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Use of Mobile Technologies for Enhancing Health Service Delivery in Nepal A case of Using SMS based mobile solution for real time reporting an analysis of Immunization Data in Nepal Bibhusan Bista YoungInnovations Pvt. Ltd. Immunization and Nepalese Context.
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Use of Mobile Technologies for Enhancing Health Service Delivery in Nepal A case of Using SMS based mobile solution for real time reporting an analysis of Immunization Data in Nepal Bibhusan Bista YoungInnovations Pvt. Ltd
Immunization and Nepalese Context • Immunization is a process by which an individual's immune system becomes fortified against an agent (known as the immunogen). • Immunization is done through various techniques, most commonly vaccination. Vaccines against microorganisms that cause diseases can prepare the body's immune system, thus helping to fight or prevent an infection. • Immunizations are less risky, easier and inexpensive way to become immune to a particular disease • Like in other countries, Government of Nepal has also made immunization a central plank in Public Health efforts. Annual Budget set aside for immunization and other child health activities for 2067/68 is Rs. 2,008,863,000* (Source: Ministry of Health and Population)
Existing Process • Immunization Plan • National Level Plan • District Level Plan • Immunization at the local level • Monitoring and Supervision 1 Coverage Reporting 2 3
Existing Process • National Immunization Plan • Routine and Campaign plans developed by Child Health Division at Ministry of Health and Population at which is propagated to regions and districts. • For each of the antigen immunization campaigns, there exists national as well as local target (districts, VDCs/Municipalities) • Each district is then responsible to plan for immunization and correspondingly immunization sessions are carried out by respective health centers at the local level (VDCs/Municipalities) • Immunization coverage • It gives the proportion of eligible children who have been immunized within specific geographic location or country as a whole • Reports from health centers and districts spread across the country provide important information about immunization coverage • Proper reporting of coverage is vital to plan and execute immunization programs
Problem with Existing Process • Delay in Coverage Reporting and Compilation Local Health Center → District →Center • Access of Data on Immunization coverage possible only after immunization sessions are completed – Lack of real time access to coverage data • Questionable ownership at the local level due to lack of visible role played by local health centers in immunization • Monitoring of Immunization Sessions for maximum efficiency is based on human intervention from different agencies involved • Quick fixes to problems during immunization session not possible due to lack of data on real time. • Possibility of misleading data on coverage resulting in faulty planning • Issues of time lag and delayed response from district and center
SMS Based Solution for Coverage Reporting • Real Time Reporting from Local Center using Mobile SMS • Advantages over Existing System • Local Health Workers involved in direct reporting • Enhanced reliability of data • Real time analysis and visualization of data in NIP website • Time lag reduced significantly • Get prompt feedback from concerned agencies both at the district and central level • Use of technology that is already available at the local level (more than 60% mobile penetration in the country)
Key Features of SMS based Reporting • Toll free shortcode - 3344 • Data directly gets published online on real time • Visualization of data that is accessible to general public • Supervisor (RCS) verification sent through mobile and mapped against actual coverage reporting • Centralized monitoring and feedback mechanism • Data available for general public for further analysis and processing (downloadable in CSV format)
The Process • Development of Infrastructure and System to receive incoming data, analyze them and visualize in the website – www.nip.org.np • Training to Health Workers in respective districts • Registration of Health Workers to send data to the system • Coverage Reporting from Health Workers using Mobile SMS MRC <VDCCODE> <Coverage%> <Number of children> • RCS survey report sent by supervisors using mobile SMS • Proactive monitoring and feedback from the center based on what is received from individual VDCs/ Municipalities
Achievements so far • Piloted in MR Campaign Phase I (Feb 14 – Mar 28, 2012) in 15 Districts from Western and Far Western Region • Real time coverage reporting was around 95% • Visible Ownership at the local level • Government Agencies and others involved (UNICEF, WHO) have relied on the system for monitoring and feedback • Visible impact on planning and programming of Immunization programs
Challenges we faced.. • Problem with format while submitting reports by Health Workers • Sending Erroneous Data (eg. 4028 becomes 4082, Adding extra 0 at the end) • Issues with Telecommunication Operators • Only NTC GSM (Namaste), Ncell GSM and SmartTel – service still not available for CDMA • Disruption / Delay in SMS services Proactive Monitoring and Human Intervention Is the key to address these challenges
What is innovation in this context ? • Not invention of technology but appropriation of technology • Solving existing problem in a new way • Incorporating technology within existing mechanism and practices • Building trust and confidence of stakeholders involved on adoption of technologies
Our Learnings • Introduction of new technologies in existing mechanism requires careful planning, execution and monitoring • It is not about technology, it is about better coverage reporting, immunization and child health • Do not forget the Human Aspect !! • Build Capacities – Develop Confidence
What Next ? • Continuity of SMS based reporting in MR Campaign (Phase II and Phase III) throughout the country • Piloting of similar system in Routing Immunization in 5 districts of the country • Piloting of cold chain monitoring using mobile SMS • SMS based monitoring and reporting of immunization program as a whole SMS based reporting on immunization is already included in government annual plan and budget for the current fiscal year
Thank You ! bibhusan@yipl.com.np