Strengthening Immunisation Data Systems: a mixed methods evaluation of the Lao Electronic Immunisation Registry

The Lao People's Democratic Republic introduced an electronic immunisation registry (EIR) for routine immunisation in 2022. This study evaluated the EIR during its early stages to inform ongoing implementation and future use. We used a multi-method approach that involved five data sources: document review; health facility survey; key informant interviews; workflow observation; and data quality assessments. We surveyed 26 healthcare workers across 26 facilities. Respondents’ perceptions of the EIR were largely positive, though views on workload were mixed, and most indicated insufficient training and ongoing needs in data analysis and problem-solving. Only half consider infrastructure adequate. Eighteen stakeholder interviews highlighted strong uptake of the EIR and improved ability to generate reports and identify under-immunised children, but also persistent data gaps, limited data use, staff shortages, reliance on development partners, and the need for stronger government ownership, supervision, and a clear long-term roadmap. Data quality assessment of 849,055 non-duplicate vaccination events showed high levels of missing or invalid data and low timeliness of birth and vaccination registration; across four facilities, the EIR captured more doses than paper registers and district reports. This evaluation showed that EIR is feasible and acceptable, but individual and system-level barriers, particularly workforce capacity and capability, digital infrastructure, governance, and financing, must be addressed to realise its impact on vaccination coverage, underscoring the need for future implementation research to optimise EIR use in Lao PDR and similar settings.