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Announcement: Improving immunization coverage across vulnerable communities

24th January 2022

To support underserved communities for increasing the uptake of childhood immunizations, IRD Global’s Maternal and Child Health Program, in collaboration with the Expanded Programme on Immunization (EPI), is scaling up mobile phone based incentives, to improve routine immunization uptake across seven low coverage districts in Sindh, Pakistan.

Supported by GiveWell, the scale-up draws on evidence from a three-year randomized control trial with 11,200 children to test the effectiveness of mobile phone-based incentives for improving routine immunization coverage and timeliness in Karachi, Pakistan. The trial was led by IRD Global’s Subhash Chandir and team, in collaboration with University of Chicago’s Rachel Glennester.

This scale-up will provide cost-effective incentives for caregivers of over 500,000 infants. After children are born, they are enrolled for vaccination follow-ups. Caregivers receive incentives after the enrollment, encouraging them to complete their child’s pre-scheduled EPI visits.

Driving health initiatives within communities to improve immunization coverage

IRD Global conducted a Randomized Control Trial in 2017, that provided insights on incentivizing health services to overcome financial barriers faced by caregivers and empower them towards health seeking behaviors. The study created a system to facilitate caregivers’ health choices – by incentivizing childhood immunizations, caregivers felt motivated to complete their children and family’s vaccination schedules, without worrying about lost daily wages, resources and time. Utilizing this evidence from years of robust research on incentives and rewards, the project is now being scaled up across low immunization coverage districts in Sindh and will aim to improve immunization coverage and empower families.

A powerful strategy for increasing demand

Introducing incentives for immunizations is a powerful, evidence-based strategy to increase demand and uptake for routine childhood immunization services in low and middle-income settings. Creating a nexus for health and tech, the project incorporates conditionality to rewards, empowering caregivers to opt for vaccinations and initiate behavioral change.

Since the 2017 scale-up of the Government of Sindh’s Zindagi Mehfooz Electronic Immunization Registry (ZM-EIR), all children are now enrolled on the ZM EIR, giving the EPI actionable real-time immunization data. The government’s ZM-EIR will be used to facilitate the program within the selected districts which auto-generates individualized immunization schedules for each child, based on their age, providing caregivers a schedule of their respective child’s vaccinations. Children’s immunizations are also tracked and monitored by the EPI through the ZM EIR to improve coverage and timeliness, and prevent outbreaks of vaccine-preventable diseases.

About EPI

Established in 1978, the Expanded Programme on Immunization (EPI) Pakistan contributes towards achieving Sustainable Development Goal (SDG) 3 on reducing child morbidity and mortality. This Program focuses on increasing equitable coverage of immunization services against vaccine preventable diseases (VPD), decreasing VPD associated morbidity and mortality and improving immunization services through expansion of service delivery and cold chain.

About IRD Global

IRD Global is a research and health delivery organization at the forefront of building novel health infrastructure. The organization is committed to improving the lives of vulnerable communities by building a network to share ideas and innovations for global impact. In leveraging process and technology innovations to address global health delivery gaps, the IRD team successfully develops and implements cost effective and evidence based high-impact solutions, while building partnerships and developing capacity with community stakeholders to implement programs in a sustainable manner.

Working alongside communities to create contextualized solutions, IRD aims to increase access to new, rapid diagnostics, better treatment for the most vulnerable communities, use behavioral and economic strategies to improve treatment adherence & health seeking behaviours and utilize open-source information technology platforms to enable scale-ups in the domains of maternal and child health, infectious diseases, non-communicable diseases, mental health, neglected tropical diseases and youth engagement.

About Givewell

GiveWell is a nonprofit dedicated to finding outstanding giving opportunities and publishing the full details of project analysis to help donors decide where to give. The organization’s aim is to focus beyond financials, such as assessing administrative or fundraising costs. GiveWell also conducts in-depth research to determine how much good a given program accomplishes (in terms of lives saved, lives improved, etc.) per dollar spent. Rather than rating as many charities as possible, GiveWell focuses on the few charities that stand out the most in order to find and confidently recommend high-impact giving opportunities.


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