The problem: poor immunization coverage and government monitoring
The majority of children who die from vaccine-preventable causes live in low- and middle-income countries. Poor immunization programmes put children at a risk of deadly yet preventable diseases such as measles, pneumonia, whooping cough, polio, hepatitis B and TB. In Pakistan, 27 percent of under-five deaths are due to vaccine-preventable diseases. And every day, approximately a thousand children under the age of five die in Pakistan.
In Sindh, Pakistan’s third largest province, the immunization rate declined from 37 percent to 29 percent between 2006 and 2013. Lack of effective monitoring by the government, insufficient visits by vaccinators to villages, unverified vaccination reporting and inadequate effort at creating routine immunization awareness among parents are major causes for the declining rate.
Our solution: AKDN eHRC’s Teeko app
The Aga Khan Development Network eHealth Resource Centre (AKDN eHRC) and the Aga Khan University Paediatrics Department have partnered with the Sindh government’s Expanded Programme on Immunization to address these causes, boost immunization coverage and reduce incidence of preventable diseases in the Tando Mohammad Khan (TMK) district in Sindh.
AKDN eHRC has designed and developed Teeko, an android-based application and a web portal to assist with vaccinator and immunization tracking and monitoring.
Teeko, meaning vaccination in the local language, is used by vaccinators and lady health workers in TMK to:
- Register children into the database and sync the data to the Teeko web portal;
- Vaccinate pre-registered children and even vaccinate children when there is no internet connectivity.
- Check vaccine stock availability at their respective health facilities;
- Educate parents through the help of a video, developed by AKDN eHRC, shown at health awareness sessions to help them understand the importance of vaccinations in preventing deadly diseases.
“The Teeko app has enabled us to switch from manual to electronic data collection and reporting, which saves time and provides accurate results,” Syed Imran Shah, a vaccinator.
Vaccinators and lady health workers use the Teeko app to vaccinate children and keep a record of various vaccines administered (right)
The Teeko web portal serves several functions. A GPS tracking system built into the portal allows district health officers and supervisory staff to remotely monitor vaccinators’ activities and movements to ensure greater accountability. The portal also keeps a record of registered children’s vaccinations and routine immunization coverage reports. A SMS panel is used to send text messages to parents of registered children about upcoming vaccinations, and vaccinators and health workers are kept informed about meetings and schedules.
During the initial stages of project implementation, text messages were sent to parents to encourage them to register their children for vaccinations. But soon it was observed that parents were unable to read the messages because of the low-literacy rate. AKDN eHRC modified the application to suit the needs of the community and started sending radio messages and robocalls instead. This approach saw an increase in the number of parents bringing their children to the clinics for vaccinations.
“This project has raised awareness of vaccinations, and people are coming forward to support vaccinators and the local administration,” Sanam Khaskheli, a villager.
The research project is funded by Global Alliance for Vaccines and Immunizations (Gavi). It initiated in January 2015 and will conclude in 2017. The mHealth component of the project began in October 2015 and will be implemented over a period of 15 months, concluding in early 2017.
The Teeko web portal, synced to the app, allows for real-time monitoring of vaccinators’ activities and movements. (left)
Impact and scale-up
In just three months, “routine immunization in TMK increased from 15-19 percent to 49-84 percent as reported by independent monitoring”, says Dr Shehla Zaidi, Associate Professor, Women and Child Health Division, AKU, who is leading this project.
Impressed by these results and convinced by the intervention’s potential, the Government of Sindh has endorsed Teeko and decided to expand the project to the entire Sindh province. In addition to helping improve vaccine coverage, the scale-up project will also provide pre- and post-natal care monitoring via the mobile application.
“This technology of monitoring vaccination in real-time has amazing results and EPI Sindh would like to use it in other districts that need improvement,” Dr Agha Ashfaq, Programme Director, EPI, Sindh.
Teeko is designed to benefit low- and middle-income countries with poor immunization rates. It can be tailored to the needs of the community and translated into different languages.
Through Teeko, AKDN eHRC’s aims to create a robust governance system that is able to better coordinate with government health centres, as well as improve routine immunizations and ensure children are vaccinated against preventable life-threatening diseases.