Against the backdrop of their door-to-door COVID-19 vaccine campaign, there is also an impressive rollout of a national typhoid vaccine campaign.

Typhoid is endemic in Samoa, with an estimated 270 cases per 100,000 each year. For reference, a high endemic area is defined as more than 100 cases per 100,000 each year. Only a few countries globally have a higher incidence rate of typhoid than Samoa. Currently TCV, a highly effective single-dose vaccine, is not part of the routine immunization program.

But the hope is that is about to change. Since August 2021, Samoa has launched a campaign to vaccinate all Samoans between 1 to 45 years old.

As with many immunization campaigns, time is of the essence. The vaccines used in Samoa’s campaign have already been donated, so its vital that they are distributed and put to use before they expire.

That’s where Tamanu comes in.

Tamanu is an open-source patient-level electronic medical record system designed specifically for the Pacific region. It has already been upgraded to support an immunization model; currently in use to support the COVID-19 vaccine campaign, Tamanu has been used to record 196,578 vaccinations in Samoa to date.

For three weeks in August, nurses travelled to schools in the greater Apia urban area to vaccinate all the students. Ten teams of two nurses per team attend four schools each day. While one nurse gives the vaccination, the other finds and checks the student’s patient information in Tamanu and records the vaccination details in the system, including date of vaccination, batch number, and injection site.

Every effort is taken to ensure maximum efficiency of the operation, and that nothing goes to waste. An open vial can be used for up to six hours after opening when stored at +2°C to +8°C, and each team has an esky on hand to maintain temperatures of the doses.

“It’s tiring work vaccinating so many children per day, and it’s really hot, but it’s important we get it all done before the vaccines overheat” – Faamamafa (RN)

Each team vaccinates up to 200 students per day, and no one is left behind. Nurses record absent students so they can advise them to present to the hospital clinic, or so they can be captured in next year’s school vaccine drive.

The excitement amongst the students is palpable. All of the children sit and watch as each student gets called – some cry, others laugh, all are excited to be missing class, and all acknowledge the importance of getting vaccinated.

Digitisation of Samoa’s health system

“It’s so much faster than writing down” – Teuila Pati, EPI Coordinator RN

This is the first use of technology on the ground in this situation. Previously, patient details would be handwritten in consultation books, including name, gender, date of birth, village, mothers name, and contact details. Then, the senior nurse would spend weeks typing all the information into an Excel spreadsheet.

This system of manual data entry is time-consuming and prone to errors. Small mistakes can create delays, leaving children at greater risk of contracting vaccine-preventable diseases if not immunised effectively. Data inaccuracies also make planning difficult, leading to poor management of vaccine stocks and overall lack of efficiency. By inputting patient information directly into Tamanu, which syncs the centralised patient registry across all devices, the risk of data entry errors is greatly reduced.

Parents are keen for their children to be protected through vaccination too. All parents are present at the school with children and bring the signed consent forms and their immunisation records. In future, the printed immunization books will be unnecessary as patient information can be recorded in Tamanu and accessed by their healthcare providers.

The future of Tamanu in Samoa

Training for nurses was a key component of the national typhoid vaccine rollout. Once familiar with Tamanu, all training RNs get to work in the field and assist with data entry as part of their training.

“Trainee nurses are the way of the future, and it is so great that they get to use Tamanu and be familiar with it for when it is rolled out further across health centres” – Teuila Pati, EPI Coordinator RN

Tamanu is also supporting other public health campaigns across the country. At the moment, it is used for PEN Fa’a Samoa school nurse program. In this intervention, students’ nutritional status is assessed and monitored at schools, allowing school nurses to enrol them in health promotion programs as required.

Following the success of Tamanu for typhoid and COVID-19 vaccination campaigns in Samoa, the EMR will continue to support public health campaigns across the country. Tamanu will be expanded to be used for all routine vaccinations including BCG, DTP Booster, bOPV, PCV13, Rotavirus, Td Booster, TCV Typhoid, MMR, Hep B, IPV, Pentavalent and OPV Booster.

If you’re interested in learning more about how our tools can support vaccine & mass drug administration programs, you can learn more about Tamanu, explore our maps on Tupaia, or reach out to the team at Beyond Essential Systems.

This is why we developed the Immunisation Dashboard in the Tupaia app and launched it in Vanuatu this year.

Watch our video

Sounds simple, right? In many of the small island nations where we work access to a reliable power source, a working fridge and accurate fridge temperature monitoring, quality assurance can be a big problem.

This is why we developed the Immunisation Dashboard in the Tupaia app and launched it in Vanuatu this year.

[dt_highlight color=”” text_color=”” bg_color=””]Watch the video below to hear the full story.[/dt_highlight]

How it works?

Our immunisation dashboard automates daily fridge temperature reports using Bluetooth sensor technology and mSupply mobile. It’s designed to help national and regional health workers and managers access real-time information about what vaccine supplies are in-stock, how they are stored and if they are safe for use, all in one place.

Reports are available offline and the sensor records the highest and lowest temperature of the vaccine fridge each day, and the ideal temperature is from 2 and 8 degrees celsius. Anything above or below is classed as a breach.

The challenge

The journey of a vaccine from manufacture to a health facility on a small remote island, then to the patient, is a long one that takes time and money. This is why it’s so important they are stored effectively to avoid the need to replace vaccination supplies and equipment, all together.

Previously, accessing this information instantly and in one place has not been possible. It was administered manually using paper-based reports and different health information systems that need to be written, dispatched and interpreted.

In June 2019, the nurse working at Amauri Dispensary on Lelepa island, Risco, detected that the fridge temperatures were too high alerting staff to a fridge malfunction.

This temperature information was sent to regional and national health centres, where managers from the Expanded Programme on Immunisation and Ministry of Health could review the data instantly, and make a plan to resolve issue.

Caption: this is what a consistent temperature breach looks like. As you can see, the fridge at Amauri Clinic was repaired on 10 October 2019.

The solution

We installed Bluetooth fridge sensors at 8 health facilities in Vanuatu’s Shefa Province to automating fridge temperature tracking in June 2019.

Health workers at each clinic learned how to sync fridge data from the Bluetooth sensor to mSupply mobile to send data and interpret data within the Tupaia app. Now they can instantly see is the fridge working? Is the temperature too low or too high? What is the problem and how long has there been one?

With Tupaia, the fridge temperatures and supplies available at each clinic can be viewed anywhere, anytime, to check that vaccines are kept at the right temperature and are safe and effective for the people receiving them.

Without this oversight vaccination equipment can break and vaccines spoil and they are not easy to replace. Besides keeping vaccines cool and safe, the Immunisation Dashboard allow health workers, suppliers and decision makers to visualise immunisation data in real-time to detect problem areas quickly and proactively solve the problem.

Before	After
Daily paper-based reports recorded manually using a thermometer.	Hundreds of automated Bluetooth data reports viewed in one report.

This project began back in April 2018, when mSupply Mobile tablets were first installed at 7 health facilities around Efate. mSupply Mobile enables electronic management, tracking and ordering of medicines. Under our Gates Foundation grant, we have worked with mSupply to build a vaccines module in mSupply Mobile and in addition to this, we are collecting live fridge temperatures, facility surveys and vaccine coverage information, compiling all of the data in Tupaia. Previously, accessing this information in one place has not been possible, as it has been administered manually using numerous methods and health information systems.

To collect immunisation data at each of the health facilities and successfully introduce new mobile reporting tools, we’ve been working with public health managers, health administrators and zone supervisers, the Expanded Program on Immunisation (EPI) Pharmacy Division, Health Information Systems unit and Shefa provincial health teams within the Vanuatu Ministry of Health.

A crucial factor when it comes to administering immunisation medicines effectively, is being able to quickly find out what and where supplies exist and if there are any stock outs of vaccines at specific health facilities. Now that this information can be accessed in real-time, time delays can be reduced and immunisation supply chain systems can be strengthened through powerful data integration via DHIS2 software. 

Another win for health facilities and health workers in the Shefa province is the addition of automated fridge temperature tracking fridge devices, which allow temperature information to be monitored and tracked within the Tupaia dashboard. This means national and provincial health workers can see live information for individual health facilities via the Tupaia dashboard (see below) and take action if there are any persistent temperature breaches.  

To support the roll out of the Immunisation Dashboard our Vanuatu Program Manager, Sera Ngeh facilitated a three day workshop this month in Port Vila, with Results for Development (R4D) who are conducting the monitoring and evaluation for this project, using a process called Adaptive Learning. We’re proud to be working with R4D who have partnered with us thanks to support from DFAT’s innovationXchange. National and provincial managers and health facility staff from the Ministry of Health attended the workshop, along with lead software developers from Tupaia and mSupply. Baseline interviews and follow-up survey data that was collected by R4D and local researchers from March to June this year was presented during the workshop for discussion and action planning. These baseline surveys covered areas on the immunisation supply chain, reporting data and workflows as well as current immunisation barriers in Vanuatu.  

We will continue to support health workers at a national, provincial and health facility level understand and use mSupply Mobile for their medical and vaccine stock management and ordering and increase digital literacy around the use of this technology to improve immunisation coverage in Vanuatu. 

Whilst access to the immunisation module is password-protected, if you would like a live demo, please don’t hesitate to get in contact. To check out the other features in Tupaia for yourself, log into www.tupaia.org and explore the data. 

This project was developed in partnership with mSupply (Sustainable Solutions), with funding from the Gates Foundation, innovationXchange and the DFAT Indo-Pacific Centre for Health Security. 

From left to right: Sera (Tupaia), Erin (R4D), Risco (Nurse Amauri Dispensary), Janet (Shefa EPI/MCH Manager), Jenny (Nurse Leimarowia), Kalwat (Zone 1 Supervisor), Jocelin (Midwife Maurifanga Health Center), Agnes (Acting Principal Pharmacist), Andrei (mSupply), Dr Thyna (VCH Paediatrician), Rex (Nurse Saupia Health Center), Amy (JiCA), Andrew (R4D), Luke (R4D), Chrisilla (MCH clinic), Blaise (National EPI Officer), Laurel (R4D), Bastien (Tupaia), Edwin (Tupaia), and Morris (Shefa Provincial Administrator).