A web-based performance assessment tool for immunisation health workers in Uganda: A case of Tororo General Hospital

Abstract

Background: Assessing health worker performance is vital in determining immunisation coverage, as it is essential for making evidence-based decisions. It helps implement effective interventions to improve the quality and impact of immunisation programs within health facilities if assessment is done using the World Health Organization's performance indicators. Objective: This study aimed to develop a web-based health worker performance assessment tool to support decision-making for immunisation health workers in Tororo General Hospital. Methods: The case study utilised the Design Science research methodology to achieve its objectives. Requirements derived from this analysis were validated through a survey and used to create system designs and develop the system itself. The system employed a three-tier Client-Server architecture with load balancers to distribute requests. It had a React-based frontend, JavaScript for server-side logic, a PostgreSQL database, Microsoft Azure hosting, GitHub Actions for CI/CD, Docker for deployment, and cross-platform compatibility. The prototype was tested with a telehealth usability questionnaire, and the results were analysed quantitatively. Results: The study involved nine participants (5 males and 4 females) predominantly health workers and administrators on Tororo General Hospital’s immunisation program. The findings revealed that work overload, lack of motivation, missing data, and information loss were the main challenges affecting health worker performance assessment. The developed tool for health worker performance assessment enabled the facility to measure each health worker's performance based on their contribution to immunisation coverage in terms of timeliness, drop-out in vaccination, new vaccinations, total vaccination, competence, and total vaccination per vaccine. The system therefore rated the performance of the health worker based on their scores and a target for each indicator. It categorised the health worker in either green to show very good performance, yellow to mean good, orange to mean poor and red to mean very poor. A telehealth usability survey assessed the perceived need, ease of use, and attitude towards the tool. The respondents scored the system at 4.6, 4.65 and 4.5 for perceived need, ease of use and attitude towards the system, respectively, on a five-point scale. Conclusion: The developed health worker performance assessment tool will improve health workers' performance assessment on Tororo General Hospital’s immunisation program. Adopting the tool will lead to improved service delivery, increased utilisation of vaccination opportunities at both outreaches and facility, accountability, learning, and improved decision-making.