Reforming Routine Information Systems to Strengthen Local Management in Decentralized Health Systems: The National Immunization Program in Ukraine.

Anton Luchitsky and David Mercer, PATH

Abstract

The Ukraine Infectious Disease Program: Health Information Systems and Management Reform is a multi-year program begun in 1997 that was developed in part from lessons learned from the USAID humanitarian assistance program to combat the diphtheria epidemic in Ukraine. During the diphtheria program, it became evident that efforts by Ukraine and the international community to manage their response to the epidemic suffered due to poor access to accurate information regarding vaccine supply, consumption, and coverage, unreliable and incomplete data on immunization histories, and surveillance data of variable quality with incomplete and inconsistent case information. Our goal was to provide the Government of Ukraine (GOU) with an assistance package that concentrated on the development of tools and technical training to monitor, evaluate, and adapt information systems to strengthen regional immunization management and meet the changing needs of the Ministry of Health (MOH). To achieve this, the project has worked closely with locally appointed Working Groups of pediatricians and epidemiologists from raion and oblast levels of the health system, as well as the national MOH, to set priorities, review, propose, and approve changes to data and processes and assure that program activities directly addressed the management needs and capabilities of oblast and raion health staff. This strategy assured Ukrainian ownership and long-term sustainability of the program.

As a direct result of HIS reforms introduced by the program,

• Every level of the public health service delivery system, from the central oblast SES to the village ambulatory clinic, now has the capability to accurately forecast needs and monitor and evaluate their activities.
• Standardly applied, internationally accepted definitions and procedures for computing key performance indicators are in use.
• Every oblast has the capacity to accurately monitor supplies from existing stores, through distribution, consumption, and equipment maintenance.
• All oblasts now have the ability to monitor and respond to vaccine wastage and contraindication rates, major causes of inadequate immunization coverage in the past. For the first time, oblast and national authorities have evidence of the extent of these problems, and the information tools necessary to effectively address them.
• Local and national forecasting of key biological supply requirements can be accurately and rapidly computed.

In summary, as a direct result of program reforms, Ukrainians now have evidence of previously hidden major constraints in their public health service delivery systems. Problem areas (raions) have been identified and interventions targeted to identify and correct the source of program deficiencies. Managers at every level have access to up-to-date supply balances with usage patterns, and tools for accurate forecasting and efficient, effective resource management, and program monitoring and evaluation. In their immunization programs, this has resulted in more children being immunized with those immunizations being more timely.

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