIR and birth registry are compared on a monthly basis to identify any discrepancies; children who are captured in only one database are then added to the other for more complete population coverage.

In Brazil, there is a routine search through the civil registry to confirm children registered are also captured in the EIR.

When to consider this approach:

  • When developing digital health strategies, or conversely, during national immunization strategy development to ensure alignment with digital health strategies, and integration with efforts to strengthen data systems for PHC.
  • In contexts where the digital health architecture components exist to facilitate interoperability between systems.
  • In contexts where there is strong collaboration between immunization, maternal health service programs, and other ministries (e.g. Ministry of the Interior).