From certification, to vaccine scheduling, to resource management, digital technologies have proven to be critical throughout the pandemic. Since 2021, Jamaica, much like the rest of the world, was in need of digital solutions that could be deployed in a short amount of time, with scalability and customisation features in order to tackle the challenges brought on by COVID-19. In partnership with UNICEF – who, on behalf of the COVAX Global Facility, is leading the global vaccine procurement and supply operation to ensure equitable access to COVID-19 vaccines – Jamaica chose to implement two digital public goods: CommCare and DIVOC.
Phase one response: CommCare
While accessing the vaccines themselves was the first priority for many countries, they must also be properly documented and delivered. Digital solutions can help countries prioritise at-risk groups, adequately apply required screening and eligibility criteria, and register and track patients over time to ensure follow up or subsequent immunisations are provided. These considerations are integral to not only COVID-19 response, but can be applied to all immunisations.
CommCare is a digital public good developed by Dimagi used to rapidly configure and deploy offline first, custom data collection and service delivery support applications with minimal tech or coding expertise required. It can be customised for a number of different use cases including managing national vaccine roll-outs. CommCare can be deployed as a mobile application, and used to track and support clients before, during, and after they are vaccinated. This work is integral to helping facilities and health care workers prepare for vaccination distribution, provide analytics, and create visualisations to monitor the progression of vaccine delivery. CommCare facilitates long-term tracking, decreases wastage of vaccine supply, and pushes vaccine protocol down to the front line to reduce training costs.
In March 2021, Jamaica received its first shipment of COVAX- procured vaccines. Only three months later, on June 14th, 2021, the country launched its COVID-19 vaccination system, powered by CommCare. Following a two-week transition period which allowed training for local officials, the system was fully integrated and handed over to the Government of Jamaica. Today, this DPG is on the frontline of Jamaica’s vaccine roll out, providing real-time analytics to help monitor delivery, track rates of missed appointments and adverse events following immunisation, and ensure critical populations are vaccinated first. The choice of CommCare was driven by its proven success in other low- and middle- income countries, its ability to be adapted to meet local needs including scalability, and the fact that implementation did not require contractual obligations to proprietary technology. CommCare has helped establish the digital foundation for enhanced COVID-19 vaccine delivery and can now be applied to other vaccine use cases as well.
Phase two response: DIVOC
Vaccine supply and distribution is only half the battle. While vaccines are critical to mitigating the health risks of COVID-19, vaccine certificates have proven to be integral to economies reopening. Jamaica, again in partnership with UNICEF, decided to implement DIVOC, which stands for digital infrastructure for vaccination open credentialing. DIVOC is another DPG developed by the eGov Foundation, a DPGA member, with a proven track record of adapting to local contexts quickly. It can interact with the data derived by CommCare in order to provide seamless credentialing to those that have been vaccinated. DIVOC was developed in India and has already been implemented in the Philippines and Sri Lanka. For Jamaica, implementing DIVOC for vaccine certifications was a means of overcoming vaccine hesitancy and held the potential for a more rapid ‘return to normal’.
As the vaccination certificating component of India’s CoWin system, DIVOC has provided over 1 billion electronic vaccine certificates in India alone. By mid-December 2021, after only 1.5 months of configuration and integration, it was live in Jamaica. As part of this collaboration, DIVOC and CommCare use an API to automatically generate digital vaccine certificates following the WHO “Digital documentation of COVID-19 certificates” (DDCC) framework. UNICEF and WHO support global goods for COVID-19 response and recovery through their joint initiative, the multi-agency Digital Health Centre of Excellence (DICE).
Today, Jamaica is one of the few countries in the Western Hemisphere to be using two connected digital public goods as part of its COVID-19 response. Attention to interoperability and ensuring that solutions can be customised to both local needs and international standards was the differentiator. Prior donor investments meant that not only were both CommCare and DIVOC available when needed, they were also scalable and configurable. Increasing the number and availability of digital public goods will help in future instances where rapid, global, and equitable responses are needed. And, both serve as a reminder that sustainable funding, coupled with working with and for healthcare workers through public-private partnerships can prove critical to both emergency and non-emergency contexts alike.
Success factors in COVID-19 response
This success was made possible by a few critical factors. When the COVID-19 pandemic began, many organisations, including UNICEF, quickly began preparing for ways to support governments in their response efforts which meant exploring digital public goods that could be deployed. Karin Källander, Senior Health Adviser from UNICEF, shared how they promote and use digital public goods when working with countries and highlighted several success factors in implementing digital solutions for COVID-19 response. They included:
1. Stable funding for pre-customised technologies helps improve emergency preparedness
DIVOC and CommCare are two examples of DPGs that, thanks in part to early and long-term funding and investment, have established themselves as useful tools in COVID-19 responses. Both were developed based on specific country needs – DIVOC in India and CommCare in the United States – while also being made easily configurable. For example, with grant funding from the Bill & Melinda Gates Foundation, DIVOC was able to more effectively meet country demands by adding functionalities/modules for certification, self-registration, appointment scheduling, and more.
Prior funding for building and evolving strong and pre-customised core products meant that when implementing in additional countries, like Jamaica, the focus could be on adapting to local needs. These DPGs only required local configuration before country deployment for a COVID-19 response plan. This highlights the importance of pre-emergency investments in digital public goods.
2. The need to bring health workers along on digital transformation
Change management in the health sector can drive acceptance and adoption of digital tools, especially amongst health workers. Part of the success model of DPGs is that their transparency in code and documentation allow for communities of practice to share learnings, implementation techniques, reporting mechanisms and more. Collectively, this can help boost the confidence in and understanding of new technologies, and help facilitate easier adoption.
3. The important role of public-private partnerships
There is a critical need to foster public-private partnerships as a means of driving digital transformation and the use of digital public goods in emergency preparedness and response. UNICEF Health has used this type of partnership in their work in Jamaica in particular.
4. Digital cooperation is crucial to digital adoption
In the case of CommCare and DIVOC, both DPGs had been implemented in other countries before Jamaica. By sharing those learnings, multilateral organisations played a crucial role in instilling confidence and increasing the understanding of new technology adoption. Efforts like this help accelerate solutions, avoid duplication and bridge new opportunities for collaboration.
Jamaica’s experience implementing digital public goods for COVID-19 response serves as a case study that highlights each of the key success factors above, including as a successful example of multilaterals and countries working together to find innovative solutions.
This case study originally appeared in the DPGA’s 2021 Annual Report.
UNICEF is a co-founding member of the Digital Public Goods Alliance and a co-chair of the DPGA’s Health Community of Practice (CoP), which brought together experts to surface and aid in the discovery of DPGs that could be relevant to immunisation delivery management. This CoP released a report highlighting 13 DPGs of relevance, including CommCare and DIVOC, and undertook additional vetting to ensure the quality of DPGs highlighted. “Had it not been for the CoP it would have been much harder to implement and review products. For us at UNICEF and for others that use the report it shows the credibility of the solutions.” said Karin Källander, Senior Health Adviser at UNICEF.