Lessons from the COVID-19 Surveillance and Tracking System to Accelerate the Use of Digital Tools for Vaccination Programs

Ethiopia is the fifth most COVID-19-affected country in Africa and reported the highest number of COVID-19 cases in the east Africa region. As of November 2, 2021, the country reported 3,709,106 COVID-19 laboratory tests, of which 365,776 (9.9 percent) were confirmed cases and 6,486 (1.7 percent) deaths. Ethiopia rolled out the COVID-19 vaccination on March 13, 2021, with 2.2 million vaccines from the COVAX initiative. As of November 2, 2021, 4,907,499 doses had been administered and 3,579,852 individuals were vaccinated.

Given the scale of vaccination, digital tools have a critical role in increasing efficiency and effectiveness of the COVID-19 vaccine delivery process and the management of the vaccine program. The speed at which the vaccine is being delivered and administered requires the support of digital technologies that can play a critical role in facilitating the planning, delivery, monitoring, and management of vaccination programs. Several lessons have been taken from the process and outcomes of the COVID-19 surveillance and tracking systems implementation in Ethiopia.

The first and most important is the way Ethiopia leveraged existing digital health tools, human resources, and infrastructure to quickly deploy digital COVID-19 surveillance and tracking systems. The District Health Information Software 2 (DHIS2), Electronic Community Health Information System (eCHIS), and logistics management information system (LMIS) technical teams were repurposed to work on customizing the COVID-19 tracker, community screening, and COVID-19 commodity management tools, respectively. This helped to rapidly customize and deploy existing tools, tapped into existing teams of well-trained personnel, and hosted an infrastructure that was prepared for routine digital health systems. Using the same approach, the electronic regulatory information system; VITAS (the warehouse management system at EPSA); mBrana (the vaccine management system at woreda health office); and DHIS2 (a client tracker of COVID-19 vaccination) were used to support the planning, delivery, monitoring, and management of the COVID-19 vaccination program.

Another lesson relates to the difficulty of finding a single platform or solution that fits all of the country’s COVID-19 vaccine management requirements. Ethiopia built the DHIS2-based client tracker, which responds to most but not all requirements of the COVID-19 vaccine management at the required maturity level. It is important to apply lessons from countries like Sri Lanka, where the DHIS2 system works as the source of information for COVID-19 vaccination. As part of it’s DHIS2 innovation, Sri Lanka integrated DIVOC (a platform developed in India for COVID-19 vaccine management) with the existing platform DHIS2 to generate COVID-19 vaccine certificates. Integrated with DHIS2, DIVOC certification and verification has been used for the generation of DIVOC’s digitally verifiable certificate in alignment with the WHO’s SVC standards for vaccination certificates. Ethiopia should follow a similar approach and maximize the strengths of the two tools for scaled implementation.

Digital Health Activity provides technical and implementation support to rollout digital tools that support the COVID-19 vaccination program. We believe that our support will facilitate data-driven client prioritization and access to ensure people such as the elderly, individuals with comorbidity, frontline workers, and others who need it most are vaccinated; ensure longitudinal tracking of clients who have received the vaccine full doses and use the tracking for possible future booster doses; monitor and respond quickly to adverse vaccine reactions; track vaccines to the last mile to avoid diversions and misuse, and facilitate reporting (Adverse Events Following Immunization to WHO). DHA’s efforts will also allow community members to receive full information about the vaccine they are receiving and provide them a tool to report if they have an adverse reaction. Our suite of tools significantly improves patient empowerment and decision-making when fully implemented.