Polio-free Pakistan has been one of the major goals of health authorities in the country since decades. However, the efforts persistently failed due to trust issues by parents and failure to provide vaccination system in the remote areas of the country. Polio virus has been eradicated round the globe with only two countries still affected by this menace: Pakistan and Afghanistan.
Expanded Program on Immunization (EPI) which is accountable for managing all the immunization activities in the country, has recently revamped their program using technology. EPI is committed to immune every child from the following diseases: Poliomyelitis (commonly known as Polio), Neonatal Tetanus, Measles, Diphtheria, Pertussis, Hepatitis-B, Hib Pneumonia, Meningitis and Tuberculosis. EPI states that 27 percent child deaths in Pakistan occur due to absence of timely vaccinations.
E-vacc: Monitoring the Attendance of Field Vaccinators
The revamped vaccination program tackles two major challenges including low geographic penetration and absence of field vaccinators. EPI joined hands with Punjab Information Technology board (PITB) and made a digital system named “E-Vaccs” to track the attendance of field vaccinators.
E-Vaccs was initially designed and launched by Punjab government in 2014. At present, the immunization information system is linked with a smart phone app which is provided to vaccinators. This app stores real time vaccination records and saves it into a centralized database.
The program was initially launched in only four districts of Punjab but later it was implemented in 36 districts within a span of four months. Subsequently, 3750 smart phones were provided to field operators to boost their attendance.
Here’s How the Basic Mechanism of E-Vaccs Works
Paper driven register based attendance is replaced by check-in at the assigned location. Vaccinators will sign in thrice a day on various locations. First check in will now be made at the given location. Second at the kit station and third at the end of the day where they have to enter the number of children vaccinated (in their smart phone app) and which antigens were used during the day. The sign-in is done by taking a picture of the kit station with the app, where pictures cannot be fabricated due to Geo-tagging and time-stamping. As a result, it will also prove the presence of the vaccinators at the location.
Soon after the revamped system was implemented, attendance of field vaccinators dropped significantly from 94 percent to 54 percent as fake attendance could not be marked. However, valid attendance record improved later as vaccinators now had to be physically present at the location. According to the Chairman of Punjab Information Technology Board, Dr. Umar Saif:
“By using our smart phone application, the attendance of field vaccinators could now be monitored properly for the first time. The result was that attendance improved drastically from a mere 36pc to a staggering 94pc”
However, the low penetration of rural areas still remains a challenge. To cater to this problem, PITB designed a color coded visualization technique to view vaccination coverage in different areas. The coverage was monitored with the help of paper maps by taking out images from Google Maps and syncing it with the GPS data taken from vaccinators’ apps.
These maps later became impractical due to their printing costs and transportation issue. Later, Dr. Mohsin Ali, a faculty member at Lahore Information Technology University came up with an algorithm to highlight the developed areas where population resides.
The above mentioned efforts resulted into a centralized and digital database available on a dashboard. As a result, EPI could now track the performance of each district and every vaccinator and termed this system as E-Vacc- 2. Hence, the geographic coverage improved drastically from 25 percent in 2014 to a significant 88 percent by 2016.
Har Zindagi And The New Immunization Card
EPI now had another major challenge at hand, which was to improve the immunization levels as most parents couldn’t keep track of their children’s vaccination dates and diseases.
Har Zindagi, a research project from ITU, came in the picture by proposing a solution to improve the immunization system with an easy to use interface. Har Zindagi made record keeping easy by designing an immunization card for parents.
The new card enables real time information sharing between the card owner and the vaccinator. This creates a detailed digital record for every child that is used for all later visits.
End Polio: A Dream or a Reality?
The number of polio cases in Pakistan has dropped significantly to 51 in 2016 as compared to a massive figure of 294 cases in 2014 (which was the highest number in any country in the world back then). This technology driven immunization system has now been launched in KP and Baluchistan as well.