PATH is a global nonprofit dedicated to achieving health equity. With more than 40 years of experience forging multisector partnerships, and with expertise in science, economics, technology, advocacy, and dozens of other specialties, PATH develops and scales up innovative solutions to the world’s most pressing health challenges.

The Center of Digital and Data Excellence (CoDE) at PATH works with government ministries of health, the private sector, and donors to strengthen the use of digital technologies and data for improved health services. Digital Square is one of CoDE’s flagship global initiatives. It is PATH-led and funded by multiple donors, including USAID and the Bill & Melinda Gates Foundation, to advance digitally enabled health services to help close the health equity gap. Conceived from the lessons of the inefficiencies and redundancies of prior investments in digital technologies for international development, Digital Square works with ministries of health to align adaptable, interoperable digital technologies with local health needs and brings partners together to improve how the global community designs, uses, and pays for digital health tools and approaches.

Digital Square is currently recruiting a TECHNICAL CONSULTANT TO ASSESS THE IMMUNIZATION INFORMATION SYSTEM AND FACILITATE DEPLOYMENT OF AN ELECTRONIC IMMUNIZATION REGISTRY (EIR) IN JAMAICA. THE CONSULTANT WILL BRIDGE WORK BETWEEN UNICEF AND THE MINISTRY OF HEALTH VIA THE Digital Center for Excellence (DICE) MECHANISM, which delivers agile and coordinated technical assistance to National Governments on sustainable and scalable deployment of carefully chosen mature digital health solutions that address health priorities in the context of the COVID-19 pandemic and post-pandemic health systems needs.

BACKGROUND & JUSTIFICATION

The United Nations General Assembly mandates UNICEF to advocate for the protection of children’s rights, help meet their basic needs, and expand their opportunities to reach their full potential.  UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across 190 countries and territories, UNICEF works for every child, everywhere, every day, to build a better world for everyone.

With a fundamental mission to promote every child's rights, UNICEF is and has always been committed to saving the lives of children and their mothers and generating evidence to promote this work.

Electronic Immunization Registries (EIRs) are designed to capture individualized data, the vaccine record for each individual, on doses administered by multiple health care providers. Providers can use the information captured in an EIR at the point of service to determine an individual’s vaccine schedule and eligibility to ensure each individual receives the right vaccine dose at the right time. An EIR can also be used to establish reminders (by e.g SMS) to families on when their children are due for their next vaccination; a function that has shown to increase vaccination rates in other countries. Furthermore, an EIR can also provide the backbone to a more comprehensive child health registry whereby other health milestones are also registered and followed-up longitudinally (e.g growth monitoring, early childhood development indicators, chronic and acute illness etc).

A Master Patient Index (MPI)—also referred to as a patient master index, patient registry, or a client registry— is an electronic database that holds demographic information on every patient who receives healthcare services. The MPI aims to match and link records by uniquely identifying individuals accurately. An accurate MPI may be considered the most important resource in a healthcare setting because it is the link that tracks an individual’s activity within an organization and across the continuum of care, including different across different health facilities, Electronic Medical Records (EMRs), and different Electronic Immunization Registries (EIRs).

MPIs/EIRs must have the ability to assign a distinct, unique identity for an individual (a patient), as expressed by a Unique Identifier (UID) that is unique within the scope of the exchange network, given characteristics about that individual, such as their name, date of birth, gender. Efficient patient identity management leads to high patient identity integrity across different digital health systems.

Official proof of identity is fundamental to an individual’s ability to enforce their rights and secure access to vital services such as healthcare, education, mobile connectivity and social protection. For this reason, the United Nations Sustainable Development Goals (SDGs) have set a specific target to ‘provide every person with a legal identity, including birth registration, by 2030’ (SDG 16.9). 

Unique identifiers (UID) enable the identification of unique persons in an EIR and can foster linkages between different digital health systems (dependent on the legal framework approving such linkage). Some potential attributes for the unique identifier in an EIR/MPI are:

• National Identification Number (NIN) – The same number used for the assignment of a TRN by the Tax Administration of Jamaica.
• The NIN issuing authority (i.e., owning source)
• Type (e.g., medical record number, EIR ID) – Not a universal number and may not be available outside of the public health system.

UNICEF Jamaica supported the Ministry of Health and Wellness to develop and deploy an electronic COVID-19 vaccine registry built on the CommCare platform and is now looking to expand this platform for routine immunization. Augmenting the existing digital health ecosystem will establish automated, real-time person-centric data collection to support integrated healthcare service delivery across the continuum of care. The overall goal is to develop solutions that do not require manual data entry, aggregation, reporting or special data collection. Data is aggregated automatically at the local, district, and national levels for aggregate reporting and analytics. The ecosystem is designed to support this functionality through its interoperability and data sharing capabilities.

In this regard, UNICEF Jamaica seeks a service provider capable of conducting an initial assessment for the deployment of the person-centric Electronic Immunization Registry (EIR) that links with the existing EPI database as well as deployment of the National ID in Jamaica, and the national Electronic Health Record systems (including Master Patient Index, and shared open platforms). The NIN and the EIR are considered the first step toward introducing the Electronic Health Records (EHR) with different building blocks. Once the NIN and EIR are linked, either through a Master Patient Index or otherwise, the same design and blueprint pattern will be used for the EHR. The interoperability and data sharing among all the systems will be ensured.

OBJECTIVES, PURPOSE & EXPECTED RESULTS

The key strategic goal of this initiative is to prepare the ground for the implementation of an initial set of proven digital health solutions that will establish the foundation for patient-centred digital health infrastructure. This initiative targets and addresses immediate and longer-term national health system strengthening.

This assignment aims to identify the necessary infrastructure and functionalities of the EIR and links with NIN/MPI for Jamaica, to develop a realistic, phased plan and implement the EIR in Jamaica.

ACTIVITIES AND RESPONSIBILITIES:

1. AS-IS ASSESSMENT OF THE EIR LANDSCAPE IN JAMAICA

The Consultant will conduct a comprehensive readiness assessment (legal, processes, technical, operational, management, logistics and infrastructural) of the EIR landscape in Jamaica to understand the context and the opportunities and limitations of the current EIR systems in place (e.g. the COVID-19 vaccine platform). The as-is assessment will consist of the identification of key stakeholders in Jamaica, their needs, and their level of engagement; a review of the current technology landscape, including but not limited to the physical and technical infrastructure (including the EPI database), human capacity, training needs, legal landscape, government strategies (including digital health strategies/roadmap, ICT policy), and standards for the digital EIR systems in the country, and compliance with external best practices for technology projects (particularly around data sharing, confidentiality, and interoperability).

The assessment will be conducted by collecting, reviewing and analyzing publicly available data (desk reviews) and, if possible, by primary research via key informant interviews and focus group discussions with various stakeholders, including but not limited to the National and provincial governments in charge of the HIS, non-governmental organizations, local research institutions including the academia, telecommunications sector and others.

Working closely with the Ministry of Health and with the assistance of UNICEF Jamaica and regional office colleagues, the Consultant shall curate a comprehensive list of key stakeholders and conduct interviews, using online or physical meetings where possible, to understand current practice, list the ongoing initiatives and status of their progress, and identify opportunities for linkages between the UNICEF and other stakeholders work in digital health. The key stakeholders may include, but are not limited to, the following:

• Ministry of Health (headquarter, sub-national)
• Registered nurses both at headquarter and health facility levels: the interview should highlight the current workflow of data recording and reporting to assess the level of technical readiness of nurses, which will inform the level of required training to transition from the current practice to the proposed digital systems
• Ministry of Health’s IT unit
• Major donors/development partners in digital health, e.g. PAHO, World Bank and IDB
• Telecommunication service providers
• Hardware service providers
• Custodian of Civil Registration, Civil Identification and Vital Statistics
• The Academic/Research Institutes

Working in close collaboration with the key stakeholders, the Consultant shall:

• Review the national digital health strategy (if it exists) and related HIS policies, including best practices and lessons learned regarding digital health deployment in Jamaica
• Review the National ICT Policy and assess any legal implications to deploy EIR and NIN/MPI systems
• Map existing digital health tools and databases used for EPI, and opportunities for linkages/information exchange
• Identify the inefficiencies, delays and informal practices involved in the current processes and the root causes of these issues
• Assess the local capacity for hosting the EIR solution
• Assess the capacity and training needs of actors to conduct current process steps, including the digital capacity of citizens to use digital/electronic processes/transactions.
• Identify barriers i.e., reasons why immunization records have not been accurately updated.
• Identify opportunities to include other child health and development indicators in an EIR
• Identify and document change management and knowledge sharing processes that would be involved in the successful implementation of the EIR/MPI systems
• Identify the capacity needs to integrate with the national digital certificate platforms. This should also include assessments of international requirements for acceptance for digital documentation for vaccination certificate compliance

2. STAKEHOLDER NEEDS AND TARGET STATE FOR EIR SYSTEM AND THE USE OF NIN/MPI FOR INFORMATION EXCHANGE ACROSS THE DIGITAL HEALTH SYSTEMS

The Consultant shall gather, synthesize, and analyze requirements from the stakeholders to compile the business, functional and non-functional requirements for an EIR system in Jamaica. The functional requirements must be aligned with the UN recommended human-centered design approach and documented from the perspective of the user. Special attention will be given to collect information on work already conducted in relation to EIRs or other longitudinal health records, to avoid duplication of efforts made by other partners.

Using the opportunities and limitations identified in the first deliverable and considering the power of technology as an enabler, the Consultant shall identify areas to strengthen the automation of the system and make multi-stakeholder recommendations to significantly increase the likelihood of digital immunization records using a NIN/Master Patient Index (MPI).

Based on stakeholder consultations and field visits, the Consultant should also conduct an assessment of human capacity baseline and training needs.

3. DEVELOP A RAPID DEPLOYMENT MODEL AND A COSTED WORKPLAN FOR THE DEPLOYMENT OF EIR LINKED WITH THE NIN/MPI

The Consultant will use the analysis of the information gathered through the Deliverable #2 to develop a rapid deployment model of the EIR using a link to the EPI database, the NIN, or an MPI for interoperability, as well as a country-specific costed workplans.

The Consultant shall map out the target state business processes as well as the functional and system architecture being proposed, which must include business processes and workflows, core data elements and data flow between systems, priority metrics and indicators, and high-level resources, both technical and human. 

A country-specific costed workplan should indicate resources required, financial, technical and human, and include timelines of implementation. It should also include costs associated with infrastructure, interoperability and integration with other existing systems, training and documentation.

The costed workplan should also contain recommendations to the Jamaica Government to enhance its ownership, accountability and sustainability of the proposed design, after completing the costed workplan. This includes capacity building and training needs and training needs of the Government, M&E framework, system review, sustainability of the implementation of the system.

Note on data protection:

Compliance and adherence to local, and if applicable, regional and international data protection policies and laws must be given the highest priority while defining system requirements and architecture for the proposed system, to protect children’s rights.

ADMINISTRATION

The Consultant will be hired by PATH/Digital Square under the DICE framework, while daily operations and reporting will be with the UNICEF Jamaica country office. Frequent contact with project focal point will be expected to ensure clear communication, expectations, and update project progress and performance.

The Consultant’s work will be directly supervised by the UNICEF regional digital health analyst and regional business analyst, in collaboration with PATH/Digital Square. It is highly recommended to schedule a weekly teleconference to discuss the status of deliverables.

DELIVERABLES

1. As-is Assessment of the EIR landscape including process flows.
2. Stakeholder needs and target state and processes for EIR system and the link with the NIN, or use of MPI, for information exchange across the digital health systems.
3. Develop a rapid deployment model and a costed work plan for the deployment of EIR linked with NDI/MPI.

Required Skills Required Experience

Consultant must demonstrate experience in the following areas:

• Experience in developing Electronic Immunization Records linked with NINs or Master Patient Index systems, especially deploying Digital Public Goods (DPG)-standard EIR and MPI.
• Knowledge of agile software development methodologies, analysis and design skills
• Proven experience working on a project from the initial requirements and design state to the final implementation.
• Experience developing and deploying low-bandwidth applications in challenging work environments.
• Experience developing and deploying solutions in a manner following the Principles for Digital Development (digitalprinciples.org)

COMPETENCIES

• Strong organizational and detail-oriented skills
• Ability to process and synthesize large amounts of information
• Flexibility to accommodate schedule to respond to requests
• Fluency in written and spoken English required

LOCATION AND DURATION

• Starting period: Immediately
• Duration: 4 months
• Location(s): On-site in Jamaica (preferable) or remote with frequent country visits

COVID-19 VACCINE REQUIREMENT:

PATH has instituted a COVID-19 vaccine mandate for all employees, interns, consultants, and temporary staff based in the United States. Individuals selected for job opportunities in the United States must be fully vaccinated, and show proof of vaccination status, upon hire. Individuals are considered fully vaccinated 2 weeks after their second dose in a 2-dose series, such as Pfizer or Moderna, or 2 weeks after a single-dose vaccine, such as Johnson & Johnson. Individuals with medical issues or sincerely held religious beliefs that prevent them from getting the vaccine may request an exemption from the vaccine requirement.

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PATH is dedicated to building an inclusive workforce where diversity is valued.

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PATH is an equal opportunity employer. Every qualified applicant will be considered for employment. PATH does not discriminate based on race, color, religion, gender, sexual orientation, gender identity, genetic information, age, national origin, marital status, disability status, political ideology, military or protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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