Cell Coverage: Reaching Pakistan's Children with the Polio Vaccine

This use of information and communication technology (ICT) for development involves reporting of health data - including polio immunisation data - with SMS (text message). Data is sent directly from the field using cell phones. As revealed in a Humanitarian Technologies Project report, top-down initiatives, such as those following Typhoon Haiyan in 2013, pursued without community feedback and a consideration of local human needs can fall short of successful humanitarian interventions. This is why Rotary was so careful not to impose a purely technological approach with its cell phone project in Pakistan, which is led and implemented entirely by volunteer community leaders. To begin, local needs were rigorously assessed. For example, in the highest risk districts, 48% of missed children are not seen simply because a team did not visit them. And when families are reached, a limited number refuse vaccines due to a number of factors, from lack of information, to religious and cultural objections, or the pressure of extremists. To overcome these challenges, Rotary chose an approach that integrated two key factors: appropriate technology and human capacity building.

First, Rotary partnered with Telenor, the second-largest mobile operator in Pakistan, Eycon Ltd (a data monitoring and evaluation specialist), and local governments to provide phones and training to Lady Health Workers (LHWs) and Community Midwives throughout 9 districts in Pakistan. LHWs are employed extensively by the polio eradication effort, as they are trusted to enter households and have the interactions with mothers and children necessary to deliver the polio vaccine. They also provide health education and services for antenatal care, routine immunisation (RI), and maternal health. Rotary conducts trainings for LHWs at its Rotary Resource Center in Nowshera, Khyber Pakhtunkhwa, focusing on how to record data on the phones and log daily reports to create a database. As of July 2016, Rotary has trained 533 LHWs, who have logged over 32,000 log reports since the project's rollout in April 2014.

Specific codes are assigned to various maternal, newborn and child health indicators (pregnancies, deliveries, newborn deaths, maternal deaths, etc.) and immunisation indicators (immunisations administered, refusals, missed children, etc.). For example, cell phone reporting allows health workers to quickly alert polio partners about missed children in high-risk (security-compromised) areas, who develop strategies to safely access them with the vaccine. The LHWs also enter the reason for refusal (e.g., religious, fear, lack of understanding); such data can be used to create strategies such as involving religious leaders to educate their communities about the importance and safety of the vaccine.

Immunisation and Vaccines, Maternal and Child Health

Vaccinators, risking attacks from militants, have to target and track with precision civilians fleeing a war zone in the country's northwest provinces. In 2014, nearly a million people were displaced by the government's military operation to root out terrorists in northwestern Pakistan. Inevitably, this massive migration caused challenges as fleeing families reached refugee camps and new communities. However, this situation also opened up a window of opportunity to vaccinate more than 850,000 children who had not been accessible to health workers since 2012. With so many children missed by Pakistan's polio vaccination effort, the country needed to conduct a swift, precise campaign to ensure that a devastating disease did not spread further. Pakistan is one of only two remaining polio-endemic countries, and polio infection rates soared in 2014, with 306 cases, the highest number in over a decade.

A 2012 report [PDF] predicted that mobile health technologies could save 75,000 mothers and children every year in Pakistan and reduce hospital costs by US$1 billion annually through accurate remote diagnostics that ensure treatment at the right level, reducing hospital referrals.

According to organisers, the progress of the project is striking, both in the quality of reporting by health workers and the vaccine coverage achieved through acting on this new data. In one district, Nowshera, there were 20 reporting health workers in June 2015, compared to 85 in December 2015. Whereas there were 77 daily log reports using cell phones in June 2015, this number had increased to 1,138 6 months later. The plan for the cell phone project is to extend it to cover more health workers and link it to the National Database Registration Authority to enhance RI efforts.