Smart paper technology set to track children defaulting on vaccination in Uganda

Routine and complete vaccination of children against preventable diseases by their second year of life helps to reduce mortality and morbidity. According to the Uganda National Expanded Program on Immunization (UNEPI) schedule, a child must receive vaccination five times before the first birthday.

Despite the preventive benefits of vaccines, some parents and guardians default on vaccinating children. This under-vaccination poses a risk to the continual spread of diseases in the community. 

According to Ms. Justine Kambabazi, a Nursing Officer at Kinyara Health Centre III, Masindi District, in Uganda’s Bunyoro sub-region, parents or guardians may choose not to bring a baby for vaccination due to seasonal migrations that see them offering casual labor in sugar cane plantations.

“When they go to seek money, they return after months to the same spot. Other parents dread trekking long distances to the facility when a child is not visibly sick,” says Kambabazi.

Kabango Parish, one of the parishes from which parents or guardians must trek long distances has the highest number of children defaulting on vaccination. Kinyara HC III is the only vaccination outreach post for the parish that is approximately 8 km away from the facility. Of the 121 children defaulting vaccination, 38 children defaulted between March 1 and May 31, 2023.

Whereas health workers used to travel to Kabango Parish monthly to vaccinate children, the outreaches stopped due to the lack of transport for the health workers.

Apart from the long distances and seasonal migrant workers, health workers do not actively identify the defaulters while at the facility. “They also fail to link these vaccine defaulters to VHTs [Village Health Teams],” says Kambabazi.

Further, health workers have limited access to the Smart Paper Technology (SPT) system. Since the inception of the SPT system in Kinyara HCIII, health workers have not been generating lists of vaccine defaulters because of no access rights.  

It is against this backdrop that efforts by the Growing Expertise in E-Health Knowledge and Skills (GEEKS) program, a Uganda Ministry of Health, African Field Epidemiology Network (AFENET) and US Centers for Disease Control (CDC) partnership, will assist Kinyara HC III in reducing the number of children defaulting on vaccination. 

Using the SPT system, GEEKS will print lists of defaulters and link them to VHTs to support with tracking. The SPT system identifies defaulters’ individual data.

In partnership with the Ministry of Health, the African Epidemiology Network (AFENET) trains health workers like Kambabazi to use the SPT system to identify children that are due for a vaccination countrywide.

“This system will make our work easier. Fewer parents will default on their children’s vaccination,” says a hopeful Kambabazi.

GEEKS is one mechanism that can be applied to build the capacity of MoH staff as they strengthen the health information system to be able to collect, analyze and report EPI data for program planning and performance improvements.