JMIR Publications

ABSTRACT

Background:

The electronic National Immunization Information System (NIIS) was introduced nationwide in Vietnam in 2017. Health workers were expected to use the NIIS alongside the legacy paper-based system. Starting in 2018, Hanoi and Son La Provinces transitioned to paperless reporting. Interventions to support the transition included data guidelines and training, virtual data review meetings, and additional supportive supervision visits.

Objective:

We aimed to assess (1) changes in NIIS data quality and use, (2) changes in immunization outcomes, and (3) the economic costs of using the NIIS versus the traditional paper system.

Methods:

This was a mixed-methods study in Hanoi and Son La Provinces. For the first two study aims, pre-/post-intervention analyses were conducted using data from the NIIS, household and health facility surveys, and interviews to measure NIIS data quality, data use, and immunization outcomes. For the third aim, financial data were collected through record review at the national level and through interviews and cross-sectional surveys at districts and health facilities. An activity-based costing approach was done from the health system perspective.

Results:

NIIS data timeliness significantly improved from pre- to post-intervention in both provinces. For example, the mean days from birth date to NIIS registration went from 18.6 (pre) to 5.7 (post) days in Hanoi (p<.001) and from 36.1 to 11.7 days in Son La (p<.001). In Son La, most completeness and accuracy indicators improved. However, there were mixed results for completeness and accuracy in Hanoi, likely influenced by the COVID-19 pandemic. Data use improved; at post-intervention, 100% of facilities in both provinces used NIIS data for activities beyond monthly reporting compared to 34.8% in Hanoi and 29.4% in Son La at pre-intervention. Across nearly all antigens, the percent of children who received the vaccine on time was higher in the post-intervention cohort compared to the pre-intervention cohort. Upfront costs associated with developing and deploying the NIIS were estimated at $0.48 per child in the study provinces. The commune health center level showed cost savings from changing from the paper system to the NIIS, mainly driven by human resource time savings. At the administrative levels, incremental costs resulted from changing from the paper system to the NIIS, as some costs increased, such as labor costs for supportive supervision and additional capital costs for equipment associated with the NIIS.

Conclusions:

Hanoi and Son La Provinces successfully transitioned to paperless reporting while maintaining or improving NIIS data quality and data use. However, improvements in data quality were not associated with improvements in immunization outcomes in both provinces. The COVID-19 pandemic likely had a negative influence on immunization outcomes, particularly in Hanoi. There are upfront financial costs associated with these improvements.