IMG-20191023-WA0016

Mothers Waiting for their children to be registered with mVacciNation in a hospital in Tanzania

mVacciNation

mVacciNation is a smartphone app to improve vaccine coverage in under-fives in the Global South by reducing drop-out rates and addressing issues in stock and management. Parents are sent text messages to remind them when their child’s appointments are, improving adherence to vaccine schedules and enabling a greater number of children to be fully immunised. All of the app's data synchronizes with the Cloud in real-time, so stock levels and fridge temperatures can even be tracked offline!

Innovation Summary

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1.5 million children die from vaccine-preventable diseases each year (WHO, 2016). In Tanzania, challenges in the immunisation system include having different paper-based systems in health facilities across counties. This has resulted in a fragmented system of reporting and data management challenges (Suckling et al, 2006), and this confusion means parents often have reported not knowing when their child's next appointments are. In partnership with Vodafone, Amref Health Africa has responded by developing an innovative, user-friendly tool called mVacciNation, designed and implemented through close collaboration with local Tanzanian organisations. The tool addresses inconsistencies in the supply, demand and data management of vaccines, harnessing the power of technology to ensure that no-one is left behind on immunisation!

The project uses mobile technology to address the barriers to the take-up of vaccines in three key ways. Firstly, mothers (and other caregivers) are registered on the mVacciNation database and alerted by SMS on the availability and importance of lifesaving vaccinations against common childhood diseases. Awareness messages on the importance of vaccines are included, aiming to reduce the number of missed appointments. Mothers are able to schedule vaccination appointments by SMS and receive notifications of past and future vaccinations to ensure children complete the full schedule and become fully immunised. Secondly, health workers are provided with smartphones with software allowing them to contact mothers, view and record vaccination histories, schedule vaccinations and report on follow-up visits. Healthcare staff can also identify patients who need further vaccines, including in hard-to-reach areas, and community health workers are then able to visit the patient’s family home in an outreach session. This ensures people who are otherwise unable to travel to the facility can also be fully immunised. Thirdly, healthcare facilities are prompted to regularly report on crucial vaccination stock levels and fridge temperatures by SMS. This enables critical supply chain management and the availability of vaccines when and where they are needed, particularly in rural areas. The data synchronises in real-time in the Cloud. Even if the electricity fluctuates or the network signal is bad, the app will still synchronise. It works offline and on any mobile network.

Between May 2016 and October 2018, Amref Health Africa’s mVacciNation programme was implemented in fifty Tanzanian health facilities that had the greatest need (Bukombe, Mbogwe, Kahama and Msalala Districts). The electronic system replaced the paper system by caregivers, nurses, doctors, and other community members. As a result, the coverage of children under-five across the districts who were fully vaccinated increased by 5% to 98%, immunisation stock-outs decreased from 78% to 28%, and data quality and accuracy increased from 78% to 93%. This shows that mVacciNation successfully increases vaccination coverage, and over time, this will reduce the number of people who die from vaccine-preventable diseases.

Importantly the app was continually improved through community partnerships: the element of sending appointment reminder SMS messages came from user feedback, as project staff learnt that many caregivers were unsure about when their child’s next appointments were or could not travel the 20 kilometres or more to reach the health facility. So, mVacciNation created a link between the community and the health facility through messages and outreach services. This led to an increase in people attending appointments; 55% of users said that the text reminders were the biggest help in attending visits. Also, after learning that the children born in the community who were legally unregistered were often not being vaccinated, Amref met with Ministry of Health (MoH) partners to design an additional module of mVacciNation. After the meeting, new indicators were created to ensure the app could identify infants delivered in the community (outside health facilities) who had not been registered for immunisation services. This was made possible through community health workers organising potential mother/infant pairs within their catchment areas in remote areas to receive outreach services for immunisation in outreach sessions, enabling these children to become fully immunised.

Also, at district and country level, the MoH has provided initial operational support for integration of mVacciNation into their own growing electronic health system (which does not yet have a vaccine component), called VIMS. In the future, this will enable the app to be institutionalised and scaled-up across other districts of Tanzania, ensuring a greater number of people across the country are vaccinated and improving country-wide immunisation data management.

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