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.
In order to address these constraints, there is a need for an innovative, technology-based monitoring program – one that ensures effective planning, data analysis, and rigorous disease surveillance.
Post devolution of the health services to provinces in 2015 in Pakistan, each of the four provinces is implementing different strategies to strengthen their immunization program in collaboration with national and international partners.
In the Sindh province, the Provincial Health Department has collaborated with Interactive Research and Development (IRD) and the Indus Hospital and Health Network (IHHN) to provide technical support for the implementation of a phone-based digital immunization registry program ‘Zindagi Mehfooz’ across all 30 districts. The ZM program expanded to Gilgit and Islamabad.
The ZM Program utilizes an Android phone-based immunization registry to record and analyze program data in real-time.
Featuring a server-based persistent electronic record, the EMR is used for child-based vaccination coverage tracking, along with an 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 4.6 million children under 2 years of age and 1.6 million pregnant women over 2017-21. The system is currently being used by more than 3400 government vaccinators across Sindh. In Gilgit, 13,295 children and 3,059 women were enrolled in ZM over 2019-21. In Islamabad, 1,6897 children and 1,029 women were registered in ZM over 2020-21.