Improving Health Outcomes with Smart Data and User Centered Design

Care Made Visible · Immunization Tracking in Zambia


The Ministry of Health Zambia, The Bill and Melinda Gates Foundation, PATH


Blue Code






Improve immunization rates in rural Zambia through electronic immunization registers (EIR) at the local level.


According to Unicef, mass immunization significantly reduces mortality, and “is one of the most cost-effective public health interventions globally.” An astonishing 2 to 3 million deaths are estimated to be averted each year from adequate immunization. A key tool in ensuring that communities are adequately immunized is the electronic immunization register (EIR), which helps monitor individual immunization schedules and vaccination histories at the local level. According to the BID Initiative , EIRs “contain comprehensive data on the number and type of vaccines delivered, and in some cases, stock management and growth monitoring of children. EIRs support immunization programs by providing timely and precise information and may reduce workloads associated with paper-based records.”

Ona’s mandate:

  1. Develop a solution that simplified how nurses register children and record immunization visits.
  2. Relieve nurses of heavy reporting burden.
  3. Improve data quality so the national health ministry can more accurately track the performance of immunization programs, which would in turn lead to improved immunization coverage and lower drop-out rates.


What our partners say
“Ona was an excellent partner as we refined the system requirements and worked under a tight timeline to meet the government’s vision and our grant objectives.” READ MORE

Laurie Werner
Deputy Director for Better Immunization
Data (BID) Zambia, PATH

We worked with Ona in 2017-2018 on an electronic immunization registry as part of the Better Immunization Data (BID) Initiative work with the government of Zambia, using the OpenSRP platform. Ona was an excellent partner as we refined the system requirements and worked under a tight timeline to meet the government’s vision and our grant objectives. Through our partnership, the Zambia Electronic Immunization Registry (ZEIR) was developed and deployed to over 300 facilities in Southern Province. The Ona team was critical in thinking through all facets of the work, from the system itself but also ensuring the user perspective was constantly integrated and that issues of sustainability were considered. We continue to collaborate with Ona in a variety of areas.

Laurie Werner
Deputy Director for Better Immunization
Data (BID) Zambia, PATH


Developing ZEIR

Ona’s involvement in PATH’s BID Initiative began in January 2017, when we started developing the Zambia Electronic Immunization Register (ZEIR), in partnership with PATH and the Zambia MOH, to support the immunization programmes at Zambian health facilities.

    We adapted our OpenSRP product to reflect Zambia’s vaccine schedule, its clinical and data workflows, and the different use scenarios of its health workers. This work was supported by our local technical partner, Blue Code, who helped build the ZEIR on top of OpenSRP .
    Partnering with BID, MOH, and a User Advisory Group (UAG) with representation from community leaders and health workers at facility, district, provincial, and national levels, Ona served as the design lead for OpenSRP. This meant collaborating with end users in a workshop setting to develop the first iteration of the system. The UAG continued to work closely with Ona to lead the user-centered design process by providing feedback at all stages of development, testing, and implementation to ensure a quality product that could be rolled out across Southern Province and scaled nationally.
    Based on input from a range of health workers, Ona discovered a method for simulating the paper registers many had used throughout their careers—using blue to indicate boys and pink to designate girls – in a digital context. Software engineers applied the same approach to designing the child registration form, which similarly mimicked the paper child health cards that mothers carry. The color-coded, digital vaccine system effectively transitioned workers and parents from the familiar systems to the new.


Piloted in six facilities between March and May 2017, the program rolled out across 299 facilities in Southern Province. With the support of GAVI and UNICEF, Ona is working with PATH and its local technical partner Blue Code to scale the solution to over 500 facilities in Zambia including in Western Province.

ZEIR, along with other data use interventions, led to a 27% increase in health workers’ ability to identify vaccine defaulters.