The world has achieved extraordinary progress in recent decades toward ensuring that every single child has access to life-saving vaccines.
No other health intervention has impacted so many people and, today, some 80% of children in the world’s poorest countries are immunized with basic vaccines.
But, as we learned at the Gavi Mid-Term Review (MTR) meeting in Abu Dhabi earlier this month, there are now new challenges to solve and new obstacles to conquer in the effort to reach every child.
Vitally, the effort now must focus on reaching the final 20% of children — what’s known as “the fifth child.” And, as Chris Elias, president of global development at the Bill and Melinda Gates Foundation, said at the MTR meeting: “The fifth child isn’t standing next to the other four; otherwise it would be easy.”
The “fifth child” is harder to find and harder to keep track of, when ensuring that they receive their full vaccination coverage, whether it’s because they’re living in an urban slum or in the hardest-to-reach remote rural areas.
In reaching these children, innovation is going to be essential, and that’s where these organisations come in. They’re creating new technologies and adapting existing technologies. They’re ensuring vaccinations are safe and potent when they reach recipients. They’re finding out what people really need in order to access immunization.
So Global Citizen met with them in Abu Dhabi to find out how and why.
1. Medic Mobile
Medic Mobile is a software dedicated to making life easier for community health workers — those working on the frontlines of vaccine delivery. It’s currently deployed in over 15 countries in Africa and Asia.
The community health worker has the software on their phone, and it allows them to schedule their priorities and tasks; track patients and access their records, so they know their symptoms or what vaccinations they’ve had; and it supports them in making decisions, like when to refer a patient to a health facility.
We’ve released a 🆕 version of the Community Health Application Framework, version 3.0! This release improves critical infrastructure that runs the software.— Medic Mobile (@Medic) December 13, 2018
Learn more about 3.0 in our latest blog post written by Medic's Chief Architect, @ensignricky! https://t.co/pdZyctTnvCpic.twitter.com/G19akEIhin
“It gives them a lot of visibility into the work that they’re doing,” Shreya Bhatt, Medic Mobile’s Asia regional director, told Global Citizen. “Traditional paper-based systems don’t support them in the way that they should, in terms of allowing for real-time quick access, and full coverage of communities that they’re supporting and serving.”
“Technology platforms like this … can help them really focus on the work that they’re doing and the services that they’re providing, without having to worry about the coordination, and the logistics, and the information gathering and sharing, and really connect them with the [health] facilities,” she added.
2. Last Mile Health
This organisation actually launched as an HIV community health worker program in Liberia, which is where CEO Raj Panjabi grew up and trained as a physician.
Last Mile Health is primarily a training tool for frontline health workers — helping them to do away with bulky and expensive text books and other traditional training materials.
We are honored to be partnering with the Governments of Liberia, Kenya & Uganda alongside @gavi & @Living_Goods to help close the immunization gap in rural areas. #GaviMTR#GotLifehttps://t.co/5UOCwUaSC6— Last Mile Health (@lastmilehealth) December 14, 2018
“They should have access to modern learning tools, just as I did when I became a doctor,” said Panjabi. “If there’s a new vaccine or a new approach to counselling for HIV testing, it’s very hard for any government to then rapidly update [textbooks]. It costs a lot of money.”
With the Last Mile Health software, however, new learning tools can be uploaded and then accessed by health workers on their phones. They can access text and images, watch animations and live videos for teaching new procedures, take quizzes to test their knowledge, and their supervisors can check their work to decide who might need additional training.
Parsyl is currently working in Senegal and Uganda, and it’s on a mission to monitor perishable goods, like vaccines, to make sure that when they reach the person who’s going to be vaccinated, they’re actually going to work to keep that person healthy.
In reaching the most remote areas, there’s a problem in ensuring that vaccines are kept at the right temperature or humidity, for example, to make sure that they’ll still work effectively.
So Parsyl has created a small device that acts as a way of monitoring the storage conditions of the vaccines as they travel to recipients.
“We switch it on, we put it in the vaccine carrier, it has some predefined profile that you have to select,” said Souleymane Sawadogo, general manager of global health at Parsyl. “During the monitoring period it has a visible alarm so when it goes out of the predefined profile, the health worker can see the visual alarm. It blinks red, to tell you that there will be something wrong with the shipment.”
“We have a mobile app also that communicates with the device via bluetooth, so the mobile app gives more insight,” he continued. “It tells you what happened, when did it happen, and how long did it happen for — like how long was it above the threshold.
“Health care workers really like it, especially on the last mile,” he added. “This is empowering them, as they can make a decision right there and then.”
4. Living Goods
Living Goods is currently working in Kenya, Uganda, Myanmar, and Zambia, and it’s working primarily with community health workers to help tackle the challenges of training, and of logging patients’ details and records.
“We provide them with an Android phone … and we provide them with training, and then they go out to the communities they serve,” Caroline Mbindyo, director of digital health partnerships, told Global Citizen. “The device allows them not just to register the household and their GPS coordinates, but also to do the assessment.
“When they are doing assessments for children, they have a diagnostic tree that they follow that helps them to do a standard assessment,” she continued. “So, regardless of who you are, you do the assessment exactly in the same way.”
Our network of #communityhealth workers remain highly organized and on task, and our Smarthealth app helps them keep track of past due appointments as well as appointment history. Having a historical log of information helps save lives! pic.twitter.com/ait78VHoLb— Living Goods (@Living_Goods) December 19, 2018
And if a patient is sick, or they meet a child who hasn’t been fully immunized, the health worker can also refer the patient to a health facility — and follow up to make sure that the patient goes, and receives treatment.
“One of the things that we’re really trying to do is generate demand for services at the community level,” added Mbindyo. “Because for different reasons many women don’t want to immunize their children. And once we create that demand, we want to be able to incentivize action.”
And, according to Mbindyo, it’s already having a real impact. In Uganda, for example, where Living Goods’ largest program is, the organisation has seen a reduction in child mortality of 27% in just five years.
5. One Hundred
One Hundred is a little different, in that is doesn’t generally work in the nonprofit sector and is much more accustomed to working with big brands around the world.
But, through its work with brands, it is used to engaging consumers — and it’s for this reason it's now working with Gavi on health innovation.
“To say, well, why is it then that in some of these settings we’re seeing people with mobile phones, they’re drinking Pepsi, they’re engaging with brands but maybe not with some of the health issues that are happening,” said managing partner Emma Sergeant.
“Our offices in these markets, in India, Indonesia, and Nigeria, actually went in and interviewed people for quite long periods of time — at least an hour, if not a couple of hours,” added Sergeant. “And it wasn’t just talking to them about vaccines, it was talking to them about their lives, and what was important to them; what frightened them, what hopes and dreams they had. In the same way as we would do for a brand.”
And One Hundred identified two key insights among people living in urban slums. One, that people weren’t necessarily anti-vaccine, it was just low on their list of priorities. And two, that they felt no sense of community in these spaces — which is a problem because people didn’t know where or how to seek out health facilities.
Having identified the issues, One Hundred is now at the stage of creating solutions.
“One idea is creating community oases in the middle of a slum,” continued Sergeant. “A place where people come to trade, or have their shoes repaired. Creating something with the community on the ground, and then you put the vaccine clinic near it so it's there in your space, and part of your life.
“We also have an idea of a security blanket, where you’re given a basic blanket and you can sew threads into it, different-coloured threads, to help log what vaccines a child has had,” she added.
The next step for One Hundred is to trial some of these solutions with the people who would benefit from them, to find out what works and what can be scaled up.
6. Sim Prints
Sim Prints is a nonprofit biometric tech company out of the University of Cambridge, in the UK, and it essentially links a person’s fingerprint to whatever record you need to connect to.
“So it could be your medical record, or you want to track that they’re attending class every day, or in finance and linking to a bank account,” said Christine Kim, director of strategic partnerships. “Whatever needs our partners have in mind, we provide the accurate link to the exact person.”
There are so many reasons why someone might need to identify themselves however, according to Kim, there are 1.1 billion people in the world who have no official form of ID — and it’s an obstacle to everything, from setting up a bank account to getting a permanent address.
Incredibly proud to be one of @gavi INFUSE Pacesetters.— Simprints (@Simprints) December 11, 2018
We had a great first day at #GaviMTR in Abu Dhabi yesterday. We were at the #innovation space and had the chance to meet truly inspiring innovators that are working to deliver vaccines to the last mile.#VaccinesWorkpic.twitter.com/QRYj0YUjIv
“Essentially they are invisible, in terms of having the right to access essential, and in many cases life-saving, services,” added Kim. “And so what biometrics would do in conjunction with NGOs, which are doing brilliant work in these areas, is to make sure that each and every single person is reached, without anyone falling through the cracks.”
And while we may think that fingerprinting technology is nothing new, a challenge that Sim Prints identified early on is that existing technologies simply weren’t accurate enough to work in some of the settings where it was needed.
“The populations that we’re trying to reach are people who are manual labourers, farmers, rickshaw drivers, women whose hands are burned through dealing with pots with their bare hands,” added Kim. “And so when we tested five of the industry’s leading biometric tech products, all boasting close to 100% accuracy, we found terrible accuracy rates.
“And that’s untenable when you’re trying to make sure that you gave the right healthcare delivery,” she said. “So we spent 1.5 years in research and development, optimising technology to be 228% more accurate … than what existed.”