An automated mobile vaccination reminder system in South Asia – Tika Tracker
Complete childhood vaccination is essential for the prevention of a number of life- threatening diseases, including measles, poliomyelitis, diphtheria and pertussis. Yet immunization rates are far from perfect in most of South Asia. Some regions have successfully improved rates, but others lag behind. India’s latest National Family Health Survey revealed that only 36.3% of one-year-olds received complete basic immunizations
(1). In 2010, there were nearly 30,000 reported cases of measles and 40,000 of pertussis
(2).In Nepal, 80.7% of children under one year old were fully vaccinated in 2011
(3).However, the department of health services reports significant variation among the 75 districts, ranging from 80% to 100% coverage
(4).Nepal’s National Immunization Plan (2011–16) identifies a lack of reliable data as a key challenge and calls for the use of e-health technologies to ensure more even access
(5).Recent work by Medic Mobile, a non-profit organization that uses the open source text messaging system FrontlineSMS to advance healthcare in the developing world, has seen success in this area. Their immunization tracking tool, Tika Tracker, demonstrates that an automated, text message-based immunization reminder system can decrease the incidence of vaccine-preventable disease
(6).How Tika Tracker works
Tika Tracker sends automated SMS reminders to caregivers to promote complete vaccination rates during the first year of life. The tool also allows community health workers (CHWs) at vaccination clinics to update patients’ records. Caregivers and CHWs need only have simple SMS-capable phones to receive appointment reminders and to update vaccination records in real time. These records are stored on a secure cloud-based server that can be accessed both locally and remotely on any computer with internet access. When fed into Medic Mobile’s Kujua Analytics program, aggregated data can be seen and disseminated at various levels (clinic, district, state or region).
Stratifiable statistics and outcomes for analysis can then be used by officials in both private and public hospital settings to track vaccination coverage by geographical catchment area.
Supporting national public health programming
Implementation will include close partnerships with government health offices and private organizations. While the Government of Nepal plays a key role in health service delivery, the public system is largely separate from the private one. The Tika Tracker approach aims to bridge this gap by enabling all parties to share and exchange data through Kujua Analytics. These public–private partnerships strive to ensure smooth data collection, improved data validity, and streamlined care experiences for patients and providers alike.
Partnerships for support and sustainability
The Tika Tracker system is designed to be self-sustaining, based on a unique business model built around a sliding-scale payment system. Clientele range from small, poorly funded rural clinics to
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large, well-supported institutions. Local partners such as Nyaya Health will assist with local staffing and project support, and Stanford University will provide additional medical, technical and administrative expertise. Medic Mobile will work closely with various levels of the Nepali Government to support their e-health initiatives in maternal and child health. Tika Tracker can greatly reduce the workload of government nurses and CHWs.
IWG catalytic grant for mHealth programme scale-up Medic Mobile was awarded a grant to scale up the use of Tika Tracker in India by the United Nations Innovation Working Group’s (IWG’s) catalytic grant competition for maternal, newborn and child mobile health (mHealth), managed by the mHealth Alliance.
However, due to civil unrest at the initial project site at Bastar in Chattisgarh, India, Medic Mobile decided that moving the site to Nepal would be the best strategy for continuity of the IWG objectives for the grant. Medic Mobile was successful in the grant competition because it employs an effective delivery strategy for an evidence-based child health intervention, combined with creative financing strategies to promote sustainability – elements that are critical for mHealth tools to contribute to Millennium Development Goals 4 and 5.1 Through IWG, Medic Mobile is receiving specialized assistance from WHO’s Department of
Reproductive Health and Research to optimize the scale-up of Tika Tracker while contributing to the mHealth evidence base and best practices on implementation and scale-up.
Partners: Stanford University, Nyaya Health
For more information please contact: Mainul Islam, Chief Operating Officer, Medic Mobile (mainul@medicmobile.org) or Jay Evans, Regional Manager, Asia (jay@medicmobile.org)
References:
1. ‘Child Health.’ p 228 in: National Family Health Survey (NFHS-3), 2005–06: India: Volume I. Mumbai, India, International Institute for Population Sciences (IIPS) and Macro International, 2007.
2. Immunization Profile: India. Geneva, World Health Organization, 2012. (http://www.who.int/countries/ind/en)
3. Government of Nepal. New Era and ICF International. Nepal Demographic and Health Survey 2011. March 2012. (http://www.measuredhs.com/
publications/publication-FR257-DHS-Final-Reports.cfm)
4. Department of Health Services, Ministry of Health and Population, Government of Nepal. Annual Report 2068/69 (2011/2012). (http://phpnepal.org/
index.php?listId=453#.UouVmcQ0WuI)
5. Government of Nepal. National Immunization Program, Reaching Every Child, Comprehensive Multi-Year Plan 2068-2072 (2011–2016), 2011.
6. Pathak P. India Vaccination Pilot Progress Report. San Francisco, USA, Medic Mobile, 2012.
Credits:
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1 MDG 4 is to reduce child mortality; MDG 5 is to improve maternal health (www.
unmillenniumproject.org/goals/gti.htm) Automated SMS reminders
can lower rates of vaccine- preventable disease
Local volunteer enrols mother and child in
Tika Tracker system
Tika Tracker server is updated in real time with immunization records and process is repeated until
child is completely immunized CHW sends SMS reminders to:
● community to notify them of upcoming immunization day
● local volunteers to go door-to-door to motivate mothers to bring
their child for immunization
Mothers bring their children in for immunization Automated SMS reminders
can lower rates of vaccine- preventable disease
Local volunteer enrols mother and child in
Tika Tracker system
Tika Tracker server is updated in real time with immunization records and process is repeated until
child is completely immunized CHW sends SMS reminders to:
● community to notify them of upcoming immunization day
● local volunteers to go door-to-door to motivate mothers to bring
their child for immunization
Mothers bring their children in for immunization
Accham District
257 477 (2012); 299 490 (2016 estimate)
Nepal
Total population
Children under 5 years of age Number of village development committees covered
Number of children under 1 yr covered Number of children under 5 yrs covered Number of community health workers 36 389 (2012) 14 (total population 39 787)
900 6275 161
