Removing Institutional Silos in Immunisation Drives using GIS Triangulation

Overview

This project was built to provide health officials with digital tools to solve technical and administrative problems arising due to non-comparable immunization data in institutional or programme silos. It leverages Geographic Information System (GIS) technology to triangulate multiple immunization coverage indicators data and vaccine consumption data. The approach was to develop an easy-to-use application with a specific focus on including all children in rural India in the immunization programme.

The primary requirement was to create an automated solution to triangulate immunization coverage indicators data and vaccine consumption data that are routinely collected by the government and aggregated every month. The immunization coverage indicators data is available in the Health Management Information System (HMIS) provided by the Ministry of Health and Family Welfare (MOHFW) and the vaccine consumed data is collected by the United Nations Development Programme (UNDP). UNDP implements immunization programmes in India through eVIN (electronic Vaccine Intelligence Network) to strengthen the Universal Immunization Programme (UIP). The project was a winning submission for the call by Grand Challenges India for Immunization Data: Innovating for Action (IDIA) – Phase I.

Vision:To ensure universal and equitable distribution of immunization to the remotest parts of rural India and to support the implementation of the Sustainable Development Goals (SDGs) by strengthening outreach operations of immunization programs, and therefore, vaccine distribution.

Objectives

y To resolve the problem of data silos, disparate units of data and create a method of validation of data y To triangulate sets of health data: HMIS immunization coverage indicators and eVIN data for consumption of vaccines, which were in non-comparable units of measure. y To implement GIS to enable fine-tuning last mile delivery of vaccine from cold storage points to vaccination session sites y To identify all rural population clusters, including those missing in vaccination session site lists, and understand the impact of difficulties in access to health facilities and immunization session sites, water logging, annual flooding, etc. y To train local health officials to use the App y To gain insights into improving the App and get better results during rollout across other states.

Stakeholders Involved

Biotechnology Industry Research Assistance Council (BIRAC), Department of Biotechnology, Government of India and the Programme Management Unit (PMU) to oversee the activities, Bill & Melinda Gates Foundation (BMGF) for project funding, the Ministry of Health and Family Welfare (MOHFW), United Nations Development Programme (UNDP), and the Bihar State Health Society (BSHS). The project also received valuable input from mentors Dr Parthasarathi Ganguly, JSI and Mr Soumen Ghosh, Plan India, and the entire team at ML Infomap. Solution and Implementation

In consultation with BMGF and BIRAC, the East Champaran district of Bihar was selected as the study area to test the App. This is a largely rural district and still has pockets where immunization requires to reach. The district has 27 blocks, 1344 villages and a population of over 50 lakhs. The initial activities involved connecting with the immunization programme’s direct stakeholders: MOHFW, UNDP and BSHS.

There were two primary obstacles: one, MOHFW, UNDP and BSHS were reluctant to share disaggregated immunization data; and two, data could not be accessed online for integration with the proposed GIS platform. The first problem was solved with the active support of BIRAC and BMGF, and an agreement to use vaccine consumption data was signed with UNDP.

Technically, there were several interesting problems that were resolved by using a GIS platform. Since immunization data exists in different systems and is in different units of measure, algorithms were written to triangulate and map them to enable health administrators to monitor their programmes locally. This tool is customised for indicators of different diseases and vaccines, like DPT (Diptheria, pertussis, tetanus), Japanese Encephalitis, Rotavirus and many more. This complex task should now be possible to undertake with ease and fine-tune the supply of vaccines and avoid wastage.

Mapping of all rural habitations became essential. This is an important task as the distribution of vaccines to immunization session sites is currently based on the incomplete list of habitations available in HMIS. Also, vaccines must maintain the cold chain from the cold storage to the session sites and therefore timely delivery becomes critical. The distribution of vaccines is improved by accurately knowing the location of delivery points in villages and hamlets. To ensure universal and equitable distribution of immunization, mapping rural population clusters is thus essential.

Cellular network disruptions were common in East Champaran. Keeping this in mind, and the fact that we received data dumps from BSHS and UNDP, an online-offline system was developed to enable end users to perform functions without prolonged interruptions. It is suggested here that in future, near real-time immunization data should be available for geo-analytics and provided securely from health data repositories using APIs. This is technically feasible and will ensure efficient and timely use of data.