Innovations Driving Programmatic Performance in Immunization: Service Experience and Data Use + Measurement (Round 22)

The Opportunity

Immunization represents one of public health's most valuable and cost-effective interventions, and delivers positive health, social, and economic benefits. Globally, an estimated 2-3 million child deaths and 600,000 adult deaths are prevented by vaccination on an annual basis. Vaccination has been shown to contribute to improved childhood physical development, higher educational outcomes, reduced poverty and household spending, and enhances equity (Deogaonkar et al. 2015; Verguet et al 2013). Furthermore, the return on investment (ROI) of money invested in immunization programs is significant: recent research has demonstrated that every USD $1 invested in immunization results in at least USD $16 in net health and economic benefits; when accounting for the economic benefits of living longer, healthier lives, this figure increases to $44 of net benefit (Ozawa, et al, 2016). Despite these successes, considerable gaps remain in our ability to fully vaccinate all children. As health care systems - and immunization systems in particular - evolve, we see an increasing opportunity to take lessons learned from other sectors to improve the efficiency and effectiveness of vaccination systems.

High-quality and timely immunization data are vital to inform decisions at local, national, and global levels. This includes decisions about how to better reach children, successfully introduce new vaccines, document impact, monitor and improve immunization system program performance, prioritize resources and activities, and engage in performance improvement. Recently, the WHO Strategic Advisory Group of Experts (SAGE) on immunization highlighted the importance of the availability and use of high quality data for performance improvement and monitoring; data helps managers and health workers to take timely actions to optimize the performance and impact of programs. We believe that greater use of immunization data will result in positive gains in immunization program effectiveness, efficiency, quality of service, coverage, and equity.

An important complement to improving the collection, culture, and use of better quality data is to utilize that data to support novel approaches to improve process efficiency toward a better service delivery experience (for both healthcare workers and caregivers) and, ultimately, increased demand.

The Challenge

Within this call to promote the effective use of timely and relevant data to drive programmatic performance, and thus increase the number of children vaccinated globally, we are looking for innovative ideas in the following areas:

1. Innovative ideas for improving the measurement approaches for immunization data (e.g., process, equity, coverage indicators) with a focus on data use by program managers, triangulation across data sources, and methods to measure and quantify data use. We are interested in approaches to measure through both routine systems as well as periodic systems.

Or,

2. Innovative ideas that improve service delivery and experience for caregivers and/or healthcare workers during the vaccination session.

We will consider funding either:

1) Innovative ideas for improving measurement of coverage and equity data for use by program staff and managers. Specifically, their ability to collect data and deliver actionable information at the right time to the appropriate audiences would benefit from: Incorporating advances in technology to support decision makers in planning and executing program strategies Integration of immunization data systems, as well as the ability to address data use demands from multiple stakeholders. Enabling a culture that supports data quality and use e.g. provides feedback on data at multiple levels Alignment of incentives to promote reporting of accurate data above coverage estimates

2) Innovative ideas that improve service delivery and experience for caregivers and/or healthcare workers during vaccination sessions. Questions to consider: What if…improvements in processes such as session set-up, caregiver intake, wait times, and session flow, created a more positive environment for caregiver and healthcare worker interactions? What if…new approaches to how health education and information is provided were employed to improve service delivery and caregiver behavior? What if… caregivers left sessions empowered with a clear sense of: why immunization matters, when/where they need to return, and how to cope with any side effects their child may experience? What if…a number of novel approaches were integrated successfully to reduce missed opportunities for vaccination? These and similar innovations may draw from lean healthcare, design thinking or other approaches, but should have the end goal of improving the experience of caregivers, healthcare workers, or both.

 

Note: For proposals that respond to the call for innovative ideas to improve service delivery and experience for healthcare workers and caregivers, the effectiveness of the proposed approach should be evaluated in Phase I. (A clear plan for the impact of the approach on client outcomes should be evaluated in Phase II, if subsequent funding is awarded.)

What we are looking for:

Successful proposals will include:

• A clear hypothesis underlying the proposed approach to improve immunization programs and/or improving the service delivery experience of beneficiaries;
• Details on the design and pilot testing of the approach in their application;
• A plan for evaluating the effectiveness of the approach for improved measurement of the immunization program and/or improving the service delivery experience of beneficiaries;
• Outline of the design of the proposed approach/intervention; and,
• Innovations that involve building on, disrupting, or adapting existing systems. Successful proposals will describe how their approach would work within existing health systems or what change would need to occur within health systems for their approach to be effective.

Additionally, we will consider proposals in low-income countries that:

• Consider user needs, do not increase burden upon frontline health workers;
• Minimize perverse incentives (including incentives for falsification);
• Minimize human and system errors in data collection/analysis/use;
• Are relevant in multiple developing country settings;
• Data types of interest: all immunization system indicators, e.g., supervision, planning, finance, supply chain, management, demand, coverage, dropout; and,
• Constitute transformative rather than incremental improvements and are deliverable and scalable in low-income countries.

We will not consider funding for:

• Innovative ideas without a clearly-articulated and testable approach;
• Approaches not directly relevant to low-income settings;
• Approaches for which proof of concept cannot be demonstrated within the scope of the GCE Phase 1 award ($100,000 over 18 months);
• Secondary analysis of existing studies or systematic reviews unless there is a clear way in which the analysis can be scaled and will have application for continued measurement in the future;
• Proof of concept studies that do not clearly consider the current context of available financial systems and infrastructure for resource poor health settings. For example, ideas that are tested using expensive devices or require government-issued IDs in a country where few people have them, or to populations which require hospital deliveries in settings where this is not the norm;
• Approaches that circumvent the public sector completely;
• Approaches that focus only on data collection (e.g., optical character recognition, mobile data collection, barcodes);
• Approaches that present significant data safety risks (for mobile solutions, these risks must not be greater than the relative risk inherent in developed world mobile payment systems);
• Approaches which would require a donor’s long-term financial support to sustain;
• Innovative ideas that repeat conventional approaches without novel application (e.g., the development of an electronic immunization register);
• Applications that can only be applied in a single country that are not broadly applicable in multiple countries;
• Approaches that consist solely of training/capacity building for data use/collection;
• Approaches that only focus on traditional data collection types: surveillance, vaccine safety, broader HMIS without components specifically relevant to decision making within immunization programs.