Making sense of COVID-19 vaccination data
COVID-19 vaccination in Ntchisi district
A typical working day for Brave Kalambo is long and hard. During the day, the data clerk at Malomo Health Centre in Ntchisi compiles records from the facility’s outpatient department (OPD).
At 4:30 pm, however, as other health workers retire to their homes, Kalambo and another data clerk ready themselves for a different assignment: capturing COVID-19 vaccination data that health surveillance assistants (HSAs) have recorded in their registers.
Some of this data is fresh, collected by HSAs who had gone out for the current COVID-19 vaccination campaign, while the other is historical, ranging from the time vaccination against COVID-19 started in 2021.
“When vaccination against COVID-19 started, we would go out with HSAs and collect data as it was being produced, but eventually HSAs started going out by themselves because we also needed to perform our regular roles. This created a backlog. It came to a point where we had a lot of data that had not been digitised,” Kalambo says.
The backlog of data was a headache to anyone who wanted to make sense of it and plan further interventions to scale up vaccination.
“Ntchisi was the best in this COVID-19 vaccination. We beat the national target. We achieved 37 per cent when the national target was 32 per cent,” he says.
However, claiming that Ntchisi had vaccinated 37 per cent of the eligible population was easy, but backing it up was a different matter altogether because Ntchisi DHO did not have information in the One Health Surveillance Platform (OHSP), a Ministry of Health digital portal that captures health information.
“We just started vaccinating people without knowing where this data would be stored, where it would be captured,” he says.
Added to that, Banda explains, was the realisation that no one could monitor the information and evaluate how the vaccination campaign had addressed the challenge of COVID-19.
“There was a gap between the data in the register and the data that was supposed to be in OHSP for anyone to access and do the analysis anywhere. So, to clear that gap, we needed support from different partners,” Banda says.
Since the vaccination started in 2021, Ntchisi District Health Office had vaccinated 300,000 people but had a backlog data of 193,000 records that needed to be recorded in OHSP.
With funding from the Government of Ireland, through UNICEF Malawi, Ntchisi DHO has cleared the backlog data from 193,000 to the current 43,000 records.
“We worked retrospectively just to clear the backlog data by going back to the health facilities and outreach clinics conducting the vaccination campaign and collecting all the information there,” he says.
The data team worked hours into the night during working days and weekends to capture as much data as possible.
Ntchisi has 15 registered facilities against 12 data clerks, five of whom are based at the district hospital. This creates a problem as the data clerks are overwhelmed with work. They must combine their regular work, compile OPD registration records, produce reports for all departments, and capture COVID-19 data.
“In view of the Covid-19 vaccination campaign, they have to collect registers from all HSAs. But most of these HSAs stay away from the health centre. For example, Chinthembwe Health Centre has 26 HSAs against one data clerk, but only seven reside close to the health facility. So we need transport to go and collect the registers from the health posts,” he says.
But, as Banda explains, the data team is pulling out all the stops to ensure all data about COVID-19 is compiled and digitised.
“We have a problem in data storage because we are paper-based. But these [paper] registers may be damaged. Storing this information is a hassle because we don't have storage equipment such as cabinets, so we may lose it if we don't store it modernly. If we enter this data into the OHSP, it will be stored safely, and one can access it anywhere as long as they have user credentials,” he says.
Digitising the information, he adds, aids in decision-making to ensure that critical populations such as guardians of children are protected.
“We are targeting guardians because they can take care of their child if they are protected. But if they are not protected, the child may also be at risk because they cannot look after the child should they get sick. To provide for the child requires healthy guardians,” Banda says.
By January 2023, almost 3.5 million Malawians had been fully vaccinated against COVID-19, while 4.5 million had received at least one dose. The country registered 2,686 deaths due to COVID-19.
Digitisation of the COVID-19 vaccination data has helped Ntchisi DHO disaggregate the data by comorbidities, gender, age, village, and facility, among other characteristics, which, as Banda explains, has helped policymakers develop targeted vaccination interventions.