Annually, 18.7 million children under one fail to receive basic vaccinations worldwide. Improved routine immunisation coverage (RCI) is of paramount importance for polio eradication and the reduction of vaccine-preventable deaths (VPDs). In Pakistan, RCI stands at a meager 59%, well below the World Health Organization’s recommended coverage of 90%. This has led to continued polio transmission, large measles outbreaks and a multitude of deaths as a result of VPDs across the country.
With Pakistan’s drastic rise in mobile phone access and acceptability along with the high mobile penetration rate of 73%, SMS-based interventions offer great promise in improving immunisation coverage.
The Department of Paediatrics and Child Health at the Aga Khan University (AKU) in collaboration with AKDN dHRC has undertaken a research study, Paigham-e-Sehat, to assess the effectiveness of different types of text messages and automated calls in improving uptake of routine immunisations. For the study, AKDN dHRC developed and implemented the Paigham-e-Sehat web-based application. The application allows researchers and project administrators to send behavioural change communication (BCC) messages regarding routine immunisations via IVR and SMS to communities. Implementation of the platform took place in a peri-urban Health and Demographic Surveillance System (HDSS) site in Karachi and Matiari during 2018. Thereafter, research activities were carried out.
Paigham-e-Sehat, meaning ‘a message of health’ in the local Urdu language, is led by Dr Abdul Momin Kazi, Senior Instructor (Research) at the Department of Paediatrics and Child Health at AKU. The project focuses on identifying the level of acceptability of the medium of services for vaccination monitoring. It also aims to understand the perceptions and barriers that may affect text and voice-based interventions.
The baseline survey results illustrated that 74.4% and 82.6% of the participants use a simple function mobile phone, with predominantly prepaid connection, in Karachi and Matiari, respectively. Over 96% of the respondents indicated they would like to receive SMS about RI while approximately 99% indicated preference to phone calls regarding RI. Over half the participants in both sites were willing to receive weekly messages about RI.
Barriers identified during the qualitative phase of the study include lack of awareness/knowledge regarding RCI; forgetfulness of the due dates of vaccination; fear of adverse effects; and religious and societal beliefs.
The two-year project was funded by Rising Star Grand Challenges Canada.
Hayat, a transition-to-scale digital health project, funded by Grand Challenges Canada and the Aga Khan Foundation Canada
AKDN dHRC in collaboration with the Aga Khan University’s (AKU) Department of Community Health Sciences successfully secured transition-to-scale funding of CAD 1 million from Grand Challenges Canada (GCC) and the Aga Khan Foundation Canada (AKFC) for the Hayat Project. Hayat aims to increase coverage of and access to routine immunisation and maternal, newborn, child care and child growth services.
The Project focuses on the scale-up of Teeko, an award-winning mobile app, which was designed and developed by AKDN dHRC, to assist with vaccinator monitoring and tracking for a pilot research project implemented by AKU between 2015 and 2016. Used by vaccinators, the app digitised the process of vaccinations activities conducted in the field, in order to boost routine immunisation coverage.
In November 2018, Hayat was successfully launched with its first stakeholder meeting. The meeting, held in Islamabad, Pakistan, brought together senior government officials from Afghanistan and Pakistan with stakeholders from Aga Khan Foundation, Afghanistan; AKFC; Aga Khan Foundation, Pakistan; Aga Khan Health Services, Afghanistan; Aga Khan Health Services, Pakistan; and AKU.
Hayat, an innovative project, empowers frontline health workers with mobile health technologies in efforts to increase coverage of and access to routine immunisation; maternal and neonatal and child care; and child growth services that are offered in communities. Through the app’s web portal, government officials have real-time access to essential information to conveniently track and monitor field activities and health workers, improving transparency and accountability. Hayat aims to provide an overall improved governance structure to stakeholders.
Jointly funded by GCC and AKFC, Hayat (Phase I) is a 13-month project being implemented in multiple health facilities and their catchment populations in Badakhshan and Bamyan in Afghanistan and in Gilgit-Baltistan and Chitral in Pakistan. Saleem Sayani, Director, AKDN Digital Health Resource Centre, is the Principal Investigator for the project.
Currently, the Hayat app is being customised according to government requirements in Afghanistan and Pakistan, while health worker training and baseline survey has been conducted to gather information on select MNCH indicators.
During 2019, implementation, evaluation and reporting activities are to be completed.