Alerta Saúde: addressing challenges with childhood immunizations in Angola

Childhood immunizations are key building blocks to ensure child health and survival. While Angola has made advances in achieving immunization coverage over the last decade, progress towards key targets has been flat, leaving the most vulnerable children behind.

In order to tackle this last mile problem, Ona started working with UNICEF Angola and the Angolan Ministry of Health to build digital tools that allow healthcare workers to both prevent vaccine defaulting and find children who have been left out of the healthcare system altogether. 

An initial theory was that a paper-based health record system made it difficult for clients to remember important health events and for the health system to follow up effectively. As a result, in 2018 we piloted an SMS system that remind caregivers of their childs’ upcoming vaccinations. The results were positive, with 30% of moms who received SMS reminders returning for the next vaccination compared to only 7% of moms in the control group who did not receive SMSs. 

In 2020, Ona started working with UNICEF Angola to build Alerta Saúde, an improved and scaled solution integrating three tools: (1) an OpenSRP-based childhood immunization tracker mobile app, (2) RapidPro, an open-source SMS data collection platform, and (3) Canopy Discover, an Ona-built enterprise data analytics platform. Alerta Saúde allows health workers to enroll caregivers and set them up for SMS health reminders. Once enrolled, contacts are created in RapidPro, which sends two SMS reminders before the next vaccination appointment. After the vaccine period, an SMS goes out asking the caregiver if they took their child to the clinic, if the vaccine was available at the clinic, and if they were satisfied with the experience (based on wait time, cleanliness, and staff friendliness and attentiveness).

Currently, Alerta Saúde is active in two provinces in Angola. Incoming data shows a frustrating, but interesting trend where coverage rates drop dramatically with older children. For example, the 2-month polio vaccine has 75% coverage, while the 4-month penta vaccine coverage drops to 30% and the 6-month pneumo vaccine is below 15%. Another early finding, highlighting a core obstacle to achieving higher coverage rates, is that “not having money for a taxi” was the main reason caregivers provided for not bringing their child to the clinic.

Ona designed a logo based on the well known “vaccination star”, a symbol for vaccinations in Angola, and marketing collateral to introduce mothers to the service.

At the start of the COVID-19 pandemic, we anticipated major disruptions to routine childhood immunization coverage. Now that we have become accustomed to living with the pandemic, we are encouraged to see SMS reminders are having a positive impact bringing children back to health facilities. Ona remains committed to our work with partners like UNICEF Angola and the Angola Ministry of Health to build sustainable and scalable solutions to help address childhood immunization challenges around the world.

To read more about how Covid-19 is impacting access to routine childhood immunizations globally, read Global progress against measles threatened amidst COVID-19 pandemic from WHO and Five Inspiring Stories from COVID-19 Changemakers from USAID.