Table 2.

Themes demonstrating successes and challenges related to VaxTrac implementation based on interviews and direct observations, VaxTrac assessment, Western Urban, Sierra Leone, 2017.

Thematic Area	Successes	Challenges
User training	Ample opportunities to practice using the key functions of VaxTrac.	Nine of the ten health staff did not know how to identify children due for an upcoming vaccine even though the system had this feature.
User experience & functionality	Health workers were able to retrieve and update vaccination records, generate lists of defaulters, and create monthly summaries vaccines administered*. Efficient use of QR barcodes as unique identifiers to manage vaccination records. VaxTrac was helpful in quickly summarizing cumulative vaccine doses in the monthly reporting form. All tablets had Internet connectivity and were sufficiently charged*.	Malfunctioning of finger printing devices caused delays during vaccination sessions. Health workers desired to but did not know how to undertake troubleshooting for simple recurring issues with the tablets. Only one of the ten health facilities had a functional biometric fingerprinting device*. Only two facilities reported experiencing challenges with electricity supply; only one facility did not have electricity*.
Data sharing	Enabled within groups of 7 to 12 health facilities based on geographic proximity. Creation of limited data sharing group helped to speed up data synchronization between offline tablets and online data hosting servers.	When a child moved to a different locality outside of the original data sharing group, his/her record could not be accessed. Data sharing restrictions led to creation of duplicate records in VaxTrac using a new QR barcode.
Workflows	ODCH had an efficient workflow that integrated VaxTrac into existing process and with clear roles and responsibilities*.	Inconsistent and inefficient workflows in all other nine health facilities observed*.
Integration of community health workers	All health facilities reported having ten CHWs assigned to their catchment areas. CHWs may have identified children who defaulted and refer them to health facilities for catchup vaccination doses without using VaxTrac data.	None of the health facilities visited were routinely tracking defaulters even prior to the introduction of VaxTrac despite the MoHS recommendation to do so four times monthly. Although trained staff knew how to generate defaulter lists in VaxTrac, the lists were never shared with CHWs to track defaulted children.

^*Direct observations at the time of the health facility visits

QR = Quick response.

ODCH = Ola During Children’s Hospital.

MoHS = Sierra Leone Ministry of Health and Sanitation.

CHWs = Community Health Workers.