Assessing the Use of Geospatial Data for Immunization Program Implementation and Associated Effects on Coverage and Equity in the Democratic Republic of Congo

Abstract Background The National Expanded Program on Immunization in the Democratic Republic of the Congo started using geospatial data at scale in 8 Provinces to strengthen the planning and implementation of vaccination services with a focus on the identification and immunization of zero-dose children, children who have not received the first dose of diphtheria-tetanus-pertussis containing vaccine (DTP1 ). Methods The study used a mixed-methods research design including survey tools, in-depth interviews and direct observation to document the uptake, use, and perceived impact of georeferenced immunization microplans in the intervention provinces of Haut-Lomami and Kasai and in the control province of Kasai Central. A total of 113 health facilities in 98 Health Areas in 15 Health Zones in the three provinces were included in the study sample. A gender intervention in select Health Zones and Health Areas in Kasai Province was also evaluated through a targeted qualitative study. A secondary analysis of immunization coverage survey data was conducted to assess the associated effects on immunization coverage, especially for rates of zero-dose children. Results This research study shows that georeferenced microplans are well received, utilized, and led to changes in routine immunization service planning and delivery with perceived improvements in identification and reaching zero-dose children. In addition, the gender intervention is perceived to have led to a significant change in the approaches taken to overcome sociocultural gender norms and engage communities to reach as many children as possible, leveraging the ability of women to engage more effectively to support vaccination services. The quantitative analyses showed that georeferenced microplans may have contributed to a dramatic and sustained trend towards high immunization coverage in the intervention site of Haut Lomami, which rose dramatically from 8.9% in 2020 to 76.8% in 2021 and to 92% in 2022 for Pentavalent 3 antigen, while the DPT1-DPT3 drop-out rate changed little from 1% in 2020 to 1.7% in 2021 and 1.6% in 2022 after three years of implementation. Conclusion The overall study identified positive contributions of the georeferenced data in the planning and delivery of routine immunization services. It is recommended to conduct further analyses in Kasai in 2024 and 2025 to evaluate the effects of the gender intervention on immunization coverage and equity outcomes.