Mobile phones help vaccines reach every child in Laos

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In Vientiane, text messages don’t just close the communications gap. They are also closing the immunisation coverage gap

Laos

Sompasong Phongphila, a health worker, in one of the cold rooms storing the Japanese Encephalitis vaccines.
Credit: Gavi/2015/Bart Verweij

Vientiane, Laos - Sitting in front of her computer screen, watching a series of numbers as they move up and down the display, Sompasong Phongphila resembles a city trader. As she vigilantly monitors the dancing digits, she sits poised, ready to act the moment they rise too high or dip too low.

But Sompasong does not work the trading floor of a major stock exchange. Instead, she shares a tiny office, which serves as the national headquarters of Lao People’s Democratic Republic’s Expanded Programme on Immunization. The numbers on her screen aren’t share prices or currency exchange rates but the temperatures of Laos’ national cold storage unit and vaccine supply levels from around the country.

Cold store room

Sompasong may not be a trader but her work is vital in protecting the investments of Vaccine Alliance partners in lifesaving vaccines for the children of Laos.

The tightly packed boxes in the country’s national cold store room can contain vaccines with a total value of more than US$ 35,000. They must be kept between 2-8 degrees Celsius in order to remain safe and effective at protecting children against life-threatening diseases. If they spend too long outside of this temperature range, they are rendered useless and the vaccines are wasted.

“We are notified immediately if there is problem with the cold storage system,” says Sompasong. “Even at midnight on a Saturday the system will send a text message to staff living nearby if the temperature is too high or too low.”

Mobile phone monitoring

The monitoring system itself is remarkably simple.

The Vaccine Alliance at work

UNICEF supports the Lao PDR government’s vaccine administration by providing procurement and support services for all routine vaccination programmes across the country – including all Gavi supported programmes.  

Working with both Gavi and the government, UNICEF Lao PDR ensures the regular supply of all vaccines, and supports the monitoring of correct storage conditions, including vital temperature controls, to make sure the vaccines are safe and usable.  

A sensor inside the cold room sends frequent messages to a mobile phone positioned just outside the storeroom’s door. In turn, the mobile phone sends hourly messages to a database system which records the temperature on Sompasong’s computer. If the temperature is too high for a set period of time emergency messages are sent to staff to inform them that the cold room requires urgent attention.

This innovative system, which is being trialled by UNICEF using funding from Gavi, also gives Sompasong and her colleagues an overview of how the cold room is performing on a monthly and even yearly basis.

“I can analyse how often the alarm goes off over a longer period of time and spot any patterns that suggest we need to update our equipment,” says the 23-year-old IT graduate.

Reduce the risk

If the trial is successful it could lead to sensors being fitted in every refrigerator in Laos, sending messages to Sompasong’s computer in Vientiane. This would eliminate the need for manual checking and reduce the risk of overnight equipment failures, which can lead to spoiled vaccine stocks which otherwise wouldn’t be discovered until local health workers arrive at the office the next morning.

“We still have some challenges,” adds Sompasong. “We need to find a system that will send the data to me without doing it via SMS because that would incredibly expensive to do on a national scale. We are hoping the system provider will find a solution that makes it possible for us to roll this out across Laos.”

Ensuring that millions of doses of vaccines are kept within the right temperature range in Vientiane is one challenge but once they leave Vientiane on trucks and planes for distribution to provincial cities and rural areas, a new challenge emerges.

Stock level headache

Stock levels in regional and local storerooms are a constant headache for local health workers. Limited space means they must be careful not to order more vaccines than can be safely stored, but at the same time they must avoid stock shortages which leave children unvaccinated and their parents – many of whom may have travelled significant distances – with dented confidence in local immunisation systems.

Here too, Sompasong is using mobile technology and text messaging to help tackle the problem.

Health workers from districts in three provinces are now recording and sharing their stock levels with Sompasong at least once a month through text messages. This practice is becoming fairly common in developing countries but Laos is exploring a new twist – the text message is written in a specific format, which enables Sompasong’s computer to automatically update the inventory in front of her.

Real-time information

This provides close to real time information on district stock levels and supports long term planning for when doses need to be moved from the national to the regional cold stores, and then on to refrigerators in the districts and villages.

The trial has not been without challenges, however.

“To access the programme, the text messages need to be written using the British alphabet, not the Lao script,” says Sompasong. “Lao people tend to use their mobile phones to make calls rather than send texts so we had to undertake a training programme to teach them how to text using the alphabet.”

Health workers initially questioned whether they could write their inputs on paper and mail them to Sompasong but once they were shown how the database would work they immediately began using the system, even using their personal mobile phones.

“As well as recording stock levels, the health workers are monitoring their fridges to check for incidents of high or low temperature,” says Sompasong. “The system then takes this information and shows us how often problems are occurring and whether fridges are becoming unreliable.”

Seizing the opportunity

UNICEF’s Immunization Specialist in Lao PDR is excited about both projects.

“Things are moving slowly but we are seeing progress,” says Dr Ataur Rahman. “We are receiving the data almost in real time and we are able to act on it.”

With its improving immunisation rates and introduction of effective new vaccines, including pneumococcal and human papillomavirus vaccines (HPV), Lao is seizing the opportunity to test new ways of ensuring that its dedicated health workers can reach every child. And if the projects are successful they could be replicated in other countries.

“If we can make this work in Laos, it can work anywhere,” smiles Dr Ataur.

28%

Pneumonia and diarrhoea account for 28% of deaths in under-fives in Gavi-supported countries.

MCEE-WHO 2016

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