Improving Timely Vaccination through Incentives and Automating Workflow of Frontline Health Workers using Information and Communication Technology

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:

1. Do pay-for-performance incentives to ASHAs, conditional on timely administration of vaccines, improve the overall timeliness of vaccinations?

2. Does an integrated ICT platform that automates the workflow of ANMs, improve the overall timeliness of vaccination?

3. Are there complementarities between the incentives to temporary employees and efficiency-enhancing tools to permanent government employees?

4. Do personalized reminder calls to mothers/caregivers improve the timeliness to vaccination?
   
   

Methodology

The pilot adopted the following measures: ASHA workers were provided P4P incentives to register births in their catchment area through a call centre and for timely vaccination of infants. The call centre made reminder calls to primary caregivers for upcoming vaccinations. ANMs were trained on the ANM Online (ANMOL) app, which automatically generates vaccination due lists, but as the live version could not be deployed, vaccination dates were collected from ANM registers and Mother and Child Protection (MCP) cards to calculate incentives. Vaccination data of 337 children registered during the pilot (treatment group) was compared with that of 451 children born between 2015 and 2020 (control group).

Outcome

The ANMOL app and the linked web-based Reproductive and Child Health (RCH) portal are designed as complete data management tools to replace the ANM registers, and the system is comprehensive and well designed. However, the live version could not be deployed in the field due to COVID-19 duties, fear of losing devices, a backlog of data entry and delays in technical support. Of the caregivers who received reminder calls, 89% attended the VHND afterwards. Vaccination coverage increased and vaccination became timelier for the treatment group for vaccines due at birth and at 1.5 months, while coverage for vaccines due at 2.5 months declined, possibly due to the pilot completion or engagement of FHWs in COVID-19 related duties.