Pakistan currently has one of the highest burdens of maternal, fetal, and child mortality worldwide. One of the major obstacles to long-term improvements is that one in five newborn children are not registered at birth.
This effectively leaves them out of the health system and deprives them of essential healthcare services, including routine immunizations and many of them have zero doses of vaccines. Many of these zero dose children live in Super High-Risk Union Councils (SHRUCs), areas that are particularly susceptible due to poor health infrastructure, low socio-economic indicators, and high incidence of polio and other diseases. To achieve equitable coverage, it is imperative to eliminate zero-dose children and develop a coordinated immunization tracking mechanism to strengthen routine immunization programs for polio and other preventable diseases.
To address this need, the team at IRD proposed to leverage existing technologies, in particular, an electronic ‘Pregnant Women and Birth Registry’ (PWBR) feature, rolled out at the 15 birthing facilities serving 8 SHRUCs in Karachi, Sindh province.
Enrolling all pregnant women that attend the facilities for delivery, antenatal care, vaccination appointments, as well as their newborns, the PWBR provides all newborn children with a digital EPI identity.
This is connected to a centralized database, the Provincial Electronic Immunization Registry (Zindagi Mehfooz; ZM) in Sindh province.
The Registry also creates a link between women and child data with birthing facilities and catchment area vaccinators, resulting in a coordinated immunization tracking mechanism that helps in eliminating zero-dose children and strengthening routine childhood immunization programs in the long term.
The Birth Registry is currently being rolled out in 14 Birthing Facilities. Successful enrollment of pregnant women at the different sites is ongoing at antenatal care visits (ANC).
Furthermore, the PWBR facilitates automatic reminders for follow-up appointments, ensuring proper ANC visits with better pregnancy outcomes.
Newborns continue to be registered and vaccinated at birth with a birth dose of oral polio vaccine ( OPV0), and Bacillus Calmette–Guérin: (BCG [against Tuberculosis]) through the PWBR. Through the PWBR IRD is helping to eliminate zero-dose children in SHRUCs and have been successful in creating linkage with catchment area EPI centers for tracking and follow-up of future vaccinations.