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 harness the potential value of immunization data in informing program management. 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 of data-driven 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 coverage, equity, and program efficiency and effectiveness.
The ability to collect and deliver the right data at the right time for use would benefit from:
- Innovations in approaches to collecting immunization data and triangulation of data across different sources
- Enabling a culture that supports data quality and use (e.g. provides feedback on data at multiple levels) alongside the development of a measure to quantify data use
- Alignment of incentives to promote reporting of accurate data
An important complement to improving the collection, culture, and use of better quality data is to utilize that data to improve process efficiency to improve the service delivery experience (for both healthcare workers and caregivers) and, ultimately, increase demand.
Improvements in process efficiency are particularly interesting when thinking through what those improvements allow. It may be interesting to examine a focused topic, such as:
- If you improve process efficiency, what will that enable healthcare workers to do that might positively impact interactions with caregivers? (this may or may not include a time-motion element)
- If you improve upon education and the transfer of information, how will that impact service delivery experience and caregiver behavior?
- If you improve/personalize healthcare worker/caregiver interaction, will that impact caregiver experience and behavior?
- If you redesign the structure of an immunization session, can you reduce waiting times and improve caregiver satisfaction? (moving away from batch-processing of immunization session elements such as growth monitoring, group educations sessions, etc.)
- As you improve process efficiency, can you build in opportunities for reducing Missed Opportunities for Vaccination?
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 specific areas:
- 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.
- Novel approaches for improving process efficiency that will lead to improved quality of service delivery.
What we will consider funding:
- Innovative ideas for improving measurement of coverage and equity data for use by program staff and managers. Specifically, their ability to collect and deliver the right data 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.
- Innovations in process efficiency toward improved service delivery. These may stem from lean healthcare, or other approaches, but should have the end goal of improving the experience of healthcare workers, caregivers, or both. Proposals might reflect, but need not be limited to:
- Improvements in processes such as data recording, set-up, session flow, or other, that will allow healthcare workers to have more time to interact with caregivers; ideas for how additional time may be leveraged for improved quality of service delivery, including time-motion analysis.
- Improvements to, or new approaches to how health education and information is provided during an immunization visit, with a focus as to how that might improve the service delivery experience and caregiver behavior.
- A study on how new approaches/structures for healthcare worker/caregiver interaction might positively impact experience and caregiver behavior.
- Operational research on the application of lean healthcare principles to reduce waiting time (through re-designed immunization session structure, or other).
- An integration of approaches to reducing Missed Opportunities for Vaccination through improved process efficiency.
Note: The effectiveness of the proposed approach on process efficiency/quality of care should be evaluated in Phase I, and a clear plan for the impact of the approach on client outcomes should be evaluated in Phase 2 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 user 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 user experience of beneficiaries;
- Outline of the design of the proposed approach/intervention; and,
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
- Include 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; and,
- Constitute transformative rather than incremental improvements and are deliverable and scalable in low-income countries.
No additional preference will be given to proposals that address both data and quality of care.
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;
- 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;
- 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