Introduction and implementation of an immunization information system in Indonesia province of Daerah Istimewa Yogyakarta: lessons for scale-up

Abstract Background : Immunization is undeniably critical to save children from infections. To increase vaccination coverage, valid and real-time data is needed. Accordingly, it is essential to have a good report system that serves as defaulter tracking to prevent children's immunization failure. Daerah Istimewa Yogyakarta (DIY) health office introduced an electronic immunization registry and successfully implemented it for more than five years. It is the only individual-based record system in Indonesia that has been sustainably operated for such a long time. Yet, no systematic assessment of this system had been conducted to date. This study examines Sistem Informasi Imunisasi Terpadu (SIMUNDU) introduction and implementation process in order to draw lessons that could inform scalability and sustainability across the country. Methods : This study used an explanatory sequential mixed-method design, which collected quantitative data from 142 participants and qualitative data from 9 participants. Entry data clerk in health facility was systematically selected to participate in the survey. While in the key informant interview, the informant was selected based on the survey result. A descriptive and thematic approach was adopted to analyze the quantitative and qualitative data. Results from across the two approaches were integrated for comparison and contrast. Results : Findings are presented according to three core themes emerged from the data: system strengths, potential threats, and opportunities for scale up. Strengths -i.e. factors contributing to the success of SIMUNDU - include management, system performance, people’s behavior, and resources. Potential threats to sustaining the system include individual capacity, technical or system issues, and high workload. Opportunities – i.e promising factor that SIMUNDU can be operated sustainably – such as continuity, expectation and scale up possibility. Conclusions : SIMUNDU is a promising innovation for the entire country, beyond DIY. There is agreement about the potential for scale-up of this IIS to other provinces. Experience of implementing this system in DIY over the past five years has shown that the benefits outweigh the challenges, and SIMUNDU has grown into a robust and yet user-friendly system.