Indonesia has the fourth highest number of under-immunized children in the world — 1.9 million. It also has a government determined to take action to improve immunization coverage.
Together with UNICEF, the Government of Indonesia saw the potential that real-time information could have in supporting the country’s largest-ever immunization campaign to vaccinate 70 million children against measles and rubella in 2 years.
To support the campaign on harnessing real-time data, RapidPro, an open source platform was integrated. This platform enabled real-time coverage analysis at the level of the community health centre, or puskesmas. There are 3617 such centres spread across Java, and never before has coverage analysis reached this level of detail.
UNICEF’s Office of Innovation met community health workers in their Puskesmas (local health posts) at Bandung Barat District in West Java Province, 3 hours outside of Jakarta, to learn more about their recent experience in deploying the measles and rubella campaign and their experience using Rapidpro.
Taking a closer look
Mr. Jauhari is the Head of the Surveillance and Immunization Unit of the Bandung Barat District Health Office, meaning he looks after a population of some 1.6 million people. “In previous campaigns, formal reporting was daily, paper-based with signatures,” he explains. “Provincial only had aggregate for each district but no breakdown up to Puskesmas. We cannot see performance or spot problems at the lowest level, we were not able to take action in real time.”
He adds “on the dashboard I can see the reporting and every Puskesmas has their daily target and I can ask, “what happened to the unimmunized children?”
Daily digital reporting powered by RapidPro has made a big difference particularly in quickly identifying, assessing and mapping of problem areas. The data – which can be viewed by the day, week, or month – is uploaded to the RapidPro dashboard, providing a scorecard that shows which province, district, and puskesmas are hitting vaccination targets. Every clinic and district have location codes. In addition, conducting regular consultations and having a good understanding of the needs of the users are integral towards the development and in optimizing the use of RapidPro.
The UNICEF Innovation team traveled further out to a peri-urban area in Puskesmas Cihampelas to learn more from the people directly providing health services (including immunization) to communities.
Ms. Enung Nurhayati, the immunization coordinator of the Puskesmas, has become a fan of RapidPro. “It is easy to report. Before, I had to remember and write it all down and come back here to the Puskesmas office to report. It used to take 4 people to prepare the reporting. Now I can report the children I have immunized from anywhere, any time.”
Ms. Enung shows us the record of her work — the reports she sent and the daily feedback she received on how she was doing against the goal she had to meet to be on track to meet the coverage target for the health centre.
“We always keep the daily SMS report and feedback as our record,” she explains, and is proud to show us her good performance.
Dr. Rahmi is the Head of Puskesmas Cihampelas and is Ms. Enung’s boss. She likes the performance monitoring aspect of the solution too. “This daily coverage feedback is useful,” she explains. “When I see how we are progressing, I can see where there is a problem. I can ask why. I can trigger action to look into various areas.”
That’s the same benefit Bapak Jauhari appreciates, though in his case, the real-time dashboard allows him to identify — at a glance — which health centre covering the 175 villages in his district may be in need of follow-up. He gives us an example.
“This time I could spot [gaps], and we took actions like responding to parent’s concerns, setting up a door to door schedule to immunize missed children.”
The proof is in the results — the district’s routine immunization coverage is 90% but this campaign reached 96.8%. The health centre Dr. Rhami manages exceeded their target and achieved 95.4 % coverage.
Health workers we met shared positive sentiment towards the integration of Rapidpro to the immunization campaign. But also expressed how they can see this platform used in their areas of work that require monitoring from routine immunization, and nutrition monitoring – to name a few.
“We are happy, yes, about the campaign,” smiles Ms Enung as she points to a board with nine sets of printouts mounted on it, titles ranging from routine immunization to nutrition. “But we need to RapidPro everything!“
The government of Indonesia has also seen the value of real-time information and in having a tool to effectively manage campaign rollouts. The government sees how RapidPro can bring similar benefits in other areas of work. First up, plans to utilize it for the rollout of their mosquito bed net campaign.