Achieving immunisation impact through strengthened data systems
Lessons learned from HISP’s eight-year collaboration with Gavi illustrate how open-source platforms and country-level technical assistance can drive rapid advances in immunisation programme management.
- 16 April 2026
- 7 min read
- by HISP Centre
For the past eight years, we at the HISP Centre at the University of Oslo, alongside our network of local HISP groups in Africa and Asia, have partnered with Gavi to help strengthen immunisation information systems in the global south.
The goal driving this work has been to help national programme managers and local health workers have access to timely and accurate data on their vaccination programmes. This empowers them to make informed decisions that improve efficiency, reduce costs and wastage, and help reach more people with vaccines, including in the most fragile and hard-to-reach places.
As Gavi begins its next strategic phase, we wanted to take the opportunity to share our reflections on what has worked and what challenges still lie ahead.
Long-term investment in open-source platforms has transformed national immunisation data systems
When we began our collaboration with Gavi in 2018, national immunisation programmes were plagued with data challenges.
Fragmented data systems were commonplace. Reliance on paper or Excel for data collection caused widespread reporting delays and data quality challenges. Only 7 of 54 Gavi-supported countries had integrated their immunisation data into national routine data systems.
Our work with Gavi has centred around DHIS2, an open-source software platform used in 75+ lower-income countries as a national-scale health management information system.
The HISP Centre has developed DHIS2 tools and guidance to support key immunisation use cases based on best practices and global standards, while local HISP groups have worked with country partners on local system design and implementation. As of this year, 40 Gavi-supported countries now use DHIS2 as their main immunisation data platform, fully integrated with their national health information systems.
This digital transformation has helped countries achieve real results. Countries now have timely access to granular data on their immunisation programmes, helping guide decision-making. Leveraging DHIS2 for disease surveillance has helped countries detect and respond to disease outbreaks more rapidly and effectively. And integration of facility level vaccine stock data into DHIS2 has helped improve supply chain efficiency and reduce stock-outs of essential vaccines and health commodities.
Reaching zero-dose children calls for fine-tuned approaches
These achievements have been made possible by strengthening countries’ routine data systems.
While these systems are a robust, cost-effective way to collect and analyse data, they do have some limitations. For example, a recent article from Gavi’s Zero-Dose Learning Hub (ZDLH) illustrates how relying on aggregate data when targeting zero-dose children can contribute to “leav(ing) missed communities unseen.”
However, it is not ultimately the country’s DHIS2 systems or data that are the issue, but how they are used. There are numerous examples of countries innovating with DHIS2 to achieve results.
For example, in Mozambique, using DHIS2 helped identify and reach 524,383 zero-dose children in often missed settlements. Kenya used DHIS2 to support three national supplementary immunisation activities reaching 4.3 million children, with digital microplanning tools deployed in 12 high-priority counties.
Have you read?
This helped identify 127,000 previously unvaccinated children, achieve 95+% vaccination coverage in campaign areas, and reduce data reconciliation time from three weeks to four days.
Emerging innovations such as leveraging WorldPop’s granulation population data estimates for vaccine microplanning, which has been piloted in the Central African Republic, offer countries even greater ability to leverage their DHIS2 systems to make an impact on their zero-dose burden.
As DHIS2 is a fully open-source, community-driven platform, these innovations can be easily shared between countries, supporting rapid advancements in vaccination planning. This was demonstrated during the COVID-19 pandemic, when globally shared DHIS2 innovations helped 60 countries quickly deploy digital tools for COVID-19 surveillance and vaccine delivery.
Achieve sustainable person-centric immunisation systems by building on what works
One significant technological change inspired by the response to COVID-19 was a shift from routine reporting of aggregated vaccination data, like how many children received the BCG vaccine at a specific health facility in a given month, to systems that maintain a digital vaccination record for each individual child.
Countries such as Rwanda, Liberia, Sri Lanka and Laos all deployed these Electronic Immunisation Registers (EIRs) during the COVID-19 pandemic.
Using DHIS2 as their Electronic Immunisation Registry platform allowed them to leverage existing IT infrastructure and human capacity, saving time and money in system deployment and scale-up.
Research by Exemplars in Global Health found that Rwanda’s use of a DHIS2-based EIR brought significant efficiency gains for health workers:
“In Rwanda, the E-Tracker electronic immunization registry and Kwivuza digital platform for claims management were associated with an 82% reduction in monthly hours spent on administrative tasks, freeing up staff time for clinical work and service delivery. Health workers who used E-Tracker spent significantly less time on tasks involving aggregate patient data (for example, the time they spent creating defaulter’s lists dropped by 93%) and shifted their time toward tasks involving individual patients such as registering children.”
A research paper assessing the EIR roll-out in Laos PDR found that the large majority of users were positive toward the new system, finding it faster and easier to use than their previous system. The authors of that paper note that:
"The Lao experience demonstrated that strategic technology choices can accelerate adoption. In our study, the stepwise approach and the use of an existing platform (DHIS2 in this case) as the host for the EIR were emphasised by key informants as crucial to initial success and as important drivers of acceptance and uptake of the system by healthcare workers (HCWs). This was due to the preference of both policy makers and users to use existing technological platforms, infrastructure and HCW experience to promote use and to ensure interoperability with existing systems.”
This is an example of a larger trend. LMICs have shown increasing interest in building on and expanding the scope of their DHIS2 systems, covering more health programmes with more granular data. DHIS2 allows them to do this while leveraging existing resources instead of standing up new parallel systems.
Recognising the potential offered by this technological shift, a group of authors including the Director General of Africa CDC, Dr Jean Kaseya, called for all countries in Africa to digitalise health data with DHIS2 Tracker programs, collecting person-centric health data at the community level.
They argue that this will improve health service delivery, disease surveillance, and supply chain efficiency and resilience, and “reflect Africa’s move from parallel systems to integrated, flexible digital architectures”.
Collective investment is needed to reduce fragmentation
As the ZDLH authors rightly note, data fragmentation and parallel systems make it more difficult to generate accurate zero-dose estimates and impede vaccination efforts. We see integration and data triangulation as essential to a well-functioning health information system. For this reason, we have designed DHIS2 and our immunisation toolkit to support interoperability, and HISP groups have worked with in-country stakeholders to co-design integrated data architectures.
The integration challenges that countries face are not purely technical. Donor priorities have been a driver in the creation of parallel systems. In the HISP network, we work with global health partners both at the global and the national level to facilitate collaborative discussions and collective action on health system strengthening wherever possible.
Through tools like the DHIS2 maturity profile, which is used to assess the maturity of DHIS2 implementations, we aim to help countries get a holistic view, identifying and prioritising the foundational components of their health information architectures that require additional investment.
While the degree of national DHIS2 capacity and country ownership has greatly improved over the past decade, our experience with Gavi has shown us the importance of targeted advanced technical assistance (TA).
This is particularly important when rolling out new tools or features or making significant platform upgrades. Through our flexible global TA contracts, Gavi and HISP were able to work collaboratively with countries to identify and respond to gaps and needs as they arose.
On the occasions when several global partners joined forces on these arrangements with HISP, such as Gavi, the Global Fund and Norad during the COVID-19 pandemic, this helped catalyse large-scale improvements in a cost-effective way, reducing duplication of effort and channelling resources toward a shared goal.
Looking ahead: continuing support for national systems
As Gavi begins its next strategic phase, DHIS2-supported immunisation systems provide a strong foundation for country-led, resilient and integrated delivery.
Targeted country engagements in Nigeria, the Democratic Republic of the Congo and Somalia illustrate how digital public goods can support Gavi’s goals to strengthen sustainable vaccine supply chains, enable fully digital and reusable campaign platforms and sustain immunisation delivery in fragile and humanitarian settings.
While the HISP-Gavi collaboration during Gavi 5.0 has achieved significant impact in 40 countries, many of these countries require ongoing support to reach their immunisation goals.
The investments made thus far demonstrate how Gavi and other global health partners can advance equity, efficiency and global health security through continued support for national DHIS2 systems.
The team at the HISP Centre is ready to support this work, and to continue assisting lower-income countries in making progress towards their immunisation and public healthcare goals.
More from HISP Centre
