Changing dimensions in immunization: Implementation research on the E-tracker intervention for improving vaccination of children in Dhaka and Moulvibazar, Bangladesh
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BRAC James P Grant School of Public Health, BRAC University, 6th Floor, Medona Tower, 28 Mohakhali Commercial Area, Bir Uttom A K Khandakar Road, Bangladesh
EPI Bangladesh, Directorate General of Health Services, EPI Headquarter, Mohakhali, Dhaka, Bangladesh, Bangladesh
EPI Bangladesh, Directorate General of Health Services
UNICEF Bangladesh
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A598
Achievement in the national Expanded Programme on Immunization (EPI) is globally recognized as an example in Low- and Middle-Income Countries (LMICs). However, the 2019 Coverage Evaluation Survey (CES) shows that 84% of children are fully vaccinated nationally. Digital solutions like mobile phone help reduce vaccination program challenges. Therefore, Bangladesh has been implementing a pilot intervention of individual electronic tracking (e-tracking) of children in Moulvibazar District and Dhaka South City Corporation and planning to scale it up.

The current implementation research was conducted to understand the implementation process, success, and challenges of the e-Tracker system in Bangladesh and obtain lessons learned and scaling-up recommendations.

The study followed the embedded mixed-method design, including both beneficiaries and implementers. This study occurred in selected areas of Moulvibazar District and Zone-5 of Dhaka South City Corporation and lasted from 1st April to 30th June 2021. A secondary analysis of existing vaccination coverage data of both the e-Tracker and the paper-based system was performed. Data were analyzed using Re-AIM Implementation Framework.

According to the implementors, they get individual accurate coverage data, minimize dropouts, avoid mistakes, monitor, and recognize invalid doses from a single device. The caregivers receive SMS reminders of the child’s vaccination date, yet many reported not receiving the SMS regularly. The frontliners, mostly from urban were comfortable using the e-Tracker app; however, the ageing rural field workers initially struggled to use the device. The e-tracker system creates additional load and requires regular troubleshooting and will require regular internet support and technical staff, especially from the government.

This study found that the e-Tracker can produce accurate real-time data and identify dropouts; however, we need technology friendly manpower, feasible technology, the uninterrupted internet, and logistics support with a sustainable maintenance mechanism to implement and scale up this technology-dependent intervention successfully.

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