Out of every 1000 live births, 104 infants die from vaccine preventable diseases in Sindh. Among the factors contributing to suboptimal immunization coverage are poor management, suboptimal service delivery and monitoring with a high reliance of routine immunization on outreach service delivery suffering from inadequate transport infrastructure and overburdened immunization staff.
Post devolution of the health services to provinces in 2015 in Pakistan, each of the four provinces is implementing different strategies to strengthen immunization program in collaboration with national and international partners.
The ZM Program utilizes an Android phone-based immunization registry to record and analyses program data in real time. It features a server-based persistent electronic record for child-based vaccination coverage tracking along with electronic decision support system to guide vaccinators for routine and catch-up immunizations, Quick Response (QR) Codes as unique child identifiers and SMS reminders for parents for upcoming immunization visits. The application is supported through a web based dashboard allowing preparation of performance based immunization reports, defaulters reports, population based coverage reports, vaccinators tracking and attendance, vaccinators micro planning and surveillance forms, as well as vaccine stock maintenance.
The Sindh province wide scale up has registered over 2.2 million children under 2 years of age and 0.7 million pregnant women over 2017-19 . The system is currently being used by more than 2200 government vaccinators across Sindh.