Assessing electronic immunization registries: the Pan American Health Organization experience.

OBJECTIVE: To develop a methodology to assess electronic immunization registries (EIRs) in low- and middle-income countries (LMICs) in Latin America and the Caribbean. METHODS: A team from the Immunization Unit at the Pan American Health Organization (PAHO) reviewed existing methodologies to evaluate health information systems, particularly the Performance of Routine Information System Management (PRISM) framework and methodologies used to assess information systems. In 2014, the PAHO team convened a small working group to develop an evaluation approach to be added to the existing World Health Organization immunization data quality self-assessment (DQS) tool. The resulting DQS with an added EIR component was named "DQS Plus." The DQS Plus methodology was used in Panama in May 2014 and in Honduras in November 2015. RESULTS: The DQS Plus tool proved feasible and easy to implement in Panama and Honduras, including by not adding much time or resources to those needed for a usual DQS. The information obtained from the DQS Plus assessment was practical and helped provide health authorities with recommendations to update and improve their EIR, strengthen the use of the registry, and enhance the data the assessment produced, at all levels of the health system. These recommendations are currently being implemented in the two countries. CONCLUSIONS: The DQS Plus proved to be a practical and useful approach for assessing an EIR in an LMIC and generating actionable recommendations. Further work on defining operational and related EIR functional standards in LMICs will help develop an improved EIR assessment tool for Latin America and the Caribbean, and potentially elsewhere.

Assessing electronic immunization registries: the Pan American Health Organization experience

[ABSTRACT]. Objective. To develop a methodology to assess electronic immunization registries (EIRs) in low- and middle-income countries (LMICs) in Latin America and the Caribbean. Methods. A team from the Immunization Unit at the Pan American Health Organization (PAHO) reviewed existing methodologies to evaluate health information systems, particularly the Performance of Routine Information System Management (PRISM) framework and methodologies used to assess information systems. In 2014, the PAHO team convened a small working group to develop an evaluation approach to be added to the existing World Health Organization immunization data quality self-assessment (DQS) tool. The resulting DQS with an added EIR component was named “DQS Plus.” The DQS Plus methodology was used in Panama in May 2014 and in Honduras in November 2015. Results. The DQS Plus tool proved feasible and easy to implement in Panama and Honduras, including by not adding much time or resources to those needed for a usual DQS. The information obtained from the DQS Plus assessment was practical and helped provide health authorities with recommendations to update and improve their EIR, strengthen the use of the registry, and enhance the data the assessment produced, at all levels of the health system. These recommendations are currently being implemented in the two countries. Conclusions. The DQS Plus proved to be a practical and useful approach for assessing an EIR in an LMIC and generating actionable recommendations. Further work on defining operational and related EIR functional standards in LMICs will help develop an improved EIR assessment tool for Latin America and the Caribbean, and potentially elsewhere.

[RESUMEN]. Objetivo. Formular una metodología para evaluar los registros de inmunización electrónicos en los países de ingresos bajos y medianos de América Latina y el Caribe. Métodos. Un equipo de la Unidad de Inmunizaciones de la Organización Panamericana de la Salud (OPS) examinó las metodologías existentes para evaluar los sistemas de información de salud, en particular el marco Performance of Routine Information System Management (PRISM), que analiza la gestión de la información sistemática, así como otras metodologías empleadas para evaluar los sistemas de información. En el 2014, el equipo de la OPS reunió a un pequeño grupo de trabajo para idear una estrategia de evaluación que se le agregaría a la herramienta existente de la Organización Mundial de la Salud para autoevaluación de la calidad de los datos (DQS) relativos a la inmunización. La herramienta DQS resultante, con un componente añadido de registros de inmunización electrónicos, se denominó “DQS Plus”. La metodología de DQS Plus se usó en Panamá en mayo del 2014 y en Honduras en noviembre del 2015. Resultados. Se demostró que la herramienta DQS Plus fue factible y fácil de aplicar en Panamá y Honduras, entre otras cosas por no requerir mucho tiempo ni recursos adicionales a los necesarios para la DQS ordinaria. La información obtenida mediante la evaluación con DQS Plus fue práctica y contribuyó a proporcionar a las autoridades sanitarias las recomendaciones para actualizar y mejorar sus registros de inmunización electrónicos, fortalecer el uso del registro y mejorar los datos que arrojó la evaluación, a todos los niveles del sistema de salud. En la actualidad están poniéndose en práctica dichas recomendaciones en los dos países. Conclusiones. Se demostró que DQS Plus es una estrategia práctica y útil para evaluar un registro de inmunización electrónico en los países de ingresos bajos y medianos y generar recomendaciones aplicables. El trabajo ulterior para definir las normas operativas y funcionales de los registros de inmunización electrónicos en los países de ingresos bajos y medianos contribuirá a crear una mejor herramienta de evaluación de dichos registros en América Latina y el Caribe, y posiblemente en otros sitios.

[RESUMO]. Objetivo. Elaborar uma metodologia para avaliar os registros eletrônicos de vacinação em países de baixa e média renda na América Latina e no Caribe. Métodos. Uma equipe da Unidade de Imunização da Organização Pan-Americana da Saúde (OPAS) analisou as metodologias existentes para avaliação dos sistemas de informação em saúde, em particular a estructura de Desempenho da Gestão Rotineira dos Sistemas de Informação (PRISM) e as metodologias usadas para avaliação de sistemas de informação. Em 2014, a equipe da OPAS formou um pequeno grupo de trabalho com a incumbência de desenvolver um método de avaliação a ser integrado à ferramenta existente de autoavaliação da qualidade dos dados de imunização (DQS) da Organização Mundial da Saúde (OMS). A ferramenta DQS com o novo componente de registros eletrônicos de vacinação foi denominada “DQS Plus”. A metodologia DQS Plus foi empregada no Panamá, em maio de 2014, e em Honduras, em novembro de 2015. Resultados. A ferramenta DQS Plus provou ser viável e fácil de ser implementada no Panamá e em Honduras, principalmente por não despender mais tempo ou recursos aos já necessários com a habitual ferramenta DQS. As informações obtidas na avaliação com a ferramenta DQS Plus foram práticas e contribuíram com recomendações às autoridades sanitárias de atualizar e melhorar os registros eletrônicos de vacinação, reforçar o uso do registro e aprimorar os dados produzidos com a avaliação em todos os níveis do sistema de saúde. Essas recomendações estão atualmente em fase de implementação nos dois países. Conclusões. A ferramenta DQS Plus é comprovadamente um método prático e útil para avaliar os registros eletrônicos de vacinação em países de baixa e média renda e gerar recomendações executáveis. Outros estudos com o objetivo de definir os padrões operacionais e funcionais relacionados aos registros eletrônicos de vacinação nos países de baixa e média renda devem contribuir para o desenvolvimento de uma versão aprimorada da ferramenta de avaliação de registros eletrônicos de vacinação para a América Latina e o Caribe e possivelmente para outras regiões.

Examining the cost of delivering routine immunization in Honduras.

BACKGROUND: Many countries have introduced new vaccines and expanded their immunization programs to protect additional risk groups, thus raising the cost of routine immunization delivery. Honduras recently adopted two new vaccines, and the country continues to broaden the reach of its program to adolescents and adults. In this article, we estimate and examine the economic cost of the Honduran routine immunization program for the year 2011. METHODS: The data were gathered from a probability sample of 71 health facilities delivering routine immunization, as well as 8 regional and 1 central office of the national immunization program. Data were collected on vaccinations delivered, staff time dedicated to the program, cold chain equipment and upkeep, vehicle use, infrastructure, and other recurrent and capital costs at each health facility and administrative office. Annualized economic costs were estimated from a modified societal perspective and reported in 2011 US dollars. RESULTS: With the addition of rotavirus and pneumococcal conjugate vaccines, the total cost for routine immunization delivery in Honduras for 2011 was US$ 32.5 million. Vaccines and related supplies accounted for 23% of the costs. Labor, cold chain, and vehicles represented 54%, 4%, and 1%, respectively. At the facility level, the non-vaccine system costs per dose ranged widely, from US$ 25.55 in facilities delivering fewer than 500 doses per year to US$ 2.84 in facilities with volume exceeding 10,000 doses per year. Cost per dose was higher in rural facilities despite somewhat lower wage rates for health workers in these settings; this appears to be driven by lower demand for services per health worker in sparsely populated areas, rather than increased cost of outreach. CONCLUSIONS: These more-precise estimates of the operational costs to deliver routine immunizations provide program managers with important information for mobilizing resources to help sustain the program and for improving annual planning and budgeting as well as longer-term resource allocation decisions.

Tracking financial flows for immunization in Honduras.

INTRODUCTION: In Honduras, until 2008, vaccine and injection supplies were financed with domestic resources. With the introduction of rotavirus vaccine in 2009 and pneumococcal conjugate in 2011, the country's Expanded Program on Immunization required an influx of resources to support not only vaccine procurement but also investments in cold chain infrastructure and programmatic strategies. This paper examines the origin, allocation, and use of resources for immunization in 2011 in Honduras, with the aim of identifying gaps in financing. METHODS: An adaptation of the System of Health Accounts (2011) codes was used to specifically track resources for immunization services in Honduras for 2011. All financial flows were entered into an Excel database, and each transfer of resources was coded with a financing source and a financing agent. These coded financing sources were then distributed by provider, health care function (activity), health care provision (line item or resource input), and beneficiary (geographic, population, and antigen). All costs were calculated in 2011 United States dollars. RESULTS: In 2011, financing for routine immunization in Honduras amounted to US$ 49.1 million, which is equal to 3.3% of the total health spending of US$ 1.49 billion and 0.29% of the GDP. Of the total financing, 64% originate from domestic sources. The other 36% is external financing, most importantly Gavi support for introducing new vaccines. This analysis identified potential financing gaps for many immunization-related activities besides procuring vaccines, such as expanding the cold chain, training, social mobilization, information systems, and research. CONCLUSIONS: The funding for Honduras' immunization program is a small share of total public spending on health. However, new vaccines recently added to the schedule with financial support from Gavi have increased the financing requirements by more than 30% in comparison to 2008. The Honduran government and its partners are developing sustainability plans to cover a financing gap that will occur when the country graduates from Gavi support in 2016. Access to lower vaccine prices will make the existing and future program, including the planned introduction of HPV vaccine to adolescent girls, more affordable.

Integrating health promotion and disease prevention interventions with vaccination in Honduras.

OBJECTIVE: We sought to review and describe health interventions integrated with immunization delivery, both routine and during national vaccination weeks, in Honduras between 1991 and 2009. METHODS: We compiled and examined all annual evaluation reports from the national Expanded Program on Immunization and reports from the national vaccination weeks (NVWs) between 1988 and 2009. We held discussions with the persons responsible for immunization and other programs in the Health Secretary of Honduras for the same time period. RESULTS: Since 1991, several health promotion and disease prevention interventions have been integrated with immunization delivery, including vitamin A supplementation (since 1994), folic acid supplementation (2003), early detection of retinoblastoma (since 2003), breastfeeding promotion (2007-2008), and disease control activities during public health emergencies, such as cholera control (1991-1992) and dengue control activities (since 1991, when a dengue emergency coincides with the NVW). Success factors included sufficient funds and supplies to ensure sustainability and joint planning, delivery, and monitoring. CONCLUSIONS: Several health interventions have been integrated with vaccination delivery in Honduras for nearly 20 years. The immunization program in Honduras has sufficient structure, organization, acceptance, coverage, and experience to achieve successful integration with health interventions if carefully planned and suitably implemented.

An overview of the National Consultative Council of Immunization in Honduras.

The State of Honduras instituted its technical advisory committee on immunization in response to recommendations made by the Pan-American Health Organization (PAHO) and the National Extended Program of Immunization (EPI). On 9 October 1999, the "National Consultative Council of Immunization" (NCCI) was established to provide support and recommendations to the EPI program for the eradication, elimination and control of vaccine-preventable diseases. The seven permanent members of the Council are all paediatricians. Additionally, there are liaison members (from PAHO, the national EPI team, and others) who participate in NCCI meetings when required. Meetings take place three times per year. The high quality of Council recommendations is demonstrated by the fact that the health authorities have adopted all of them.