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The Costs of Digital Health Interventions to Improve Immunization Data in Low- and Middle-Income Countries: Multicountry Mixed Methods Study
Digital health interventions, such as electronic immunization registries (eIRs) and electronic logistic management information systems (eLMIS), have the potential to significantly improve immunization data management and vaccine logistics in low- and middle-income countries (LMICs). Despite their growing adoption, there is limited evidence of the financial and economic costs associated with their implementation compared to traditional paper-based systems.
We aimed to measure the costs of implementing eIR and eLMIS systems in LMICs and to estimate their economic costs as compared to the previous paper-based registries.
The study was conducted across four countries-Guinea, Honduras, Rwanda, and Tanzania-which implemented the tools in 2018, 2012, 2019, and 2014, respectively. A combination of primary and secondary data sources was used for the analysis. Retrospective cost data regarding the design, development, and implementation of the tools were directly obtained from implementers and National Immunization Program offices in all countries. Primary survey data were collected to gauge the operational expenses of immunization information systems, both with and without electronic tools, using an activity-based costing approach in 275 facilities. The annual cost of the immunization information system at the national level was then extrapolated and compared to national spending on immunization as a measure of affordability. Costs were reported in 2023 international dollars (I$).
The total costs of designing, developing, and deploying eIR, eLMIS, or both were I$ 2.2, 6.4, 6.8, and 44.3 million in Guinea, Honduras, Rwanda, and Tanzania, respectively. Design costs were greatly affected by the degree of customization of the tool, whereas rollout costs were mostly driven by the costs of purchasing hardware and training health workers. Overall, the implementation of the electronic systems was associated with higher costs in Honduras (I$626 per facility, 95% CI 516-821) and Rwanda (I$399, 95% CI I$108-I$691), a cost reduction in Tanzania (-I$2539, 95% CI -I$4290 to -I$789) and no significant cost difference in Guinea. The percentage weight of the cost of managing data with the electronic systems over the total national immunization budgets was estimated at 0.7%, 7.7%, 3.3%, and 4.8% for Guinea, Honduras, Rwanda, and Tanzania, respectively.
Digital health interventions such as eIR and eLMIS can potentially reduce costs and improve the efficiency of immunization data management and vaccine logistics in LMICs. However, the extent of cost savings depends on how effectively these digital systems replace traditional paper-based methods and the extent of their use in decision-making, especially at the facility level. Careful planning and investment are essential to unlocking the full economic potential of digital health in LMICs.
Journal Article
Criticism by third world countries against WTO
This research discusses a short background of the WTO. It provides insights from those who believe that the organization is not to be blamed solely for creating umbalanced situation between the member states of the WTO. The theme in this research includes main topics related to the legal framework of the WTO as one of the important international organizations. The aspects of this theme deal with the rules-based system, legal and political encroachment, overregulation, andthe dispute settlement mechanism. Finally, the research gives out severalrecommendations to the developing countries in relation to free trade.
Book
Juvenile arthritis management in less resourced countries (JAMLess): consensus recommendations from the Cradle of Humankind
Juvenile idiopathic arthritis (JIA) is the most prevalent chronic rheumatic disease in children and young people (CYP) and a major cause of pain and disability. The vast majority of the world’s children and their families live in less resourced countries (LRCs) and face significant socioeconomic and healthcare challenges. Current recommendations for standards of care and treatment for children with JIA do not consider children living in less resourced countries. In order to develop appropriate recommendations for the care of CYP with JIA in less resourced countries a meeting of experienced pediatric rheumatologists from less resourced countries was convened with additional input from a steering group of international pediatric rheumatologists with experience in developing recommendations and standards of care for JIA. Following a needs assessment survey of healthcare workers caring for CYP with JIA in LRC, a literature review was carried out and management recommendations formulated using Delphi technique and a final consensus conference. Responses from the needs assessment were received from 121/483 (25%) practitioners from 25/49 (51%) less resourced countries. From these responses, the initial 84 recommendations were refined and expanded through a series of 3 online Delphi rounds. A final list of 90 recommendations was proposed for evaluation. Evidence for each statement was reviewed, graded, and presented to the consensus group. The degree of consensus, level of agreement, and level of evidence for these recommendations are reported. Recommendations arrived at by consensus for CYP with JIA in less resourced countries cover 5 themes: (1) diagnosis, (2) referral and monitoring, (3) education and training, (4) advocacy and networks, and (5) research. Thirty-five statements were drafted. All but one statement achieved 100% consensus. The body of published evidence was small and the quality of evidence available for critical appraisal was low. Our recommendations offer novel insights and present consensus-based strategies for the management of JIA in less resourced countries. The emphasis on communicable and endemic diseases influencing the diagnosis and treatment of JIA serves as a valuable addition to existing JIA guidelines. With increasing globalization, these recommendations as a whole provide educational and clinical utility for clinicians worldwide. The low evidence base for our recommendations reflects a shortage of research specific to less resourced countries and serves as an impetus for further inquiry towards optimizing care for children with JIA around the world.
Journal Article
