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Grand Challenges is a family of initiatives fostering innovation to solve key global health and development problems. Each initiative is an experiment in the use of challenges to focus innovation on making an impact. Individual challenges address some of the same problems, but from differing perspectives.

Challenges: Immunization Delivery
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Beyond Data Collection: Actionable Insights to Vaccinator Supervisors

Mustafa Naseem, University of Michigan (Ann Arbor, Michigan, United States)
May 1, 2019
Grand Challenges Explorations> Immunization Delivery

Mustafa Naseem of the University of Michigan in the U.S. will create an android application to present digital immunization and performance data from front-line health workers to their medical supervisors to improve vaccination coverage in Pakistan. Polio is a vaccine-preventable disease, eradicated in much of the world yet endemic in Pakistan due to poor compliance with immunization schedules. Vaccine administration in rural provinces is challenging because of understaffed, understocked, and sparsely-located healthcare centers. To improve this, the government introduced eVaccs – a smartphone-based monitoring system to track the movements and vaccinations administered by each vaccinator. However, these data remain largely inaccessible to their direct supervisors. To address this, they will develop an application to present them with relevant data in a useful format in real time. This will enable supervisors to better monitor performance, identify key challenges to comprehensive vaccination coverage, and help them better manage vaccine supplies. They will perform behavioral experiments in the field to test whether their approach positively influences vaccination coverage.

Human-Centered Design Approach to Improve Efficiency of Routine Immunization

Shola Dele-Olowu, Clinton Health Access Initiative (Boston, Massachusetts, United States)
May 1, 2019
Grand Challenges Explorations> Immunization Delivery

Shola Dele-Olowu of the Clinton Health Access Initiative in Nigeria will consult with a team of community members and health professionals to improve the efficiency of routine immunizations in primary health centers in Nigeria. The vaccination rate in Nigeria varies: while the overall average is 33%, in some areas only 3% of the population is vaccinated. Historical issues with service delivery including long wait times and lack of information have caused fear and mistrust of the healthcare system among caregivers. Although the government is working to improve vaccine coverage, the focus on increased efficiency without consideration of consumer perspective does not address this fear. They will apply a human-centered design (HCD) approach, increasingly applied in healthcare, to identify deficiencies and implement a workflow redesign to meet both caregiver expectations and the needs of overworked healthcare workers. They will consult with caregivers, healthcare workers, and community members to work through the core HCD phases of inspiration, ideation, and implementation, and develop two solutions. These will be tested in a randomized-control trial in healthcare facilities in Katsina state and evaluated for their impact on wait times, caregiver satisfaction, and efficient use of resources.

Smart Immunization Targeting by Combining Artificial Intelligence and Mobile Tools

Rumi Chunara, New York University (New York, New York, United States)
May 1, 2019
Grand Challenges Explorations> Immunization Delivery

Rumi Chunara of New York University in the U.S. will collect data from mobile phones of healthcare workers to develop algorithms that will help prioritize healthcare resources to increase vaccine coverage in Punjab, Pakistan. Immunization is one of the most cost-effective and successful public health strategies and is estimated to prevent up to three million deaths each year. Still, many rural areas of low- and middle-income countries have an under-vaccinated population due to a lack of formal education and awareness of the importance of vaccinations. They will collect data on disease incidence and vaccine resources and coverage from the mobile phones of 3,800 rural healthcare workers. These data will be used to train an artificial intelligence model to identify the ideal times and locations to target vaccine efforts. The model will also address accessibility and awareness issues by incorporating distance to healthcare centers and frequency of visits. Their approach will be evaluated by analyzing coverage before and after implementation. Once proven, it can be scaled to other areas in Pakistan.

Structured Speech Recognition Platform

Noshad Ali, Precision Health Consultants Pvt Ltd (Karachi, Pakistan)
May 1, 2019
Grand Challenges Explorations> Immunization Delivery

Noshad Ali of Precision Health Consultants Pvt Ltd in Pakistan will develop a speech recognition platform to record child vaccination data and increase efficiency at vaccination clinics. Adherence to the recommended vaccination schedule is critical for reducing vaccine-preventable disease in developing countries and is increased when caregivers have positive interactions with healthcare workers. They will implement a system that will allow caregivers to dictate and record child vaccination information via speech recognition. This will decrease the amount of time spent recording data, allowing vaccinators more time with caregivers to address any concerns. This should help strengthen the relationship between healthcare workers and caregivers and thereby promote vaccination adherence. Software developers will shadow vaccinators in clinics during the design phase, noting the main discussion topics and questions asked. Once functioning, the success of the platform will be measured by software precision and satisfaction of vaccinators using the technology.

Using Birth Registry Data to Increase Timely Vaccination

Fatema Khatun, International Centre for Diarrhoeal Disease Research, Bangladesh (Dhaka, Bangladesh)
May 1, 2019
Grand Challenges Explorations> Immunization Delivery

Fatema Khatun of the International Centre for Diarrhoeal Disease Research, Bangladesh in Bangladesh will develop a digital intervention to enable sharing of existing digital health data between community health workers and provide them with feedback indicators along with tailored messaging to parents to improve timeliness and coverage of vaccination against tuberculosis in rural Bangladesh. Tuberculosis is the number one cause of death by infectious disease worldwide, and 95% of deaths occur in developing countries. In Bangladesh, the bacille Calmette-Guerin (BCG) vaccine against childhood tuberculosis is usually administered at six weeks of age, despite the fact that vaccination at birth could decrease mortality by three percent – a significant number of cases in this tuberculosis-endemic country. Immediate vaccination is especially important for high risk neonates including low-birth-weight babies and those born to hepatitis B-positive mothers. The digital intervention strategy will be developed to combine the existing electronic health record system with the pregnancy and childbirth registry and to provide digital communication between the community workers providing prenatal and delivery care and those providing BCG vaccination. This will ensure that newborns at increased risk for tuberculosis are prioritized for immediate vaccination. The system will also send direct messages to mothers before and after birth, reminding them of the importance of timely vaccination. Their approach uses existing data in a new way to improve overall vaccination rate and timeliness and decrease infant mortality.

Using GIS for Reducing Inequities in Immunization in Urban Settings in Nairobi and Kisumu Counties

Caroline Kabaria, African Population and Research Center (Kitsuru, Kenya)
May 1, 2019
Grand Challenges Explorations> Immunization Delivery

Caroline Kabaria of the African Population & Health Research Center in Kenya will use geographic information systems (GIS) to map the location of health facilities and community health volunteers in Kenya to identify particularly marginalized slum populations that need better access to health services such as vaccinations. Nairobi and Kisumu contain over 100 slums where residents live in dense and unsanitary conditions. The specific health needs of these residents are difficult to assess from national statistics that often exclude them. To address this, they will conduct an in-depth assessment to identify equity gaps specifically in childhood immunizations. Community health volunteers will be trained to use GIS mapping techniques and to register households, and the data will be integrated with the existing district health information system (DHIS 2). This will be used to produce an interactive map of the two cities that includes the spatial and social structures of informal settlements and the location of health facilities. They will also provide training and guidance to local stakeholders on how to utilize the map to improve vaccination coverage.

Voice-Based Platform to Enhance Service Delivery and Improve Caregiver-Community Health Worker Interactions Around Immunization

Sumeet Singh, OneKeyCare Ventures Private Limited (New Delhi, Delhi, India)
May 1, 2019
Grand Challenges Explorations> Immunization Delivery

Sumeet Singh of Onekeycare Ventures Private Limited in India will develop a voice-based platform to store immunization records and improve caregiver attitudes toward vaccination in rural India. Adherence to a standard immunization schedule is essential to reduce childhood death from vaccine-preventable diseases. However, many mothers in rural and remote India are unaware of the recommended childhood immunization schedule and how crucial it is to follow it. They will develop a voice-based platform for health workers to easily update immunization records and to provide automated reminder calls to caregivers when vaccinations are due. They will also develop voice-based games to educate caregivers on hygiene best practices and the importance of immunization for health and provide the opportunity to earn points that can be redeemed for rewards. Importantly, these systems are independent of internet or smartphone access, which are largely absent in remote areas. They will test their platform in a target area by training a group of health workers and influencer caregivers and evaluating its effect on awareness and behavior.

Accessible Metrics of Access: Novel Tools to Measure Immunization Coverage

Ross Boyce, University of North Carolina at Chapel Hill (Chapel Hill, North Carolina, United States)
Nov 1, 2018
Grand Challenges Explorations> Immunization Delivery

Ross Boyce at the University of North Carolina in the U.S. will develop an approach that uses new methods of mapping households together with available health data to better identify places that have limited access to healthcare to improve immunization coverage. Many sub-Saharan African countries have very poor rates of childhood vaccination coverage. Improving coverage requires identifying those households and areas with poor access to healthcare, but this is challenging with the limited data available. To more accurately measure healthcare access and thereby immunization coverage, they will perform a six-month study in a rural sub-county of western Uganda. By providing user-friendly tools to health workers and providers, they will generate more accurate household maps and assess three different metrics of healthcare access using freely available software and a Bayesian statistical framework. They will evaluate the accuracy of their approach for predicting coverage by conducting a cross-sectional survey to determine the vaccination status of all children aged between 12 and 23 months in the sub-county.

Crowd-Sourcing Vital Records to Improve Subnational Data

Chinedu Chugbo, Avigo Health L.L.C. (Washington, District of Columbia, United States)
Nov 1, 2018
Grand Challenges Explorations> Immunization Delivery

Chinedu Chugbo of Avigo Health L.L.C. in the U.S. will develop an approach to crowdsource reports of infant births and deaths from community members by health workers to better monitor vaccine coverage in low- to middle-income countries. In Nigeria, only 30% of births are registered, making it difficult to estimate numbers of vaccine-eligible children and ensure every child is properly vaccinated. Current methods for estimating population sizes include household surveys, which are costly, or records from health clinics, which suffer from limited coverage. Crowdsourcing is a proven method for efficient data collection, although data quality may be variable. They will develop electronic data-collection and storage tools and pilot test their crowdsourcing approach in a selected region in Nigeria. Health workers will be trained to administer brief interviews to community members visiting clinics and during outreach programs to document local births and deaths. They will evaluate the performance of their approach and particularly data accuracy by comparing it with data collected by household surveys in the same region.

DigiMat. Tracking Realtime Immunisation Data (DigiTrack)

Chibuzo Opara, DrugStoc E Hub Ltd. (Lagos, Nigeria)
Nov 1, 2018
Grand Challenges Explorations> Immunization Delivery

Chibuzo Opara of DrugStoc E Hub Ltd. in Nigeria will equip vaccine storage and transport sites with calibrated weighing mats (Digimats) that automatically transmit vaccine quantities in real time to better monitor delivery chains in the community and improve supply. Monitoring the movement of vaccines at the national and district level is currently performed by the Nigerian immunization program. However, accurate monitoring at the local level requires alternative, more automated approaches to avoid human error. They will calibrate their Digimats to recognize the weight of specific vaccines, and identify 20 sites across three states, including storage warehouses and trucks, where they will be positioned to automatically transmit data over a period of six months. These data will be collected by mobile tablets and interfaced with the national vaccine delivery dashboard to provide real-time stock counts and resupply alerts.

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