A mother waits for her baby to be vaccinated at the Bugurundi Clinic in Dar es Salaam, Tanzania. Credit: Kristin Palitza/IPS

By Kristin Palitza
DAR ES SALAAM, Dec 22 2012 (IPS)

A nurse working in a remote clinic in Mueda, a small town in northern Mozambique’s Makonde Plateau, receives a shipment of vaccines from the national health department. Using special software on her mobile phone, she sends out a mass text message to alert mothers in the area about the availability of immunisations.

She also uses the phone to schedule appointments, access patient records and order new vaccines when stock runs low.

It is – for now – a theoretical scenario on how mobile technology can help improve childhood immunisation in sub-Saharan Africa. But it will soon become a reality in Mozambique, a country the size of Turkey, where 135 out of 1,000 children die before their fifth birthday.

The southern African nation’s Department of Health has teamed up with the GAVI Alliance, a public-private partnership for immunisation, to launch a pilot project in about 100 clinics in early 2013 where health workers will test the effectiveness and cost benefits of using mobile phones to communicate with patients.

The yearlong three-million-dollar pilot project has been co-financed by British telecommunications giant Vodafone and the United Kingdom’s Department for International Development. At the end of the trial, vaccination levels in Mozambique should improve by five to 10 percent, the donors say.

“One thousand new mobile broadband connections are made every minute in the developing world, which means we have a tremendous opportunity to transform lives in an easily accessible way,” explains U.K. Secretary of State for International Development Justine Greening.

Africa is the world’s fastest-growing mobile phone market and the second largest after Asia, according to Groupe Speciale Mobile Association, a global industry body. There are about 700 million mobile connections on the continent and the number of mobile phone users increased by nearly 20 percent every year over the last five years.

Although not every mother in the poor nation of Mozambique, which according to United Nations statistics had a meagre gross national income per capita of 382 dollars in 2009, has a mobile phone, at least one family member or a neighbour usually does.

As part of the pilot project caregivers will be registered on a health ministry database and will be educated and alerted by text message about the availability of vaccines and their importance. They can reply via SMS to schedule clinic appointments and will receive notifications and reminders about their children’s past and future vaccinations to make sure each child receives a full immunisation schedule.

Mozambique’s health workers will receive smartphones with software to access records and schedule appointments and help clinics in remote locations monitor stocks to make sure vaccines are available when mothers arrive with their children.

“Mobile technology will help us identify children who until now have been missed and make sure they get a full set of vaccinations,” GAVI CEO Seth Berkley tells IPS. The ability to notify and remind mothers of vaccination appointments is expected to make a big dent in high drop-off rates, where a child receives only one out of two or three necessary injections to make a vaccine effective, he says.

According to the World Health Organization (WHO), immunisation is the most cost-effective public health intervention after the provision of clean water. More than a million children die each year from vaccine-preventable diseases, while every fifth child in Africa remains unimmunised, the organisation says.

A number of other African nations have started to use mobile technology in some areas of public health care, although the Mozambican pilot project will be the most comprehensive when it comes to immunisation and will use software specifically developed for national conditions and needs.

Tanzania, for example, uses mobile stock management technology to track malaria treatments in 5,000 clinics across the country. In South Africa, 1,800 remote community health workers use mobile phones to access and update patient records. And when Ghana rolled out rotavirus and pneumococcal vaccines this April, a major local religious organisation helped notify mothers about the new immunisations by arranging for 1.5 million SMS messages to be sent out.

South Sudan, supported by the WHO, began to manage vaccine stocks through mobile technology in mid-2012 in its central and state stores, while Rwanda’s health ministry uses mobile phones to monitor maternal and child mortality.

“The cell phone has been revolutionising (African) healthcare more than any other technology,” Richard Sezibera, Rwanda’s former minister of health and current secretary-general of the East African Community, tells IPS.

Providing health workers with mobile devices “has really changed life in Rwanda,” he adds. The strategy has helped bring down Rwanda’s under-five mortality rate from 163 per 1,000 live births in 1990 to 56 per 1,000 live births in 2011, according to U.N. Children’s Fund figures.

Sezibera also believes that using mobile technology can help health departments to better manage their usually meagre budgets. Since most African nations only spend an average of five percent of GDP on health, “how we finance health is becoming increasingly important,” he says. “Using mobile technology can help reduce supply chain and transaction costs.”

If Mozambique’s pilot project is successful, it will be expanded to 1,500 clinics across the country. If that works well, GAVI hopes to implement it in many other low-income countries in sub-Saharan Africa, Berkley says.

Civil society organisations, which have been working to improve child health in those countries for years, believe the approach could make a huge difference to children’s lives.

“We know the children in remote areas are missing out (on being vaccinated), with 22 million around the world being left behind,” says Justin Forsyth, CEO of the international charity Save the Children. That is every fifth child. “Mobile technology, in the hands of front line health workers, could help close the gap.”

Anuary Saidi, who suffers from viral diarrhoea, with his mother Mariam. Credit: Kristin Palitza/IPS

By Kristin Palitza
DAR ES SALAAM, Dec 13 2012 (IPS)

Half asleep, Anuary lies exhausted on his bed in Amana Hospital in Dar es Salaam, Tanzania’s capital. His mother, Mariam Saidi, sits on the edge of his mattress, staring blankly out of the window. Every now and then, she turns to wipe her 18-month-old son’s forehead.

When she brought Anuary to the hospital the day before, he had a high fever, was suffering from viral diarrhoea, was severely dehydrated and had lost consciousness by the time he was admitted. The doctors saved his life, but he faces a slow discovery.

“Viral diarrhoea and respiratory infections are very common in children here,” hospital director Dr. Meshack Schimwela tells IPS. “Both illnesses are leading causes of death of children under the age of five in Tanzania.”

Anuary’s hospitalisation puts Saidi, a single mother who works as a hairdresser in the slum of Buguruni on the outskirts of Dar es Salaam, under severe economic strain. Each day that she spends next to her son’s bed is a day that she does not earn any money.

Already, she struggles to make ends meet with her meagre salary of four dollars a day, which, she says, affords her only one meal a day. “God knows how we will cope,” the 21-year-old tells IPS. “It’s very difficult.”

Anuary’s illness could have been easily prevented had he been immunised against the Rotavirus, which causes severe diarrhoea, commonly known as “stomach flu”. But the vaccine is currently not available through the public health system in this East African nation.

The situation is similar in many other countries on the continent. About 20 percent of Africa’s children – or every fifth child – are not immunised, according to the international children’s charity Save the Children.

“It’s always the poorest children who don’t get access to vaccination services,” says Kirsten Mathieson, health policy and research officer at Save the Children. “Much more needs to be done to reach the ‘fifth child’.”

In Tanzania, at least, this may soon change. Through co-financing from the GAVI Alliance – a global public-private partnership for vaccines and immunisation that negotiates lower vaccine prices for the world’s poorest countries – the government will be able to integrate Rotavirus as well as pneumococcal vaccines into its routine public immunisation programme from January 2013.

“Children in developing countries have an 18 percent higher chance of dying before their fifth birthday (than those living in developed countries). Vaccination could make a big difference,” GAVI deputy chief executive officer Helen Evans tells IPS.

Dr. Mtagi Kibatala, acting chief paediatrician at Amana Hospital, agrees: “A lot of the children in our paediatric wards would not be here had they access to Rotavirus and pneumococcal vaccines.”

Vaccinating all of the children in this country of over 885,000 square kilometres, almost four times the size of the United Kingdom, will take time. Reaching nomadic families and those living in remote rural areas or on small islands will be especially tough, Kibatala tells IPS. She expects it will take “at least a year” to see an improvement in child health and a decrease in mortality rates.

Another hurdle is Tanzania’s severe health worker shortage. About 40 percent of positions in the country’s public health facilities are vacant, according to the Ministry of Health. Without sufficient personnel, it will be difficult to provide health care to every child, Schimwela says.

The impact vaccines can have on children’s health “is very clear”, explains Schimwela. Tanzania has seen a steady decline in child mortality since it started offering vaccines through its public health system that protect against polio, tetanus, tuberculosis and diphtheria.

As a result, mortality of children under the age of five decreased from 155 per 1,000 live births in 1990 to 76 per 1,000 live births in 2010, according to the United Nations Children’s Fund.

Although the introduction of the Rotavirus vaccine will come too late for Anuary – children have to be younger than 15 weeks for it to be effective – thousands of Tanzania’s children will not only be able to lead healthier, but also happier, lives.

One of those children will be six-week-old Rosemary Julius.

Her mother, Janet Julius, patiently sits on a blue plastic chair in front of the Buguruni health clinic, fanning herself against the stifling December heat, Rosemary snug on her lap.

Rosemary is one of seven infants who were chosen by the clinic staff to receive dual Rotavirus and pneumococcal immunisation. Although the vaccines will officially only be available from next month, the health department decided to immunise a small group of babies in celebration of the launch of the new vaccines.

Julius, a 22-year-old housewife who was told about this opportunity during a post-natal check-up, says she is extremely happy that Rosemary will now be protected against pneumonia and viral diarrhoea. She tells IPS: “I have seen babies get very sick and die. The vaccine will help my child to grow up well.”