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Building Care giver loyalty to immunization

We transform the Mother and Child Immunization Card into a credit and loyalty Card.

Photo of Caroline Aura

Written by

Describe what you intend to do and how you'll do it in one sentence (required 250 Characters)

We will administer and track a Barcoded Mother and Child Immunization Card innovation to quickly elicits a positive behavioral response for immunization adherence in rural smallholdings (

Explain the idea (less than 2,000 characters)

We address the problem of persistent non-immunization and vaccination dropouts in rural smallholdings of Trans-Nzoia due to out-of-pocket expenses and loss of productive work-hours. Poor vaccinating farm households in rural Trans-Nzoia have tough decisions to make, should they go work on their farms for daily upkeep, or take their infants (who are not yet sick) for vaccination at a distant clinic and have no money to feed the family in the evening? Despite their knowledge of the importance of child vaccination and the health risks involved these struggling farmer families make resource allocation trade offs in favor of daily survival as opposed to investing in preventative health services. This has had a negative impact on the health of their children and is reflected in the low vaccination rates currently at 44%. The aim of our innovation is to nudge caregivers to vaccinate their children without feeling it is a time-wasting and money-draining exercise Our idea is a rewards program that offers price discounts on livelihood goods as an incentive to caregivers that show proof of child immunization. We use an innovative Barcoded Mother & Child Wellness card to implement the idea. In Kenya, mothers attending their first antenatal care visit are given the Mother & Child Wellness Card. Which contains an immunization schedule for the expectant mother and her child once its born. Whenever the caregiver with this card visits a health facility and she or the child receive a vaccine, a unique QR-code is affixed to the card. The QR-code encodes agro-credits, which the mother can redeem at partner agribusinesses. She then takes the Barcoded Mother & Child Wellness card to local suppliers partnering with the project who will sell them agricultural products at discounted prices.

Which part(s) of the world does this idea target?

  • North Africa
  • Eastern Africa
  • Middle Africa
  • Southern Africa
  • Western Africa

Geographic Focus (less than 250 Characters)

Sub-Saharan Africa rural smallholdings (

Who are your end users and how well do you know them? (750 characters)

Women: Who wake up and have to make tough decisions and who need to be reached in the middle of their hardworking lives with solutions that solve their daily challenges in immediate and concrete ways. Children (<5 years old): Who need to be immunized against vaccine preventable illnesses to give them a real chance for a bright future. Male partners: Who are intimate partners to the mothers and need to get involved and supportive of their women and children when seeking healthcare.

How is the idea unique? (750 Characters)

We transform the Mother and Child Wellness Card into a credit and loyalty Card. We use a behavioral economics approach to nudge caregivers to vaccinate their children without feeling it is a time-wasting and money-draining exercise. In this respect we empower caregivers to ask for full vaccination services and nudge them behaviorally to seek vaccination services thus translating intention into action. This is clearly differentiated from current command and control approaches by government.

How many months are required for the project idea? (140 characters)

24 months to roll out the barcodes project on a wider scale and increase under-5 vaccination rates of TranNzoia from 44% to 70%.

Organization Name (less than 140 characters)

GrainBank and VaccineLink Limited

Type of Submitter

  • We are a For-Profit Startup or Startup Social Enterprise

Organizational Characteristics

  • Locally/community-led organization

Organization Location (less than 140 Characters)

Offices: DPU CBPS campus, Riverside Drive Nairobi, Kenya. 2. Sikhendu Medical Clinic Building, Sikhendu Center, Webuye; Kitale Road, Kenya.

What is the current scale of your organization’s work?

  • Community (working within one or a few local communities within a region)

Website URL

Tell us more about your organization/company (1-2 sentences)

We build loyalty to immunization through smart partnerships

Who will work alongside your organization in the project idea? (750 characters)

We have built a partnership network in the project area that is based on both trust and expertise in service provision. They comprise, Local health facilities, Agro-vets, Seed sellers, Open market traders, Community health workers, Traditional birth attendants, local leaders, Religious leaders, Motorcycle taxis (boda-boda).

How many people are on your team?


Tell us more about you and your team

The GB&VL team has a strong working chemistry over six years and has been implementing innovations in maternal and child health in rural North-Rift Kenya. It is comprised of professionals with diverse backgrounds. Caroline Aura: Chief operations officer (Social Scientist); Dr. Benson Wamalwa: Principal innovations officer (Bio-Chemist) Sammy Karanja: Chief finance officer (CPA II) Elizabeth Nyongesa: Partnerships officer (Community work) and Denis Muguta: Information and communications officer (Bioinformatics)

Overview of How Your Concept Has Evolved (5-6 sentences):

We delved further into our idea by immersing ourselves in the user’s (women/mothers) context and in the process learnt more about their motivations and fears and trying to deeply understand why they were not utilizing immunization services. What emerged were reasons and interesting statements which we used to further focus our idea. The business model canvas activity enabled us to scrutinize the project viability in much more detail and to align the idea in ways that leverage the available resources. Expert Webinars including an Openideo prototyper meet-up in Nairobi provided a much useful context for the team to iterate the idea further. Prototyper support led to design representations of our idea that were simple and implementable.

Viability (3-4 sentences and activity upload):

Insights and potential working plans derived from the business model canvas activity included establishing clear criteria for selecting partnering businesses in line with our idea’s value chain; how our users currently interphase with partnering business and their community relations; the need to monitor business profitability during implementation and sustainability and bottlenecks in providing discount incentives over the long-term; expanding the incentive base to accommodate shifting user priorities; consider responsive and flexible implementation steps for the program to reach users in their hard working lives.

Feasibility (3-4 sentences):

How the idea works: A user (caregiver) is enrolled in the loyalty program using her immunization card. She receives points whenever her baby is vaccinated on time and bonus points if she shows up with her male partner or immunization group members. She can then redeem her loyalty points through price discounts on purchases from partner businesses and receives SMS/text notifications of accrued points and vaccine information. Prototyper was a perfect match for our idea and team. The team appreciates her design skills which greatly simplified the final idea concept making it actionable.

Desirability (3-4 sentences and activity upload):

Currently immunization is low on their priority list, especially when it is competing with other household priorities for time and resources. By tying the loyalty card to immunization we enable this smallholder caregivers to make a healthy choice of fully vaccinating their children.

Community Focus (2-3 sentences):

In the target community, women often come together in groups of more than five people to save (table banking). During seatings they discuss ideas and work collectively on group projects that empower them in various ways. We see a strategic value in leveraging the tried and tested group approach to drive the loyalty program’s “time-saving” vision where women with a similar immunization schedule attend clinics as a group. Immunization women groups can create change in the community by encouraging caregivers to make the healthy choice

Community Impact (2-3 sentences):

We expect a positive change in husband’s attitudes towards immunization ( a worthwhile activity) and the gain of soft power by women across married couple households. This difference could be observed as quickly as couples successfully redeem their rewards, say within the first month post-vaccination. Loyalty program discount incentives will be continued through long-term partnerships that last beyond Gates Foundation funding because they are sustainable since partner businesses can still make a margin.


Join the conversation:

Photo of Marichu Carstensen

Hi Carolina, thanks for including me in your team. I hope I can help your team with whatever skill and talent I have that you might need. Even if you are so far away, our lives are inter twined.

Best regards,

Photo of Marichu Carstensen

Hi Carolina, we had a region in our country that was devastated by a strong typhoon. We brought open pollinated seed for them to plant instead of hybrid seeds. I am wondering if it is possible to give them open pollinated seeds instead of hybrid so that they can produce their own seeds and not depend on suppliers alone.
Best of luck and more seeds of ideas to grow!

Photo of Caroline Aura

That’s an interesting perspective. Its trues we’ve met farmers with a preference for open pollinated varieties of, for example, yellow corn as opposed to hybrid varieties. Just wandering what kind of open pollinated crop varieties are popular with farmers you work with and how the yields are like?

Photo of Marichu Carstensen

Hi Carolina, with open pollinated seeds, you can get seeds from your own yield. You can produce your own seed supply. We supplied them with beans, peas and tomatoes. They are less expensive than hybrid varieties and more flavorful. Hybrid varieties are usually for large scale planting, they are more resistant and can be stored for longer periods. For your purpose of starting a community garden and kitchen, it is more practical to use open pollinated seeds as it is just small scale. They had good harvests seen from our follow up visit.

Photo of Marichu Carstensen

Hi Carolina, with open pollinated seeds, you can get seeds from your own yield. You can produce your own seed supply. We supplied them with beans, peas and tomatoes. They are less expensive than hybrid varieties and more flavorful. Hybrid varieties are usually for large scale planting, they are more resistant and can be stored for longer periods. For your purpose of supplying seeds for agribusiness hybrid seeds might be more practical but the farmers will never be self reliant. The farmers we supplied had good harvests seen from our follow up visit. they were able to survive the devastation of their crops after the big typhoon.

Photo of Isaac Jumba

Hi Caroline Aura 

Great to read through your idea. I'm wondering if you could share more on how the funding or sustainability is like. Do you get grants so as to subsidize the products and services? Are you working with partners?

Photo of Caroline Aura

Hi, Isaac
Our partners are majorly agro-vets and seed companies. What our startup GB & VL does, is to go to this companies and negotiate price discounts on essential farm commodities e.g. hybrid seed, fertilizer etc. A percentage of this discount goes to supporting GB & VL activities and the rest is passed on to caregivers that show proof of immunization.
Supposing 500 caregivers enrolled with our program require (X) KG of hybrid seed retailing at (Y) Kenya shillings a product of company C. GB & VL approaches C and negotiates for a price reduction (K). GB & VL would take D% of price discount K and the rest, which is F%, would be passed on to loyal vaccinating caregivers. Meaning caregivers can now get hybrid seed at a reduced price of (Y-K)+D% of K, which is an incentive for them to complete vaccination.

Our sustainability model is a commission based on discounts. However GB & VL would require a grant to do further market research so as to expand the incentive base, to reach other vaccinating caregivers who are not smallholders and also to understand market dynamics in order to ensure that out partners can still make a margin.

Photo of Isaac Jumba

Thank you so much Caroline Aura  for the response. I wonder if there is similarity between how you idea works and t-safe: - which is also based out of Nairobi ( that offers rewards for positive behavior by rewarding teens to access SRH services. If this is helpful, I can put you in touch with.

Photo of Caroline Aura

Hi Isaac,
Thanks for this information. The loyalty team has looked at the “t-safe” business model, as posted at the link you provided. It would be interesting to actually connect with them to further understand if they work on the basis of discount (and for which specific products) or 100% free incentives for everything on offer. The former would align perfectly with what we are doing if the products include what would broadly be defined as livelihood goods (this closes the sustainability loop for us). One of our partner providers is in the AMUA health franchise, which collaborates closely with Marie Stopes and therefore a suitable entry point for your suggested connection should our models align.

Thank you very much,

Photo of Ashley Tillman

Hi Caroline Aura great to have you in the Challenge! Have you also checked out our Urban and Highly Mobile Populations Challenge?

Photo of Temba Vicent

Hi Caroline Aura,

Thank you very much for connecting the immunization services with Agricultural production. It is really interesting.Kindly what kind of crops which your focus on your idea.How will you managed the effects in case the price of agriculture outputs is low and women farmers are not making the profits?
Thank you

Photo of Caroline Aura

Hi Vincent,

Thank you for your comments.

We are currently working in Trans-Nzoia and Bungoma counties of Kenya. These geographic areas have a mix of large commercial farms as well as subsistence smallholders who grow maize, beans, leafy vegetables and rear dairy animals for milk.

In our program, women (families) that show us proof of child immunization are connected to partner Agro-Vets shops who then sell to them authentic products (e.g. certified hybrid seed and other agro-chemicals) at a discount price. We expect these high quality farm-inputs to improve their farm productivity and yields.

At GB&VL we recognize that market prices for raw agricultural commodities may not be favorable to the farmer time and again. Through our GrainBank portfolio we offer postharvest advice. For example, (1) Using long-term storage solutions for grains and pulses such as low-cost hermetic storage triple bags until break-even market prices are reached). (2) Exploring value added products like fortified flour from the raw harvest of grain and pulses using a variety of appropriate technologies available in the local market in order to fetch a good price for their produce.

Photo of Temba Vicent

Hello Caroline,

Thank you for quickly response. How will you measure the adoption of good agricultural practises with the effects on immunizations? Do you thinks the Adoption of good Agricultural practises can influence the behavior changes of caregivers? Do you have some findings to share?

Thank you

Photo of Caroline Aura

Hi Vincent,

Good agricultural practices encompass wide-ranging regulations, principals of production and technical recommendations. In the context of our work smallholder farmers want to have the best seed, healthiest methods of storing food etc. , this drives them towards seeking that discount incentive and in turn nudges them to go for vaccination. We have established a direct correlate between their vaccine seeking behavior and redeemed discounts, which answers the question as to whether the adoption of good agricultural practices can influence the behavior changes of caregivers? (kindly refer to;

Thank you.