KARACHI: A remarkable increase in routine immunisation has been visible under a pilot project launched a few months ago in district Tando Mohammad Khan, experts at the Aga Khan University (AKU) reported on Monday.

They said the improved results had been achieved through real-time performance monitoring of routine immunisation process with the help of a mobile application named Teeko.

Aimed at assessing and strengtheningthegovernmentlaunchedExpanded Programme on Immunisation (EPI), the two-year project is being implemented by the AKU with the support of the district administration and the Global Alliance for Vaccines and Immunisations.

`The breakthrough came by focusing on performance accountability of the immunisation process which was monitored independently through a smart phone android application,` said Dr Shehla Zaidi, project leader and an associate professor at the Women and Child Health division at the AKU.

The mobile application, she said, monitored the movement of vaccinators, the number of children being immunized, and the availability of vaccine stock at the union council. The district officials took action by suspending low performing vaccinators and pub-licly appreciating those who performed well.

Declining immunisation According to health experts, routine immunisation rates have been falling in Sindh from 37 per cent in 2006-07 to 29 per cent in 2012-13. This is one of the reasons behind polio endemicity and a major factor leading to the outbreaks of deadly, preventable childhood diseases such as measles.

Other diseases covered by routine immunisation are hepatitis B, pneumococcal infections, diphtheria, tetanus, and pertussis.

The main bottlenecks in routine immunisation, according to Dr Zaidi, are low accountability of routine immunisation, children getting missed for vaccination at health facilities, insufficient visits to villagers by vaccinators, and little efforts for immunisation awareness.

`Most importantly, there are discrepancies in the data prepared by different government departments. For instance, the number of immunised children reported by the government`s EPI is much higher than the data reported by the National Pakistan Demographic and Health Survey, showing gaps in performance accountability.

To address these problems, a number of steps were taken under the two-year project to increase immunisation rate, reduce the number of missed children,as well as to ensure collection of authentic data.

These measures included developing a detailed district micro-plan and a team approach to vaccination by bringing the health department and People`s Primary Healthcare Initiative staff together on one platform.

In addition, a one-window system was introduced at basic health units and rural health centres, and all relevant health staff was trained to actively counsel and refer children for immunisation.

Besides, an online system of reporting was introduce d along with details of `under-performing and over-performing union councils`` to check discrepancies in the vaccination data.

`Public messages were sent to mobile phone users and broadcast through the local FM radio to create a demand for vaccination. The innovations were designed in close collaboration with Sindh EPI and implemented through the district government and input from the UN agencies,` said deputy commissioner of Tando Mohammad Khan, Agha Abdul Raheem.

A major challenge for the district administration, he said, would be to sustain the progress achieved once the project was over.

Dr Zaidi, however, believes that the `government can easily take over and incorporate the project in its upcoming expanded EPI programme as it involves very little additional cost.