Immunization goes digital in Timor-Leste with launch of e-tracker

Henriqueta Sarmento has worked at Manleuana health post long enough to remember when it stood looted and empty during the country’s years of conflict, and when it slowly returned to the community it was built to serve.  Through those years, one part of the work barely changed: the immunization registers. A daily register for every child coming to the centre. A register organized by vaccine. And a third aggregate register for each aldeia, used for reporting upwards. Three separate acts of writing for every single child who walks through the door.

“For 20 years, I have written children’s names and the same details across multiple books,” Sarmento said. “This digitization will change everything.”

Nurse Henriqueta Sarmento presents immunization ledgers used for recording vaccination data. © WHO Timor-Leste 
 

The Ministry of Health (MoH), with technical support from the World Health Organization (WHO) Timor-Leste and financial support from Gavi, the Vaccine Alliance, has launched a pilot of the Immunization e-Tracker, a digital tool designed to transform how vaccination data is recorded, tracked and used. Importantly, this initiative promises to strengthen data quality, a long-standing constraint in the young nation.
 

At selected facilities across Dili, vaccinators have begun entering vaccinations directly onto tablets, marking the country’s first move to individual-level digital immunization records right down to the health-post level.

Dr Elisabeth Leto Mau, DG, Primary Health Care, says that piloting the Immunization e-Tracker was a pivotal step in safeguarding Timor-Leste's hard-won gains: polio-free status, elimination of maternal and neonatal tetanus, measles and rubella, by anchoring them in real-time data that is accurate, complete, and timely. The system will allow managers at every level to monitor performance and make evidence-based decisions," she added.

From ledger to tablet

In practice, the e-Tracker may look deceptively ordinary. A mother arrives with her child. The vaccinator opens an app on a tablet instead of a ledger. The child’s record, created at the first visit, is already populated. The dose is logged in seconds. The next appointment can be scheduled in seconds. If the mother does not return, the child's name is flagged on a drop-out list, which the vaccinator sees as an alert in the e-Tracker system. 

WHO Timor-Leste formally hands over tablets to support the implementation of the Immunization e-Tracker. © WHO Timor-Leste

“What the e-Tracker gives us is something we have never had before at this scale: digitized immunization registries, interactive dashboards and automated monthly reporting,” said Dr Arvind Mathur, WHO Representative. “More importantly, it gives health teams the critical ability to identify and track children who miss vaccinations or drop out of the schedule. Instead of finding them months later, they can follow up sooner and ensure no child is left behind,” he added.

Tracking the children who slip through

In May, the MoH and WHO trained 30 health personnel, including nurses, immunization focal points and doctors, drawn from 12 facilities: eight health posts, one Community Health Centre (CHC), and three private clinics in Dili. Each participating site has received tablets and SIM connectivity for real-time entry. Private clinics are also part of the rollout, since the government supports immunization in private facilities in Timor-Leste. 

Mr Mateus Pinto, Director of the Dili Municipality Health Service, thanked the Health Ministry and WHO for entrusting Dili with the pilot, adding that the tool will help staff track zero-dose and partially vaccinated children.

The drop-out rate in some vaccinations, such as measles-rubella, is estimated at 7–8%, above the desirable limit of about 5%, said Joaquina Francisca Belo, District Public Health Officer for Dili Municipality. “A digital system can alert us sooner that a child has not shown up,” she added. Children who move between facilities or areas are also often re-registered, a duplication that a digital system can eliminate, she said.

Joaquina Francisca Belo presents the tablet to be used for the Immunization e-Tracker. © WHO Timor-Leste

“A digital system also shields records from the slow damage of time, weather and storage,” says Margaretha Motu Bere, immunization focal point at Comoro CHC and among those trained on the tablets.

The Immunization e-Tracker dashboard displaying real-time vaccination data. © WHO Timor-Leste 

The e-Tracker can function offline, essential in a country where connectivity remains patchy beyond the larger towns. The app has been built within the Timor-Leste Health Information System (TLHIS), the country’s principal health management backbone, which runs on the open-source DHIS2 platform.

The e-Tracker is part of a broader digital health push. Patient-level tracking, introduced in 2024 for tuberculosis, HIV, and malaria, has since expanded to hypertension and diabetes, and now to immunization.

Thirteen antigens, 40,000 newborns a year

Timor-Leste’s immunization journey has expanded from six to thirteen antigens. Under the national programme, children receive vaccines from birth through the first two years of life, including protection against tuberculosis, hepatitis B, polio, diphtheria, tetanus, pertussis, pneumococcal disease, measles and rubella. Each year, roughly 40,000 newborns enter that schedule. The HPV vaccine for adolescent girls was added in 2024.

Dr Leto Mau adds that the lessons learnt from the pilot will inform its expansion to more health facilities, and eventually a nationwide rollout.

For nurse Sarmento, the shift promises continuity as much as change. “The big change since independence is that parents now willingly bring their children to get vaccinated,” she says. “Systems should constantly evolve as people are evolving too.”