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!
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.
What Makes Your Project Innovative?
mVacciNation is innovative as it reflects how parents, teachers, adolescents, religious leaders and health staff can work in partnership with NGOs to collaboratively design, develop and test an app that successfully enables a greater number of under-fives to be fully immunised. As the app’s data is open-source and synchronises in real-time with the Cloud, it is easily and freely available. Even if electricity fluctuates or the signal is bad, data still synchronises. It even works offline and on any network. This enables staff to monitor the demand for and uptake of services; staff are alerted when stock-levels are low or when a technician is required for temperature maintenance. The unique feature of sending SMS reminders to caregivers three days ahead of their child’s next appointment also gives them time to plan for the visit. Further, the outreach system enables remote communities to be reached. This significantly reduces morbidity from vaccine-preventable diseases. And, it is free!
What is the current status of your innovation?
Diffusing Lessons - using what was learnt to inform other projects and understanding how the innovation can be applied in other ways.
Collaborations & Partnerships
Amref Health Africa are now disseminating the successful project data and are looking to up-scale the app for use in other districts. The Ministry of Health of Tanzania has been very supportive of mVacciNation and has recently approved the linkage of the app to the government-run electronic healthcare system (that does not yet have a vaccine component). This crucial step can build a comprehensive immunisation system that links national level data to community level data.
Users, Stakeholders & Beneficiaries
Vodaphone, UNICEF, GSK, HDIF, Mezzanine, the Ministry of Health of Tanzania, Amref Health Africa Tanzania, Amref Health Africa Kenya, Amref Health Africa UK, and many health facilities, schools, parent groups and religious organisations in the communities
Results, Outcomes & Impacts
Data on more than 430,000 children under five have been captured in the mVacciNation system. There is now improved immunisation data efficiency and management in Bukombe, Mbogwe, Kahama and Msalala Districts – quantitative indicators demonstrated that data accuracy improved from 78% at baseline (2016) to 93% at end-line (2018). Intelligence for vaccines and commodity supply chain improved as vaccine stock-outs went from 78% to 28%. Maintenance of ideal temperatures for vaccine refrigeration also improved from 22% (in 21 health facilities (HFs)) to 82% (in 41 HFs). Over 98% of children are now fully vaccinated in the districts – a 5% increase from baseline, and 100% of under-fives have now been fully vaccinated for certain vaccinations, including PENTA 1 and PENTA 3. 150 healthcare workers from the facilities were retrained and supported to use the mVacciNation platform. 24,616 stock updates and 31,507 temperature updates were registered. Replacing the paper system also saved money!
Challenges and Failures
No huge challenges have been encountered. However, when the Amref team, Mezzanine and the MoH, developed and tested the new community module in the mVacciNation system that allows data on immunisation and births at community level to be captured, the option to integrate the mVacciNation community component into the pre-existing MoH system was discussed, and the MoH granted approval for this to happen. Nonetheless, the practical aspects of linkage will require a larger investment, which Amref is actively sourcing. A challenge has been funding this, as the existing budget was created on the assumption that Mezzanine would implement the entire development and integration. However, in the course of implementation, it was agreed that the two systems will not be integrated, but rather linked, and only the community module of mVacciNation to be linked to the MoH system. To raise the additional resources, Amref has been liaising with various possible partners.
Conditions for Success
Success, for Amref, lies in: supportive funding from a wide range of different partners that share a common goal to improve the health of communities; app design in collaboration with as many stakeholders from the community as possible; strong community feedback mechanisms and ability and willingness to redesign/add in additional elements to the app if needs be; flexible, empowering leadership; clear guidance and rule dissemination; and clear and comprehensive human resources for app use.
mVacciNation is now being administered in Mozambique and Nigeria by Mezzanine, in partnership with Amref Health Africa. As of January 2019, across the three countries, 183,977 children have been registered into the system, successfully recording 955,558 antigen/vaccine administrations. With funding from USAID and GAVI, the pilot in Mozambique is being independently evaluated by the J-PAL Africa research unit, based at the University of Cape Town (UCT), and the National Institute of Health of Mozambique. The UCT team includes researchers from Yale University and Harvard School of Public Health. The evaluation will rigorously measure the impact of the program as well as assess its cost effectiveness, helping to inform scale-up decisions both across Mozambique and in other African countries.
Through multi-stakeholder design and community management, key obstacles in vaccine uptake, supply and demand (supply chain failures, demand side failures and data capture) in the Global South can be combined via three interrelated interventions (caregivers/mothers, health workers, and facilities) into one mobile platform to significantly improve immunisation rates.
Amref are extremely proud that mVacciNation has been selected by the Gavi Vaccine Alliance as one of "11 finalist innovations which, if scaled, have the potential to drastically improve vaccine coverage and equity in developing countries — one of the greatest challenges in immunisation today", and has been nominated for the Bond Innovation Award, 2020!