Implementation strategies to promote e-Tracker use in the childhood immunization program in Rwanda - a mixed methods
Thaoussi Uwera1,2, Ingvild Fossgard Sandøy1,3, J Frederik Frøen4
1Center for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
Frontiers in Health Services
|August 14, 2026
Summary
Co-designed strategies improved health workers' acceptance and feasibility of the digital immunization registry (e-Tracker) in Rwanda. Participatory approaches may enhance sustained use of digital health tools.
Area of Science:
- Digital Health
- Implementation Science
- Public Health Informatics
Background:
- Rwanda faces challenges implementing the e-Tracker, a digital immunization registry within DHIS2.
- The e-Tracker aims to improve the National Immunization Program's data management.
Purpose of the Study:
- To design, implement, and evaluate targeted strategies to enhance e-Tracker adoption and sustained use.
- To address implementation challenges of the digital immunization registry in Rwanda.
Main Methods:
- Implementation research using a mixed-methods approach.
- Co-designed facilitation-based strategies with health workers in 12 intervention facilities.
- Compared intervention group with 36 control facilities; evaluated acceptability, appropriateness, and feasibility.
Main Results:
- Intervention group showed significantly higher acceptability (p=.026) and feasibility (p=.002) of the e-Tracker.
- Appropriateness scores were similar between groups (p=.84).
- Data consistency for key vaccines remained high (~100%) in both groups post-intervention.
Conclusions:
- Co-designed strategies enhanced e-Tracker acceptability and feasibility among Rwandan immunization staff.
- Participatory, facilitation-based approaches may foster sustained use of digital health tools.
- No impact on data consistency was observed, suggesting focus on user engagement is key.
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