How Pakistan turned around its vaccination programme using technology
It is the last ball of the match, Bilal's team needs two runs to win.
The captain and the bowler have a discussion and make some last minute changes to the field. The bowler returns to his mark, and starts his run up. Bilal squirms in his seat, beads of perspiration on his brow. Cricket has always meant so much to him.
The bowler crosses the umpire and delivers the ball: it's a low full toss, the batsman, a friend of Bilal's, pushes the ball towards long on and rushes to get the two runs, a fielder moves in to pick the ball, the batsmen turns for the second – everything happens in the blink of an eye – the ball hits the wicket, is he in or out?
Everybody turns to the umpire, "in", he says – and the celebrations begin.
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All the boys waiting by the boundary rush to congratulate their friends, except Bilal. He sits on the side, unable to join in the celebrations, because he can't run that fast. In fact, he cannot run at all because he has polio, an infectious and completely preventable disease.
Polio is one of the most worrying childhood diseases in Pakistan. It is one of the diseases that parents fear most because it can cripple a healthy, able-bodied child. A few days after being infected by the polio virus, muscle stiffness, nausea and fever breaks out in the human body.
In severe cases, such as Bilal's, there is paralysis of the muscles leading to a permanent disability.
To date, Pakistan is one of only two countries in the world where children are still being infected by the polio virus.
The Expanded Program on Immunisation (EPI) in Pakistan is responsible for coordinating and overseeing all immunisation efforts in the country.
According to EPI, 27 per cent of deaths in children under the age of five are due to diseases that can be prevented through easily available vaccinations. These diseases include Poliomyelitis (also known as Polio), Neonatal Tetanus, Measles, Diphtheria, Pertussis (Whooping Cough), Hepatitis-B, Hib Pneumonia, Meningitis and Childhood Tuberculosis.
In the past the disease has persisted in Pakistan because of a disinformation campaign by the Taliban to halt immunisations, mistrust by some minority groups and vaccination administrators struggle to reach remote areas.
To fulfil their mission of vaccinating every child in the country, EPI decided to revamp their strategy and address vulnerabilities within the program itself. These challenges included less geographic coverage and low performance of field vaccinators.
To solve this, EPI enlisted the help of the Punjab Information Technology Board (PITB), which made a digital system called E-Vaccs to monitor the attendance of all the vaccinators sent out into the field.
Under E-Vaccs, an immunisation information system with an accompanying smartphone application for vaccinators was made, that also stored real-time immunisation records onto a centralised database.
The first E-Vacc application was launched in June 2014 in four districts of Punjab and it was rapidly rolled out to all 36 districts by October 2014. Under this system, 3,750 smartphones with the mobile application were provided to the field vaccinators in a bid to improve their attendance.
Instead of signing paper registers at Basic Health Units (BHUs) as proof of attendance, vaccinators now had to sign-in three times a day. The first check-in is at their assigned location, the second at their kit stations which is usually a mosque or a house in the district and the third at the end of the day when they have to enter a vaccinator log on their smartphone application of how many children were vaccinated and which antigens had been used.
The sign-in is done by taking a picture of the kit station with the smartphone application. The pictures are geo-tagged and time stamped, providing foolproof evidence that the vaccinators are physically present at the location and have shown up to work.