Tuesday, 18 April 2017

Mobile Health Pilot Boosting Immunization in Urban Java

By Cory Rogers, Communication Officer

Karin Hulshof wipes a tear away from a child who will soon receive a health checkup at a local health post in West Jakarta. © Cory Rogers / UNICEF / 2017  

The line curls out of the door and into the alley, where dozens of mothers stand patiently, cradling newborns under an early morning drizzle.

“I’ll wait for the line to thin out and take my baby in later,” Eka* told UNICEF East Asia and the Pacific (EAPRO) Regional Director Karin Hulshof in her doorstep during Karin’s visit to Indonesia last week, her first as EAPRO Regional Director.

Like other young mothers in this West Jakarta slum, Eka looks forward to the opening of the posyandu (community-level health post) each month. “The difference is I’m not so eager to get wet,” she laughed.

“At the posyandu I get my baby checked and vaccinated for free,” Eka said motioning for Karin to come inside her house. Six people sleep cheek-by-jowl in the one-room home each night.

Eka lives in one of hundreds of informal settlements that have sprouted up due to accelerating rural-urban migration rates in Jakarta. While these slums can be vibrant zones of community life, they are typically poor, densely populated, and located near riverbanks, where flooding is common and sanitation is poor.

Combined with the fact that urban migrants often lack the residency papers for accessing essential health services like immunizations, these shantytowns are climates par excellence for outbreaks of vaccine- preventable disease.

It’s in the slums were the risk of outbreak is highest, and the rate of immunization is lowest, said UNICEF Child Survival and Development Chief Paul Pronyk, who accompanied the Regional Director during her field visit.

“That makes it the most important site for intervention efforts to protect children,” he added.

Eka waits at the local health post in Cengkareng, West Jakarta to take her youngest daughter for a health check- up. © Cory Rogers / UNICEF / 2017  
Since 2015, UNICEF has been piloting a mobile health solution for boosting vaccine coverage for children between 12 and 23 months of age in several  Jakarta shantytowns.
The initiative leverages Indonesia’s high levels of mobile connectivity and the digital platform RapidPro to introduce a number of key interventions.
During the first stage, local health workers go door-to-door to register newborns. Then, over a series of months, automated reminders are sent to parents and guardians about upcoming vaccinations at local health posts (posyandu). A separate feature allows health workers to record when vaccine stocks dip, permitting real-time monitoring of coverage by Government officials.
Two years after the intervention’s launch, progress has been strong: nearly 3000 infants have been reached, and the programme has spread from Jakarta into dozens of urban districts in the neighbouring provinces of East and Central Java. All enrolled health facilities, meanwhile, have provided monthly updates on the stock levels of each of the six vaccines monitored in the intervention.
The Regional Director stressed the need to ensure that UNICEF continues to work with the Ministry of Health to ensure the platform is “complementary and integrates with national data systems”. Interoperability remains a prime aim of the intervention.
“Given hthe igh degree of mobile penetration in Indonesia, where there are more SIM cards than people, the time is ripe to explore the potential of mobile health,” Pronyk said. “There’s promising potential here for scale-up by our Government partners across a range of initiatives,” he added.  
Ibu Helvina, the head of the posyandu, reckons the mobile health pilot is a big reason why the clinic is, as Eka pointed out, buzzing of late– even on days when it rains.
“For mothers who have a tendency to forget the [immunization] schedule, it really helps them,” she said. “And once we know who they are and where they live, we go out and get them if they’re not here by 10am,” she said.
Such dedication and synergy between community members and local health workers is indispensable to boosting low immunization coverage, or indeed to addressing any health challenge, Karin Hulshof said.
“The level of engagement here between mothers, health workers and government officials was marvelous,” she added.
“It is hard not to feel like if all children living in informal settlements [shantytowns] in Jakarta had access to the kind of services here, the indicator [on low rates of immunization] will start to come up,” she said. 
Though grinding poverty and social exclusion leave indelible marks, “there was a lot of heart on display here, a lot dedication to improving the community,” she added.
“In the end, it’s the ‘human touch’ that makes the difference.”