ZAINAB and Sughran have two completely different stories to share about the vaccination courses for their children, even though they live in the same house.

Zainab has never missed any of her infant’s vaccination appointment because he is enrolled under the Har Zindagi pilot that was rolled out in October 2016 for enhancing the coverage and completion of the child immunisation cycle through the innovative use of technology to make each child traceable. She receives a reminder from the district vaccinators a week or so ahead of her son’s vaccination dose is due.

“I usually forget the due date of my child’s vaccination, but these reminder calls always alert me,” Zainab says. “Even if I am unable to get my baby vaccinated on the due date for some reason, the vaccinators visit us the next morning. They just don’t let us miss any of it.”

Sughran, on the other hand, would often miss the vaccination doses for her younger son because he was born just before the Har Zindagi pilot was launched. “I have no one to remind me in case I forget the vaccination date,” she complains. “Every time Zainab’s son is vaccinated, I am reminded that my child has missed his vaccination.”

The Har Zindagi project spanned a period of 21 months and the pilot was deployed in 50 union councils of Sahiwal and Sheikhupura, covering almost a quarter of each district, between October 2016 and February 2017 as an extension of the existing e-Vaccs programme of the provincial government. The project was implemented by the Punjab Information Technology Board (PITB) with financial assistance from the Punjab Sub-national Governance (SNG) programme, an initiative of the UK’s Department for International Development (DFID). The project cost a total of Rs47 million with SNG contributing Rs38m and the provincial government Rs9m.

Child immunisation is a serious challenge in Punjab and elsewhere in the country because of numerous factors. According to data with the Expanded Programme on Immunisation (EPI), almost 27 per cent deaths of children under five are caused by diseases such as measles, whooping cough, polio, diphtheria, pneumonia and meningitis, that can easily be prevented through widely available vaccinations.

Though the EPI has to a large extent overcome the problem of low attendance of vaccinators and geographic coverage of the project in Punjab and other parts of the country through the development of a digital system called e-Vaccs by the PITB, the completion of the vaccination courses hasn’t improved. Parents often forget their children’s next vaccination dates. The drop-out rate for diseases such as measles with a significantly long time period between two doses remains quite high.

The Har Zindagi -- Every Life Matters pilot was tested to effectively reduce the drop-out rates by increasing the coverage of immunisation in low-resource communities and creating traceable records to ensure that children, once immunised, are retained in the system. The experiment aimed to achieve significant performance improvements in immunisation administration, such as increased uptake, retention, and the quality of immunisation, by addressing low-resource communities.

“The key innovation under the project was replacement of the existing yellow immunisation card with a green immunisation booklet with an inbuilt Near Field Communication (NFC) electronic chip to make it more intuitive for low-literate users by adding visual instructions, graphic illustrations, etc,” notes the Har Zindagi programme manager, Aimen Shah. “The inbuilt NFC tag inside the card enables real-time information-sharing between the card and the mobile application used by the vaccinators once they are tapped together. This helps generate detailed digital records for each child.”

“The booklet is user-friendly and very helpful in educating parents about details of their child’s vaccination regimen,” says Amna Batool, the technical lead at Har Zindagi. “It helps parents keep track of exactly which vaccination their five-month-old or two-year-old child needs and vaccinators to effectively reduce the default rate.”

Ms Shah says calls and SMS reminders for vaccination dates are also part of the project. “There are three types of reminders. The first one is sent to the parents seven days before the due date. The next one is sent a day before their kid is due for the vaccination. And the last is sent after the due date.” She claims that nearly 23,000 newborns were registered under the Har Zindagi programme during the five months of the pilot. “It has been a great success and the provincial government agreed to scale it up and roll it out in all Punjab districts. Procurements are under way for its expansion at the provincial level.”

A provincial planning and development department official confirmed that the Punjab government planned to scale up the project and replace the existing e-Vaccs with Har Zindagi. But he was not certain if would be implemented from the next financial year. “With the government in its last month in power and waiting to be replaced by the caretakers, I doubt we will be able to roll out this project next year,” he said.

There are some serious challenges that demand the urgent attention of the government. Ensuring that no parent misses their child’s vaccination doses is one of them. The earlier the Har Zindagi initiative is deployed across the province — and eventually the entire country — the better.

Published in Dawn, May 4th, 2018