Tuesday, 19 September 2017

RapidPro: a secret weapon behind the Measles-Rubella campaign

By Cory Rogers, Communication Officer

Fatul and Akhsan show off Akhsan’s purple thumb at the village health post, indicating he’s has already received his MR vaccine  © Cory Rogers / UNICEF / 2017

Semarang: “Akhsan’s mother works at the garment factory during the day, I work nights,” says Fathul in Regunang, Central Java, a shady, rolling village in sight of Mt. Merbabu, a 3,145m volcano rising slowly from the hills. 

“It’s just me here today.”

He and 3-year-old son Akhsan are the lone father/child pair on the lawn of the village health post, but they are at ease; like the 30 mother/child pairs, they’ve come for Measles and Rubella (MR) vaccines -- two diseases that, while entirely preventable, can be deadly to children. 

“Did it hurt? Fathul asks Akhsan, who is busy watching throngs of toddlers in various stages of fear and relief, seemingly amused by the commotion. Akhsan shakes his head no. “He didn’t cry once! Fathul boasts. “Not once!”

It’s a scene playing out thousands of times this month on Java, with the Government hoping to vaccinate 35 million children aged 9 months to 15 years by September’s end. Next year, another 35 million children will be targeted outside Java, making this the Government’s biggest immunization drive to date.

© 2017 Globe Media Lt

Six weeks into the two-month campaign, over 30 million children have been immunized, and the target is very much within reach. Health workers say a new technology -- RapidPro, an entirely free, SMS-based, mobile health monitoring tool developed by UNICEF – is making a big difference. 

“With RapidPro, we get the information [on coverage] immediately, and can see where there are problems,” says Ibu Ani, who heads the health agency in Semarang, the district Akshan calls home. RapidPro pilots were rolled out in Jakarta years ago, but this is the first time the technology has been scaled up by the Government nationwide. 

“The technology is simple and easy to use,” Ani says. “It is fast and it is accurate.”

How is RapidPro helping?

Since the MR campaign launched in early August, RapidPro has been providing 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.

Specialists at community health centres tally the numbers of children immunized during scheduled visits to area schools (the August phase, targeting 6-15-year-old children) or village health posts (the September phase, targeting infants and toddlers) and send the raw figure by SMS to a central database in Jakarta. 

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, which allows for the quick mapping of problem areas.

Immunization unit officials at the Semarang District Health Office, Ibu Kinanti (right) and Pak Djiat, inspect RapidPro entries from their 26 community health centres for inconsistencies with the manual, paper-based data collection, which is going on in parallel © Cory Rogers / UNICEF / 2017

“With this visibility comes greater accountability. That means laggards – all the way down to the level of the community health centre – are easily identifiable,” says I Made Suwancita, UNICEF Indonesia’s RapidPro manager. “In the context of the MR campaign, this stokes healthy competition between local governments and helps ensure every child is reached.”

He and three other UNICEF staff maintain a RapidPro help hotline, but queries are becoming less and less frequent as the campaign progresses.

Indeed, According to Susmiyati, the immunization coordinator at Tengaran Puskesmas in Semarang District (one of 26 overseen by the Semarang district health office), “the only challenge for RapidPro has been unstable networks, as sometimes we can’t send the SMS through; other than that the process is clear and straightforward.”

She attributes the popularity to RapidPro’s ability to bypass many of the shortcomings of the paper-based system.

In previous immunization drives, coverage data was notated manually at each health centre before being passed up to district, provincial and national levels. That process took days, and left a lot of room for human error. RapidPro eliminates this inefficiency and automates the tabulation. 

With RapidPro, administrators can better mount responses in trouble areas without delay, says Ani of the Semarang district health office. 

Ibu Ani poses outside her office in Ungaran, Semarang © Cory Rogers / UNICEF / 2017

She gave the example of one August day when coverage was unexpectedly low at one of the 26 health centres. A phone call showed why: half the parents at a 1000-student Islamic boarding school were concerned the MR shots were haram, or forbidden by Islam, and were refusing to allow their children to receive the vaccines.

Such opposition has surfaced in pockets across Java, requiring visits from religious figures community leaders to reassure parents that immunizations do not conflict with Islamic teachings.

“[Because of RapidPro] I was able to discover the root of this problem quickly,” Ani says, “and within 24 hours we were already going there [to the school.] Before, it could have been a week before we really knew there was a problem to address.”

As the government moves into the final push, it is clear RapidPro is helping government officials mount responses in trouble spots, ensuring no child is deprived of an MR vaccine that could save his or her life. 

“In this modern era we should make use of our information technologies so that we can get the information straightaway and know where there are problems,” Ani says.

“In my opinion, RapidPro could be used for anything.”

Toddlers and infants celebrate getting their MR shots alongside their mothers in Regunan Village, one of thousands of villages in Java where the Government is pushing its largest immunization drive to date with the help of RapidPro, a mobile health technology developed by UNICEF © Cory Rogers / UNICEF / 2017