JMIR Publications

ABSTRACT

Background:

Monitoring childhood immunization programs is essential for health systems. Despite the introduction of an electronic immunization registry called ( e-Tracker) in Rwanda, challenges such as wrong denominators persist, leading to implausible reports of coverage rates of over 100%.

Objective:

We aimed to assess the extent to which the immunization e-Tracker responds to stakeholders’ needs and identify key areas for improvement.

Methods:

In-depth interviews were conducted with all levels of e-Tracker users including immunization nurses, data managers, and supervisors from health facilities in five districts of Rwanda. We used an interview guide based on the constructs of the Human, Organization, and Technology-Fit (HOT-Fit) framework and we analyzed and summarized our findings using the framework.

Results:

Immunization nurses reported using the e-Tracker as a secondary data entry tool in addition to paper, which resulted in considerable dissatisfaction among nurses. While users acknowledged the potential of a digital tool compared to paper-based systems, they also reported the need for improvement of functionalities to support their work, such as digital client appointment lists, lists of defaulters, search and register functions, automated monthly reports, and linkages to birth notifications and the national identity system.

Conclusions:

Reducing dual documentations for users can improve e-Tracker use and user satisfaction. Our findings can help identify additional digital health interventions to support and strengthen the health information system for the immunization program.