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Use of Mobile Technologies for Enhancing Health Service Delivery in Nepal

This analysis explores the implementation of SMS-based mobile technology to improve real-time immunization data reporting in Nepal. By utilizing a toll-free shortcode, local health workers can report vaccination coverage directly, significantly reducing delays and increasing the reliability of data. The system allows for immediate online visualization and central monitoring, fostering better decision-making and ownership at the local level. Since piloting the system during the MR Campaign, real-time reporting achieved 95% accuracy, illustrating a marked improvement in immunization planning and execution.

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Use of Mobile Technologies for Enhancing Health Service Delivery in Nepal

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  1. 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

  2. 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)

  3. Existing Process • Immunization Plan • National Level Plan • District Level Plan • Immunization at the local level • Monitoring and Supervision 1 Coverage Reporting 2 3

  4. 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

  5. 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

  6. 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)

  7. How it Works ?

  8. 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)

  9. 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

  10. Registration

  11. Coverage Reporting

  12. Survey Results Reporting

  13. Visualization of Data (www.nip.org.np )

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. Thank You ! bibhusan@yipl.com.np

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