Young Child Recieving Assistance from UNICEF

From Immunization to Stronger Health Systems

Using technology-based interventions to improve maternal and child health outcomes in Nepal.

Widely viewed as a success story in immunization, Nepal has immunization coverage levels at 88–90%, but coverage levels alone do not tell the whole story. The 2011 WHO/UNICEF-supported Effective Vaccine Management (EVM) assessment reported scores below the 80% minimum target in all but one of the nine criteria. Furthermore, the lack of reliable data on expired or temperature-damaged vaccines results in difficulty assessing the efficiency of the system, potency of vaccines delivered and accuracy of reported coverage rates.

In this situation, where the precise level of investment required to get to 100% effective coverage across the EPI (Expanded Programme on Immunization) is a challenge to estimate, the ability to embrace new and innovative delivery mechanisms can improve efficiency, adapt to new demands and ultimately strengthen a system.

A case study: The Vial-to-Child project

In partnership with the US-based NGO VaxTrac, WHO and CDC, UNICEF Nepal is rolling out a pilot project to evaluate the impact of a technology-based vaccine management system. In the absence of high-integrity data needed to effectively make programmatic change, the Vial-to-Child project seeks to improve the national immunization program performance by using a mobile vaccine registry linking a child’s unique digital vaccination record to vial-level vaccine information using biometrics. This technology prevents against redundant or expired vaccinations. It also provides valuable stock management and coverage rate information, including improved accuracy in determining both the denominator for target populations and who and where the “unreached” are. The Vial-to-Child project uses accessible, inexpensive tablet or mobile phone technology that can be deployed in hard-to-reach areas with little or no electricity.

Mr. Rajendra Bhandari, Senior ANW (Medic) of Pahli Primary Health Center, in one of the project districts, explains, “Having good data is important to be able to follow up on facilities that need more attention. We need this information to focus on the children who are being missed.” By linking a child’s fingerprint with her digital vaccine history and the vial-level vaccine information, electronic health records will replace bulky and time-consuming paper systems.

"A tool that will simplify record-keeping and reduce the burden on health workers"

The project’s focus on developing local and national capacity around vaccine management and improved data collection also empowers health workers’ ability to deliver more efficient care. Mr. Mukunda Gautam, Sr. Public Health Administrator in Nawalparasi District Health Office, reports, “This is the easiest process I’ve seen to help obtain very complex information [on immunization records]. It is an encouraging tool that will simplify the record-keeping process and reduce the burden on health workers.”

The Vial-to-Child project will also be used to assess its potential as a platform that could expand from solely an immunization module to one that connects to other systems, linking clients to health services along the entire maternal and child health continuum of care. Imagine the potential: from recording the quality and coverage of antenatal care, birth registration and stillbirth incidence, to the timely identification and management of postpartum complications.  Not only will this strengthen capacity in vaccine management, but it will also improve technology-based health interventions for other areas of the health system such as maternal and child health.

eHealth: Boundless opportunity?

The Vial-to-Child project is aligned with the recent effort of the Ministry of Health and Population (MOHP) to use electronic resources to improve the efficiency of health programs across Nepal using the immunization program as an entry point. Supported by UNICEF, the MOHP views eHealth as a method to address the systemic root causes of bottlenecks as highlighted in the EVM assessments. Improvements to the immunization system are viewed in the context of the WHO-defined health systems strengthening (HSS) “building blocks” of leadership and governance, financing, service delivery, health workforce, products, vaccines and technologies, and information systems. eHealth provides an unprecedented opportunity to strengthen the health system in Nepal through addressing each of these HSS building blocks, beginning with immunization.

"eHealth provides an unprecedented opportunity to strengthen the health system in Nepal"

Recognizing the potential value of eHealth towards strengthening health systems in the country, the MOHP recently hosted a two-day eHealth workshop to launch the National eHealth strategy process, aligned with national planning documents such as the National Health Sector Programme III and Country Multi-Year Plan.

UNICEF and WHO convened the workshop, bringing together eHealth strategists, information and communication (ICT) experts, the U.S. Fund for UNICEF, and global and local NGOs. Participants shared successful and ongoing eHealth initiatives at the local and global level and showcased initiatives to deliver training content, provide telemedicine services, and strengthen supportive supervision. The group presented experiences and challenges faced while implementing these solutions, and created a detailed action plan for developing the national eHealth strategy using a participatory approach.

The Vial-to-Child project and the facilitation of the eHealth workshop highlight UNICEF’s unique role as a convener for children. Bringing together high-level government leadership, technical specialists in eHealth, and the expertise of VaxTrac, UNICEF plans to replicate the Nepal experience in other GAVI countries. Dmitri Davydov, Coordinator of Vaccine Delivery Systems at UNICEF Headquarters, says, “The partnership represents new uncharted territory that promises to reach all vulnerable children in Nepal with immunization and comprehensive maternal and child health services.”

By Michelle Pahl and Keiko Valente, U.S. Fund for UNICEF.Photos: Meredith Baker, VaxTrac.

Learn more:

Photo credit: Meredith Baker, VaxTrac