Improving Timely Vaccination through Incentives and Automating Workflow of Frontline Health Workers using Information and Communication Technology

Despite a significant increase in vaccine coverage in India, more than 20% of child deaths in 2008 were caused by three vaccine-preventable diseases alone. A major underlying factor behind these deaths is lack of vaccine effectiveness caused by delays in vaccination. As most vaccines are available for free at public facilities, it is mostly non-price factors such as lack of awareness that cause delays - caregivers in rural communities often lack appropriate information regarding the health benefits of vaccines and the time and place to avail them. Additionally, supply side-factors such as the lack of incentives for timeliness and outdated workflow management for frontline health workers are also responsible. In India, vaccinations are delivered by regular frontline health workers or Auxiliary Nurse Midwife (ANM) who is assisted by a village level Accredited Social Health Activist (ASHAs). Most ANMs are regular government employees, and their salaries are rigid, formulaic, and independent of their performance while the ASHAs are paid according to fee-for-service. The pilot study will assess the technical feasibility of an Information and Communication Technology (ICT) platform designed to improve FHW workflow and collect primary data on various other components that will be used to implement a large-scale RCT to study the effects of pay-for-performance to FHWs, an improved workflow management, and reminder calls to caregivers on timeliness of vaccine and coverage.