A pilot study to develop and test ICT tools to improve timeliness of vaccination in Bihar

Despite a significant increase in vaccine coverage in India, more than 20% of child deaths in 2008 were caused by three vaccine-preventable diseases alone. A major underlying factor behind these deaths is lack of vaccine effectiveness, which in turn depends on the timeliness of vaccination.

Factors affecting the delays in timeliness of vaccinations include:

• Manual generation of due-lists by ANMs for each village.
• The incentive structure for ASHAs is independent of timely delivery of vaccines.
• The lack of appropriate information and awareness among caregivers regarding the time and place to avail vaccines for their infants.

This pilot study aims to empirically investigate the functioning of the current workflow process and develop ICT tools that will automate the generation of due-lists for the ANM, design and field-test appropriate P4P incentives for ASHAs, and set up a call centre to test the capacity to make reminder calls to caregivers regarding VHSNDs.

The study area for the pilot is the district of Muzaffarpur, Bihar and the researchers aim to conduct surveys on three types of agents covering the public healthcare system. The first set of surveys will cover the supply-side of healthcare, for example, ASHAs and ANMs; while a detailed household survey would be administered to understand the demand-side of utilisation of vaccines to primary caregivers of infants in the study area.

Studies on timeliness of vaccination either depend on recall data or vaccination dates written on Mother Child Protection cards. Both of these sources suffer from measurement error due to bias in recall and manual error. Moreover, these data are not readily amenable for monitoring purposes. This intervention envisages a system that will automatically capture the information on timeliness of vaccination and create a comprehensive database on healthcare services utilisation, disaggregated at multiple levels, enabling real-time monitoring and intervention by policymakers. This research on the effects of performance-based incentives for timely delivery of vaccines might be of interest to policymakers to understand how redesigning incentives can affect healthcare services utilisation.