Building an electronic immunization registry in Malawi through digital innovation

© Victory Kamthunzi, Communications Officer, Digital Square

Digital innovations can improve people’s quality of life, simplify complicated procedures and enable more efficient collaboration. Digital solutions are also essential in the healthcare sector. The importance of a digital vaccine register and universal standards in the healthcare sector has not only become clear since the COVID-19 pandemic. However, many countries in the global healthcare sector are facing major challenges when it comes to expanding digitalisation.

In particular, the fragmentation of the healthcare system prevents secure and interoperable data exchange between systems, and the lack of resources prevents local actors from maintaining these systems and adapting to changing health needs – as has been the case during the COVID-19 pandemic. With Digital Square, the DIPC Initiative is working to solve these existing challenges in Ghana, Malawi and Tanzania. The goal is to develop robust, nationally scalable, and interoperable digital immunization tools that lead to more flexible and efficient pandemic-prepared health systems.

In Malawi, DIPC is building the nation’s electronic immunization registry (EIR) using digital health expertise and innovative solutions. The goal is to build an EIR that can capture and provide access to immunization data in real time, resulting in a system that is more efficient and responsive to pandemics like COVID-19 than the current paper-based system used to cover immunization in the country.


Understanding the landscape

To determine where DIPC’s resources would be most impactful, Digital Square partnered with the Ministry of Health’s Digital Health Division (MOH-DHD) and the Expanded Programme on Immunization (EPI) to map Malawi’s current immunization ecosystem. This review delved into Malawi’s health and digital governance documents, including the Malawi National Digital Health Strategy 2020—2025, which emphasizes the need to, “strengthen the sharing and accessibility of data across systems to enable use.”

The ecosystem mapping assessment reveals robust digital health governance mechanisms in Malawi, including an active Digital Health Technical Working Group. The report further identifies nine existing digital tools for immunization, though many operate in isolation, hindering the ability of the various systems to exchange data. The MOH has started incorporating standards such as HL7 FHIR® (Fast Healthcare Interoperability Resources) and Simple Object Access Protocol to support health information systems. The MOH also uses standard operating procedures and guidelines to ensure new systems align with overarching digital health policies. Despite the rapid growth in digital health system adoption, the MOH identified persistent challenges including poor data management. Some healthcare workers also lack proficiency in digital health systems, highlighting the need for capacity strengthening.


Leveraging collaborative synergy

During a pivotal consultative meeting which included the deputy directors of MOH-DHD and EPI, the DIPC project team became privy to plans to develop a national EIR that would include both immunizations for children and adults within the Hospital Wide Information System (HWIS) to cover all public hospitals. Resource constraints had, however, hindered progress on that system’s development which EPI and DHD had discussed before. The EIR pilot implementation will include 24 strategically selected health facilities (21 facilities in Mchinji district and 3 in Ntcheu district), with a planned rollout date of April 2024.


Validating the existing immunization ecosystem findings

To finalize the assessment of Malawi’s immunization system and validate the ecosystem mapping, a workshop held on July 24, 2023, brought together 54 high-level healthcare sector stakeholders. Stakeholders confirmed gaps in existing systems, duplication of efforts, and the pressing need for system interoperability (i.e., the ability of systems to talk to one another) to enhance data efficiency and quality. Systems identified to securely exchange information include client identification, demographics data exchange, facility identification, and product data.


Charting the ambitious path

In close collaboration with the MOH-DHD, DIPC has charted an ambitious path to build Malawi’s electronic immunization registry:

1. Localizing the System and User Requirements Document for Immunization

Participants developed a generic System and User Requirements Document for Immunization (SURD) which uses WHO’s Digital Adaptation Kit format and is intended to complement WHO’s SMART Guidelines initiative. This adaptation focuses on embedding national clinical guidelines for immunization into digital health systems, ensuring alignment with local needs so that the health workers can more easily adhere to standards and provide high-quality care.

2. Developing a national electronic immunization registry

The EIR will replace paper-based immunization registers, providing real-time visibility of immunization processes across static sites so that health workers can better plan for and deliver immunization services. The EIR will serve as a module within the HWIS, with plans for expansion to cover all static sites in the country beyond the DIPC project which will only cover 24 facilities.

3. Strengthening capacity for sustainability

DIPC will assess capacity needs within the MOH and provide training to ensure the continued operation and support of the EIR even after the project concludes.


Strengthening the future of immunization in Malawi

With a focus on localization, interoperability, and capacity strengthening, the DIPC initiative aims to create a resilient EIR capable of delivering high-quality immunization services to Malawi’s population. The development of the EIR within the HWIS represents a significant step toward a more unified system. With building this EIR that will provide real-time access to immunization records and strengthening capacity to sustain the new system as its goals, the DIPC initiative is contributing to a more resilient healthcare system that can effectively respond to and combat future pandemics, improving overall health outcomes for all.

More about the DIPC initiative