iTraCER: Immunization Tracking for Children Electronically in Real time
Scale up a digital platform to accurately identify infants before birth and track them for vaccinations through community health volunteers
An illustration of how the digital platform connects mothers-infant pairs to immunisation services in real time. The villages are included in the project in a predetermined sequence (stepped wedge design) allocated through a public lotery with a set of villages receiving the intervention before others. This enables us to to evaluate the effect on uptake of vaccinations while ensuring inclusion of all villages. The data for the evaluation is intrisically collected through the same platform.
Data collected by community health volunteers
An experience of a happy mother in Nairobi, who was enrolled in the project during pregnancy and followed until birth. She will continue to receive text message notifications prior to the vaccination dates of her babies until all vaccinations are completed.
Describe what you intend to do and how you'll do it in one to two sentences (required 350 Characters)
APHRC in collaboration with VAL partners and Nairobi County, aims to scale up iTraCER for community health volunteers (CHVs) to register pregnant women in Nairobi slums using smartphones linked to health centers. Messages tagged to vaccinations due dates will be sent as reminders to mothers and to the CHVs and health centres to plan services.
Explain the innovation (2,500 characters)
Rapid urbanization in Africa has led to an unplanned settlement associated with extreme exclusion of populations. Only half of the children living in the informal settlements in Nairobi complete all their vaccinations, fewer than those in rural areas. Consequently, higher infant mortality is observed in the informal urban settlements than in rural areas. Since there is no comprehensive birth registration health managers do not know how many children are in need of vaccination and where they live. At the health facilities, vaccinations are recorded on paper making it difficult to see the gap in service provision in real time. Our innovation consists of an integrated electronic platform that connects the community and healthcare providers in real time; evaluated through stepped wedge design. Mobile phones are used for registering all pregnancies and a two-way communication is established between pregnant women and healthcare workers to enable accurate and timely tracking of unimmunized children. Pregnant women are registered at home by community health volunteers (CHV) or self registration. Each CHV collects information on expected date of birth and the preferred health facility where the pregnant woman plans to give birth and take their children for vaccination. This information is relayed electronically to a central server which distributes the list of pregnant women to their preferred healthcare facilities. Exactly one month before delivery an automated standardized text message tailored to the woman is sent from the central server encouraging them to give birth at their preferred healthcare facility. Automated reminders tailored to the vaccination schedule and are sent one week prior to the vaccination date. At the health facility, vaccination status of the baby is updated electronically by the service provider and synchronized to the central server. An automated list of unvaccinated children is sent to the health facilities and CHVs to follow the women in addition to reminders sent directly to them. The specific beneficiaries are infants (from birth to one year) living in Nairobi informal settlements with estimated population of 40,000 per year. A typical beneficiary is a baby born in the slums who is missing all or part of their vaccinations. We piloted our innovation for 4 months with impressive results as shown in the image. Since urban slums in other Gavi countries are similar to ours, the innovation is feasible to roll out in those countries.
Our preliminary results from iTraCER pilot in Nairobi slums are impressive. We had estimated to double the timely birth vaccination coverage from 22% to 44% but so far 82% have received timely, and 95.8% received vaccinations any time. The intervention is well received by the communities and Nairobi county.
Which part(s) of the world does this innovation target?
We are currently implementing our idea in Nairobi city informal settlements (slums) in Kenya. But this can potentially be expanded to other urban settings in Kenya and the rest of sub-Saharan Africa.
Who will work alongside your organization in the project idea? (1,000 characters)
We are already working with VAL Partners; a private organization based in Nairobi that collaborates closely with government and research organizations in designing mobile phone solutions for increasing coverage of health services including vaccination services. They have designed the electronic platform and participated in the implementation of the community electronic registry that we are piloting. We have also worked amicably with Nairobi city council that has provided the community health volunteers and their supervision and ensured efficient supply of vaccines. Along with the Kenyan ministry of health, the Nairobi city council has made available the vaccines and the cold chain needed for maintaining the potency of the vaccines. Community leaders have also provided support in mobilizing communities. We will continue to work with these partners.
How is your idea unique? (750 characters)
We leverage our idea on real time linkage of eligible children for vaccinations starting with registering pregnant women at their homes electronically. This enables us to reach children right from birth. Our central server integrates information between the community and health center, and sends personalized messages that have a higher impact than general messages. The health facilities are able to plan better for their vaccination supplies and visits since they have real time data on where and when children need to be vaccinated. Our platform also supports the supervision by the city council health managers since they can remotely access dashboards to monitor performance of health facilities. We have tested the idea and it works.
What is the name of your organization
African Population and Health Research Center (APHRC)
Explain your organization (250 characters)
We conduct research, policy engagement and build research capacity to transform lives in Africa and pionered health services research in urban slums in Africa; currently leading the immunization Advocacy Initiative for Africa in 3 African countries.
Type of Submitter
We are a registered NGO or Non-Profit Organization
Women’s health/rights focused organization
Disabled Persons Organization (DPO)
Gender and Diversity (500 characters)
APHRC is committed to gender equality based on international standards. It promotes equitable participation and distribution of power, access to and control over resources and equitable number of women and men at various levels within the organization. For example 54% of staff are female, and in the executive leadership of 5, three are women. Gender equality is integrated into recruitment, retention, promotion, training, performance management systems, and remuneration and routinely tracked.
Organization Location (less than 250 Characters)
APHRC is registered in the USA under status 501, headquartered in Nairobi and have another office in Senegal but we conduct research in 22 countries.
Size of organization (number of employees):
Scale of organizational work
Regional (reach within 1 geographic region)
Tell us more about you
Gershim Asiki, (MD, PhD) an epidemiologist provides scientific leadership in the project design and management; Hermann Donfouet, (PhD) a health economist, designs the cost-effectiveness analysis; Martin Kavao Mutua (PhD) conducts statistical analysis;Peter Otieno, (MPH) coordinates field activities; Daniel Maina (Msc), data systems programmer, monitors the electronic data systems; Michelle Mbuthia (MA-communications), designs communication strategy to engage policy makers; Abhishek Khamrai (MBA) and Dominic Muindi (MA) both from VAL partners lead the design and monitoring of the digital platform. We value fairness, integrity, and excellence. We have a proven track record successfully implementing the pilot phase ending in July 2019.