In developing countries, vaccination campaigns have achieved enormous gains in newborn and child health over the past 30 years. However, due to inefficient data tracking and reporting, millions of children still go without the necessary vaccines every year. Disorganized storage of paper records and a faulty distribution network mean that in some areas up to 50% of vaccines don't reach the arm of a child in need, contributing to millions of preventable deaths. To increase the efficiency of vaccination and data tracking, VaxTrac implements biometric technology linked with an electronic registry that records patient data. The program has measured great success in Benin, and recently received funding to expand their services in Nepal.
I spoke with VaxTrac executive director Mark Thomas to learn more about the program’s success in implementation and scale-up to other countries.
Lane Goodman: VaxTrac combines cutting-edge fingerprint technology with a mHealth platform to make vaccination more efficient. What were some of the breakthrough moments you’ve had when implementing the program?
Mark Thomas: When we first started to train health clinic staff in the field, we assumed that uptake of the technology would be slow, and users would find the system difficult to learn. However, we were blown away by health workers’ quick understanding the VaxTrac system. They rapidly grasped how the system collects information from mothers and children in a way that formats data for easy reporting. The difficulty came in the hardware skills that we took for granted – while most of our staff in training were familiar with mobile devices, they were new to computers and fingerprint scanners. In our first training session in Benin, the workshop on the VaxTrac system was easily understood, and the rest of the time was spent on critical computer skills. We realized that a properly designed system is easily learned, especially when modeled after existing data collection techniques.
LG: So do you iterate on your design?
MT: Yes, we have a team of program staff and engineers in Benin who collect user feedback alongside health workers in the field. We’ve worked out the basic details and functionality of our technology in the environment, and our proof of concept is sound.
We also now understand how to build new systems with health workers, rather than impose our system on their efforts. We come in with engineers to determine health workers’ needs, using an A:B testing approach to design and increasing capacity.
LG: VaxTrac began in Benin, but recently started work in Nepal. How have you managed to scale your solution to new countries?
MT: Our success lies in understanding that some parts of VaxTrac’s design are universal, and that others must be local. A national vaccine schedule looks the same in every country, while other parts of the system look wildly different. For example, the Nepali lunar calendar is unique, as is each country’s language, medical terms and hierarchy. All of these distinct parts need to be local. A lot of our work in expanding the system to different countries involves translation of words and concepts.
We are working with so many actors at this point, and different countries mean distinct health reporting information, different divisions of labor, and different universes of stakeholders interacting with our system. Our technology is completely customizable, and we work with stakeholders to ensure that our back-end and data entry complies with regional reporting standards.
LG: What barriers does VaxTrac face in taking the program and product to scale?
MT: We are now in active talks with the WHO and the Ministry of Health to expand VaxTrac to Indonesia. This project has been revealing of the complex ecosystem of national policies and agendas, where international agencies and donors all have their own competing priorities. Learning to navigate this system is a large barrier to getting into any country. How do you discern what a Ministry of Health needs and wants, and how do you fund that? We frequently find ourselves in situations where there are too many cooks in the kitchen. We have learned to listen to all of them, synthesize that information, and bring that into one objective.
The Ministries of Health in developing countries are consistently bombarded with new products, innovation, and funders. Funders often unknowingly support multiple mHealth projects in the same country, and then are faced with these programs competing for their attention. The challenge is to get ministries involved early and get buy-in, and set up a process for integration and communication.
LG: What are your plans for future scale-up?
MT: Our philosophy is to move into new countries only as fast as we can manage our engagement. We currently have interest from over a dozen countries, but VaxTrac needs to support these projects internally to deliver maximum impact. The unique contexts of each country require a massive amount of preparation in order for VaxTrac to have long term success and impact.
We have a great identity and system in our organization, but we’re at the point where we need to make strategic decisions about scale. Do we try and replicate our success in all 72 GAVI countries? Do we partner with larger organizations to achieve that scale? One idea for this model proposes operating as a “lab” setting to test technologies, and then hand them off to these larger organizations.
LG: How have you learned from other programs?
MT: Networking is the single most important tool in development. We have learned a lot from programs like Operation ASHA, D-Tree International, and others. It has been helpful to learn what other programs have done, what works and what doesn’t, and ask more technical questions – how do they structure data, and how can we one day integrate these systems with each other? We enjoy learning best practices through structured and unstructured information exchanges.
The mHealth working group is a powerful way to connect implementers and technologies. Conferences are some the most useful experiences we’ve had to interact in a nonofficial capacity to learn what works from other organizations. While the mhealth space is undoubtedly a crowded one these days, the competition spurs innovation and ensures that the best ideas percolate to the top.
Learn more about VaxTrac at vaxtrac.com.
Photos © 2014 VaxTrac: (Above) Henry Fath, a health worker in Benin, using the VaxTrac system. (Center) A team of health workers in Benin training to use the VaxTrac application.