Row after row of mothers wait patiently, babies fussing in their laps. A nurse in this small clinic in rural Arusha, Tanzania, calls them forward, one by one, and gives the squirming infants shots that will protect them from killer diseases, like measles and polio.
Over the past 15 years, Tanzania has made a concerted effort to immunize its children--and has achieved a remarkable vaccination rate of almost 90 per cent. Tanzania is one of a number of African countries beating U.S. vaccination rates for all-too common diseases such as measles. That's still not good enough for the government and health organizations in that country, though. They want to get as close to 100 per cent as possible.
But figuring out which children have been missed is a huge challenge in a country where many families still live nomadic lives in remote areas.
Enter Seattle health organization PATH. It's helping out, not with more vaccines or nurses, but a database.
The Better Immunization Data (BID) initiative, shows strong health systems in developing countries aren't built on hospitals and medical staff alone. Knowledge is vital, too.
BID is an ambitious project to boost vaccination rates with an easy-to-use national electronic immunization registry. The initiative was launched in 2013 with funding from the Bill & Melinda Gates Foundation. Pilots of the system were first rolled out in Tanzania and Zambia last year. Additional technological expertise is provided by a Canadian college, Mohawk College in Hamilton, Ontario, which has been working on health information systems internationally for eight years.
"In Tanzania, we're able to accurately track needles in children's arms," says Justin Fyfe, Mohawk's senior software architect on the BID project, who explained the registry to us.
In the U.S., there is still no national electronic immunization registry. Each state, and in some cases even individual cities like New York City, maintain their own independent, unconnected vaccination record systems.
Overseas, when there's an immunization clinic in Tanzania today, nurses are equipped with digital tablets as well as needles. A nurse enters the information on each vaccination into an app, which connects into the country's national registry. In areas where lack of power renders tablets impractical, health workers use a specially-designed paper form that is later scanned into the system.
Once their children are vaccinated, parents get a card with a barcode. Any health center in Tanzania connected to the registry can scan the card and get a child's full immunization record, making it an epic time, labour, and money saver. Before BID, it could take a team of Tanzanian nurses an entire day to prepare for an immunization clinic, says Dykki Settle, a senior technical advisor with PATH. They would have to wade through a mountain of paperwork, identifying which children still need which vaccinations. If a family had arrived from another part of the country, the nurses would have no information to work with.
Tracking how many children are being immunized - and in which areas - will also help Tanzania more efficiently manage vaccine supply and distribution, Settle told us. Officials will know where the real need is, and can then ensure health centres don't run out of critical vaccines.
Perhaps the most ingenious aspect of the project is that the software is both expandable and open source.
In the future, Tanzanian health workers will be able to use the database to support other projects, such as malaria or HIV treatment. Because it is open source, anyone can change the code that makes up the software, so other developing -- and developed -- countries will be able to adapt the system for their own use, creating their own health databases at little cost.
Overall, the system is designed to eventually become a one-stop health information source, with every Tanzanian citizen having their own electronic health record.
For many donors who support international development, building a database isn't as sexy as building a hospital, but the impact is just as powerful. Just ask nurses, who spend less time doing paperwork and more time helping people. And the moms who sleep at night, knowing their children are safe from disease.
Brothers Craig and Marc Kielburger founded a platform for social change that includes the international charity, Free The Children, the social enterprise, Me to We, and the youth empowerment movement, We Day. Visit we.org for more information.