For an annual cost of between US$3.30 to $3.81 per child under the age of one, health workers in Tanzania can benefit from the better data and time savings made possible by an electronic immunization registry (EIR). In Zambia, these benefits cost US$8.46 per child under the age of one. That higher number is partly due to the fact that Zambia has a smaller birth cohort than Tanzania.
PATH recently coauthored a journal article in BMJ Global Health with partners from the governments of Tanzania and Zambia. The article helps fill a critical evidence gap on the costs associated with designing, developing, rolling out, and maintaining EIRs in low- and middle-income countries. The study uses project expenditure data for the BID Initiative between 2013 and 2018 and focused on three implementation regions in Tanzania, and one province in Zambia.
To make these calculations, we grouped expenditures into categories, including software and system development, hardware procurement, training, rollout and in-country project administration. Total costs are presented as well as the costs per health facility for rollout, and the costs per child in each country’s immunization target population.
Costs of building a digital system
In Tanzania and Zambia, the design, development, and roll out of an EIR and its related suite of interventions to the three regions and one province included in the study costs about US$4.2 million in Tanzania and $3.6 million in Zambia. Per health facility, the average cost of rolling out the EIR system—including costs for hardware purchase, training, meetings, transport, lodging and per diems for staff—ranged from US$709 to US$1,320 in three regions in Tanzania; and US$2,591 per health facility in one province in Zambia. This cost difference can be attributed to country contexts, including different procurement costs for hardware, varied rollout timelines and intensity, and differences in the type of staff doing the rollout. Tanzania was able to use more government staff time for implementation in some regions compared with Zambia, where the government could provide only limited implementation support in Southern Province.
While EIRs require a significant upfront investment, the EIRs developed under BID in Tanzania and Zambia have already resulted in indirect savings, by reducing staff time for service delivery and reporting, freeing up health workers’ valuable time, and reducing vaccine wastage with better demand forecasting of vaccines. Previous estimates have revealed that the automatic reporting features of an EIR result in an annual time savings of eight working days in Tanzania. And a recent article from Tanzania reveals that as countries increasingly integrate and use their EIRs, vaccine availability improves and the odds of a stock out decrease.
Additionally, the benefits of EIRs are not limited to their financial or economic implications. The actionable information they generate helps health workers better plan for outreach visits, defaulter tracing, and other types of follow-up to address coverage gaps.
BID is committed to helping other countries navigate their own digital journey. These findings advance the global evidence base around the costs of digital solutions. While there is more to learn about the costs of implementing solutions like EIRs, we hope this information will help countries, governments, and global leaders better understand the direct and indirect costs of establishing and operating EIRs so they can make a more informed decision about the introduction and scale up of digital solutions within their own health systems. As a result, digital solutions, such as EIRs, will be more efficient, cost-effective, and countries can continue learning from other’s experiences. The full journal article can be found in BMJ Global Health.