The Implementation of Dominica’s Electronic Immunization Registry

As the Commonwealth of Dominica transforms its Health Systems with the objective to ensure equitable access, quality care, and use of 21st century technology that is not only effective but able to produce accurate information in real time; the Covid-19 pandemic while a dark moment in our history, also created many forced opportunities.

Dr. Shalauddin Ahmed, National Epidemiologist of the Ministry of Health in Dominica gave an example of one of those forced opportunities. He says, “the lesson learned from the pandemic of Covid is that we need to move away from paper-based reporting to electronic based.”

The process of Digital Transformation is not an easy task nor an overnight feat. There are many moving parts which encompass the makeover, some transitions may take one to two years, other delicate transformations may take as much as five.

For instance, let’s shine the light on the Electronic Immunization Registry (EIR). This is an online tool which allows the storage of all vaccination information and permits people to access their vaccination records when needed.

The EIR was implemented in April 2022 by the Expanded Program on Immunization (EPI) Unit of the Ministry of Health. This online system was developed by Dominican Technology Firm “Open Solutions for Health” (OS4H) and funded by the Pan American Health Organization (PAHO).

Senior Community Health Nurse- Region One Primary Health Care and EPI Manager for Dominica Florestine Lewis is proud of the creation of the Electronic Immunization Registry.

“I think that is one of my flagships in terms of my achievements in the EPI, which is to have had us introduce the Electronic Immunization Registry. We started in earnest in 2022, although all the districts have not yet fully utilized the EIR, one of my actions in my 2024 plan is to ensure that all the districts are utilizing the registry to enter the immunization data”.

Peter Ricketts- CEO- Open Solutions 4 Health- Developer Electronic Immunization Registry- Dominica

Open Solutions for Health, the Technology firm that developed and implemented the Electronic Immunization Registry, has been creating and implementing Health IT Solutions in both public and private health institutions for more than 15 years. Chief Executive Officer Peter Ricketts says the company’s core objective was built upon the vision of his father, the late Dr. Paul Ricketts, former National Epidemiologist of Dominica. His father’s vision laid the foundation for OS4H which is to “Provide data to those who need it, where they need it and when they need it” in a sustainable manner.

The Electronic Immunization Project is one of many embarked upon by this young Dominican tech company. Registered in 2019, Peter and his team intend to get the country to a point where it values the technology and an appreciation of how it makes lives easier, setting the stage for government administrations to create long term budget allocations to sustain and support this digital standard.

To address the brain-drain issue in Dominica, OS4H has created opportunities for those coming out of the Dominica State College. Graduates are hired for six months, trained, and made “project ready”. One of the beneficiaries of this program is twenty-year old Jody Cognet. She led the development team of OS4H for the EIR project. Jody is excited about her country’s overall Health Systems Transformation.

Jody Cognet- Lead Developer OS4H- Electronic Immunization Registry-Dominica

“As a young female developer, I am excited that I could be a part of this transformation it is an opportunity for young individuals like me to have some input and be more involved in Dominica’s health system. It was a bit challenging because it was developed during the pandemic: meetings with stakeholders were virtual, the initial training was also virtual; however, it worked, and the team was pleased with the result.

Let me end by saying this… The Electronic Immunization Registry is beneficial to the Commonwealth of Dominica because we have moved away from paper-based records to digital records and let me add, the chances of losing information via the EIR is almost nil. I am proud to see Dominica taking its place in this digital age.”

Nurse Lewis lauds the immediate benefits of the EI Register

“For the health care system we benefit because we have accurate data being entered, we are able to pick up our defaulters via alerts as to who is defaulting and where they are because we have the unique identifiers on the system. This tells us who is vaccinated and when they should come for their vaccine, the system also creates appointments. We are not yet at the part where we send out text messages to the parents to give reminders; we are still doing that. This is a benefit for the parents because they will know that their child is due for a vaccine on that particular date; it is an advantage. We are also seeking to develop the EIR to such an extent that the beneficiary of the vaccine either the child or the parent can go online themselves and download their own immunization card. So, instead of coming to the nurse and asking for the vaccines records because they have to travel, that process can be eliminated because they have their unique identifier and can retrieve the information themselves.”

Training

One hundred health care workers, including nurses and data entry clerks received the first phase of training which was facilitated by developer OS4H. Training is expected to continue in 2024. According to Nurse Lewis there are a few challenges.

“When we initially started, we had a series of training, but with staff attrition including staff retirement, we have a new cadre of staff that has not yet been trained. One of the first things we are doing as early as January 2024 is to get everyone retrained, comfortable, sensitized and everybody practicing. That is the only way that I can be sure that the information on the system is accurate once everybody is entering it.”

The Electronic Immunization is undoubtedly a step in the right direction as Dominica moves closer to a full Health Systems Transformation. There has been one hiccup within the Immunization program and that is the decrease in immunization numbers, but EPI Manager Florestine Lewis is optimistic.

“I am really saddened to say that yes, we have been affected by the negative publicity that vaccines received following Covid. We used to enjoy decades of coverage of 95 percent and above in all of our antigens and sadly we have seen a significant decrease. As of 2022, our coverage is in the 80 to 88 percent range and I am not happy about that. So we have been trying to see how we can get our population to regain the trust and confidence that they had in vaccines, and we are hoping at least for the rest of 2023 into 2024 we will be able to make some gains again and get back some of those people. But this is a work in progress, and we have to keep encouraging our population.

I want to encourage you to get vaccinated. Vaccines save lives and we’ve had so many opportunities and in Dominica there are so many success stories where we can say vaccines have benefitted our population. Don’t be afraid, vaccines are safe, and they are effective in providing protection against vaccine preventable diseases."

Dominica

Barbados and the Eastern Caribbean Countries

Immunization

Primary Health Care

Health Information Systems