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The costs of developing, deploying and maintaining electronic immunisation registries in Tanzania and Zambia
  1. Mercy Mvundura1,
  2. Laura Di Giorgio1,
  3. Dafrossa Lymo2,
  4. Francis Dien Mwansa3,
  5. Bulula Ngwegwe2,
  6. Laurie Werner4
  1. 1Medical Devices and Health Technologies Group, PATH, Seattle, Washington, USA
  2. 2Expanded Programme on Immunizations, Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, United Republic of Tanzania
  3. 3National Expanded Programme on Immunization, Ministry of Health, Lusaka, Zambia
  4. 4Center of Digital and Data Excellence, PATH, Seattle, Washington, USA
  1. Correspondence to Dr Mercy Mvundura; mmvundura{at}


Objective To determine the costs to develop, roll out and maintain electronic immunisation registries (EIRs) and a related suite of data use interventions.

Methods The Better Immunisation Data (BID) Initiative conducted the activities from 2013 to 2018 in three regions in Tanzania and one province in Zambia. The Initiative’s financial records were used to account for the financial costs of designing and developing the EIRs, BID staff time, expenditures for rolling out the EIR systems and the related suite of interventions to health facilities, and recurrent costs. Total financial costs, cost per facility and cost per child were calculated in 2018 US$.

Findings Total expenditures were ~US$4.2 million in Tanzania and US$3.6 million in Zambia. System design and development costs accounted for ~33% and 26% of the expenditures in each country, respectively, while BID staff costs accounted for 39% and 52%, respectively. Average expenditures per health facility for rolling out the EIR system were between US$709 and US$1320 for the Tanzania regions and US$2591 for Zambia. The annualised average expenditure per child was estimated to be between US$3.30 and US$3.81 for the regions in Tanzania and US$8.46 in Zambia. Expenditures per child were higher in Zambia partly because of a much smaller birth cohort compared with Tanzania.

Conclusion Other countries may benefit from the investments made and lessons learnt in Tanzania and Zambia by leveraging these now existing EIR platforms and rollout strategies, and hence may be able to implement EIRs at lower costs than reported here.

  • health economics
  • health systems evaluation
  • immunisation
  • other study design

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Handling editor Soumitra S Bhuyan

  • Contributors MM, LDG and LW were responsible for the conception and design of the work; all authors (MM, LDG, LW, DL, FDM, BN) were involved in the acquisition of data for the work. MM and LDG were responsible for data analysis. MM was responsible for drafting the manuscript. All authors reviewed and provided important feedback on the various iterations of the manuscript; and all authors provided final approval of the version submitted to this journal.

  • Funding This work was supported by the Bill and Melinda Gates Foundation, Seattle, WA (grant number OPP1042273).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

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