Vanderbilt University Medical Center, Nashville, TN, United States.
Pan American Health Organization, Comprehensive Family Immunization Unit, Washington, DC, United States.
Vaccine. 2018 Nov 29;36(50):7674-7681. doi: 10.1016/j.vaccine.2018.10.083. Epub 2018 Nov 7.
The Global Vaccine Action Plan and the Regional Immunization Action Plan of the Americas call for countries to improve immunization data quality. Immunization information systems, particularly electronic immunization registries (EIRs), can help to facilitate program management and increase coverage. However, little is known about efforts to develop and implement such systems in low- and middle-income countries. We present the experiences of Mexico and Peru in implementing EIRs.
We conducted case studies of an EIR in Mexico and of a population registry in Peru. Information was gathered from technical documents, stakeholder focus groups, site visits, and semi-structured interviews of national stakeholders. We organized findings into narratives that emphasized challenges and lessons learned.
Mexico built one of the world's first EIRs, incorporating novel features such as local-level tracking of patients; however, insufficient resources and poor data registration practices led to the system's discontinuation. Peru created an information system to improve affiliation to social programs, including the immunization program and quality of demographic data. Mexico's experience highlights lessons in failed sustainability of an EIR and a laudable effort to reform a country's information system. Peru's demonstrates that attempts to improve health and other data may strengthen health systems, including immunization data. Major challenges in information system implementation and sustainability in Peru and Mexico related to funding, clear governance structures, and resistance among health workers.
These case studies reinforce the need for countries to ensure adequate funding, plans for sustainability, and health worker capacity-building activities before implementing EIRs. They also suggest new approaches to implementation, including economic incentives for sub-national administrative levels and opportunities to link efforts to improve immunization data with other health and political priorities. More information on best practices is needed to ensure the successful adoption and sustainability of immunization registries in low- and middle-income countries.
《全球疫苗行动计划》和《美洲区域免疫行动计划》呼吁各国提高免疫数据质量。免疫信息系统，特别是电子免疫登记系统（EIR），可以帮助改善规划管理并提高覆盖率。然而，对于中低收入国家在开发和实施此类系统方面所做的努力，我们知之甚少。我们介绍了墨西哥和秘鲁在实施 EIR 方面的经验。
我们对墨西哥的 EIR 和秘鲁的人口登记系统进行了案例研究。从技术文件、利益相关者焦点小组、现场访问和国家利益相关者的半结构化访谈中收集信息。我们将发现组织成强调挑战和经验教训的叙述。
墨西哥建立了世界上第一个 EIR 之一，其中包含一些新颖的功能，例如对患者进行本地跟踪；然而，资源不足和数据登记不善导致该系统停止运行。秘鲁创建了一个信息系统，以改善与社会计划（包括免疫计划和人口数据质量）的关联。墨西哥的经验突出了 EIR 可持续性失败的教训，以及对改革国家信息系统的值得称赞的努力。秘鲁的经验表明，改善健康和其他数据的尝试可能会加强卫生系统，包括免疫数据。在秘鲁和墨西哥，信息系统实施和可持续性方面的主要挑战与资金、明确的治理结构以及卫生工作者的抵制有关。
这些案例研究强调了各国在实施 EIR 之前确保充足的资金、可持续性计划和卫生工作者能力建设活动的必要性。它们还提出了实施的新方法，包括为国家以下行政级别提供经济激励以及将改善免疫数据的努力与其他卫生和政治重点联系起来的机会。需要更多关于最佳实践的信息，以确保在中低收入国家成功采用和维持免疫登记处。
