Assessing performance tracking of vaccinators using mHealth based application (TEEKO) at district, Tando Mohammad Khan- Sindh

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


The Routine Immunization (RI) stands as an essential element to achieve identified health targets in the Sustainable Development Goals (SDGs). Worldwide, 2-3 million deaths of children are caused due to Vaccine Preventable Diseases (VPDs) and averted due to RI. Pakistan reports 54% RI coverage and accounts for 27% of deaths of children under the age of five years due to VPDs. Sindh province witnessed a decline in RI coverage from 37% to 29% during 2006-7. The Global Vaccine Action Plan (GVAP) sets a target of 90% national and 80% district level immunization coverage by 2020 through country's ownership, partnership, equity, integration, sustainability and innovation. The evidence based studies have shown that mHealth interventions have great potential to uptake of RI services and have shown significant improvement in RI coverage. Hence, our study assessed the applicability of mHealth application designed for improving routine childhood immunization through increased transparency, accountability and monitoring. Methods: This was a nested study within a larger health system research study that used before and after comparison of the intervention and the non-intervention areas (quasi- experimental study design). This study was confined to post—intervention outcome and that the vaccination coverage was not the mandate of our study. This study used mixed method study design covering both the qualitative and quantitative components A qualitative exploratory research design was chosen to assess mHealth based application (Teeko) for performance tracking of vaccinators and explore experiences and knowledge of end users (vaccinators) and stakeholders (district management) at district Tando Mohammad Khan. Structured close-ended interviews of vaccinators were carried out on acceptance and end user experiences of using "Teeko" application. Key Informant Interviews (KIIs) were conducted with the help of semi structured interview guide. Field survey (quantitative component) to validate the number of vaccinator's visit and vaccination volume was performed through household survey, administered to the parehts. Results: The qualitative findings derived from relevant vaccinators were categorized under three major themes; use of technology, implication of "Teeko" application, recommendations and future sustainability plan. On the other hand the stakeholders' findings were based on three major themes; barriers to childhood routine immunization, impact of childhood routine immunization and acceptance of "Teeko" application at government level. While the quantitative findings analyzed various characteristics of "Teeko" application through the data collected with the help of closed ended questionnaire administered to the vaccinators in the intervention area. It revealed that this was an easy to use application for documentation of EPI data and has an impact on vaccinator's performance tracking and monitoring. Results of validation with respect to the number of visits and the vaccination volume among children in both the intervention and non-intervention areas were also discussed. Conclusion: The study findings explicitly demonstrate that mHealth based intervention can be used as an effective modality to improve routine immunization coverage in hard to reach rural areas of Sindh. Moreover, this innovative technology can be used to achieve targeted 80% routine childhood immunization coverage at the district level.

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