Improving Timely Vaccination through Incentives and Automating Workflow of Frontline Health Workers using Information and Communication Technology
Improving Timely Vaccination through Incentives and Automating Workflow of Frontline Health Workers using Information and Communication Technology
Year: March 2021
Collaborators: Abdul Latif Jameel Poverty Action Lab (J-PAL) and Institute for Financial Management and Research
Team: Sarang Deo
Background
Since the launch of the National Rural Health Mission (NRHM), vaccination coverage in India increased significantly from 44% in 2005-06 to 62% in 2015-16. However, vaccine preventable diseases (VPDs) such as pertussis, measles, and tetanus continue to be a major contributor to child mortality. In addition to the coverage of vaccinations, timeliness of vaccinations is also important in the prevention of VPDs in children. Delays in vaccination increase the vulnerability of infants to VPDs and reduce the positive externalities from herd immunity. Both, demand- and supply-side barriers lead to delayed vaccination and prolonged exposure to VPDs. Auxiliary Nurse Midwives (ANMs) and Accredited Social Health Activists (ASHAs) lead the on-ground efforts for vaccination of children by organizing Village Health Nutrition Days (VHND). But organization of these drives requires managing substantial data and paperwork, that leaves margin for human error and delays mobilization of parents of the target infants. Automating this otherwise labour-intensive task of data management can address the issue of delayed vaccination.
About the Study
ISB with the support of Foundation for Research in Health System (FRHS) led the implementation of the timely immunization pilot in four blocks of Muzaffarpur district in Bihar with a sub contact with FRHS. The pilot assessed the feasibility of a package of interventions to improve timely immunization of infants with the objective to answer the following questions:
- Do pay-for-performance incentives to ASHAs, conditional on timely administration of vaccines, improve the overall timeliness of vaccinations?
- Does an integrated ICT platform that automates the workflow of ANMs, improve the overall timeliness of vaccination?
- Are there complementarities between the incentives to temporary employees and efficiency-enhancing tools to permanent government employees?
- Do personalized reminder calls to mothers/caregivers improve the timeliness to vaccination?
Methodology
The study used an experimental design wherein following measures were adopted: ASHA workers were provided P4P incentives to register births in their catchment area through a call centre. The registered births were stored in a central database that feeds into an android application. This was available to the ANMs in the study area on their handheld devices. The android application automatically generates vaccination due lists based on vaccination schedules and the vaccination calendars in the study area. Besides, a separate interface of the Android app allowed the call centre agents to make reminder calls to primary caregivers for upcoming vaccinations. ANMs updated the vaccination profiles of each infant during the vaccination session. Using this information ASHAs were incentivized for timely delivery of vaccines. Overall, we expected to observe an improvement in the timeliness of vaccination rates for multiple vaccines. A byproduct of the introduction of this new workflow management is that it will facilitate real-time tracking and monitoring of vaccinations.
Outcome
ANM Online (ANMOL) app and the linked web-based (Reproductive and Child Health) RCH portal are designed as complete data management tools to completely replace the ANM registers. The system is comprehensive and well designed for functions including registering births, integration of ANMOL data with RCH, and creating automated vaccination due lists. 89% of parents responded to reminder calls. Vaccination coverage increased and vaccination at birth became timelier for the treatment group.