1. Using GSM-based GIS tracking to improve workforce monitoring
for improved geographic coverage of immunization services
Subhash Chandir, PhD
Director, Maternal & Child Health Program
Dec 13, PHCA Conference

2. The Problems 1 2 3
Despite having multiple mass immunization campaigns, Government fails to achieve optimum immunization coverage for polio and/or measles

3. Fatigue among health workers
The Problems 1 2 3
Fatigue among health workers

4. Resistance to repeated and now routine immunizations among parents
The Problems 1 2 3
Resistance to repeated and now routine immunizations among parents

5. Immunization Services in Pakistan
Public sector Expanded Program on Immunization (EPI)
Routine immunizations centers
Door-to-door supplemental immunization activities
Majority of vaccination events
Essential for finding ‘missing’ children

6. Constraints of Supplemental Immunization Activities
Inability to track SIA teams in field
Repeatedly missed households
Administrative
Lack of accountability
Inaccurate,
hand-drawn maps of SIA site
Monitoring
Icons: treasure map by Lloyd Humphreys, Track by Akhil Komath All icons were downloaded from The Noun Project at thenounproject.com

7. Solution - I GSM based GIS tracking of healthcare staff
No additional infrastructure required
Better mapping of target areas
Highly scalable

8. Solution - II + = + GSM based GIS tracking Real-time monitoring
Mobile Phone SIM + = +
Online tracking

9. What is GSM? Global System for Mobile Communications
Geospatial positional system that utilizes cell towers for triangulation
Accurate from 50m (urban) to 100m (rural)
Compatible with all mobile phone devices
1 Rasouli S, Timmermans HJP, editors. Mobile technologies for activity-travel data collection and analysis. Hershey (PA): IGI Publishers; 2014.

10. What is GPS? Global Positioning System
Geospatial positional system that utilizes satellite signals
Requires GPS device
Accuracy of up to <10m

11. GSM vs GPS tracking GPS GSM Universal Compatibility
Requires GPS-enabled smartphones
No battery drain
GPS feature drains battery rapidly
No activation required
Tracking disabled if GPS turned off
No internet required
Requires internet data package

12. Objectives
Pilot test the use of Global System for Mobile Communications (GSM) based GIS tracking for vaccinators during polio SIAs.
Assess vaccinator and supervisor attendance/performance
Identify & cover missed areas
Create cost-projection for district-wide scale-up
Icons: calendar by anbo, Find missing piece by Chris Homan, graph projection by Bezier master All icons were downloaded from The Noun Project at thenounproject.com

13. Methodology - Setting Shikarpur District 242,000 U5 Children
523 active SIA Teams
Shikarpur District
242,000 U5 Children
523 active SIA Teams
Sukkur District
262,412 U5 Children
586 active SIA Teams

14. Methodology - Participants
Sukkur
Shikarpur
1 Medical Officer
6 Area In-Charges
3 Vaccinators

15. Methodology – Tracking Enrollment
Verbal Consent
Collection of names and phone numbers
Affirmative response to tracking confirmation
Automatic tracking every 15 minutes
Monitoring on web portal

16. Methodology – Tracking of Field Workers
Real-time monitoring through web portal
Automatic location reporting at 15 min intervals
Report generation
Field sites visited
Time spent in the field

18. Tracking Map Types
Team Tracking
Member Route Tracking

19. Tracking of 500 individuals
Tracking Costs
130 USD
Tracking of 500 individuals

20. Results - Team attendance & performance
Team and individual tracking allowed detection of personnel:
Starting work 2-3 hours after 8am (reporting time)
Visiting sites for 30 minutes in the afternoon
Going out of town during SIA
Failing to visit assigned SIA site
Identification of missed areas

21. Results – Cost Projection
USD 695,448
Annual cost of district-wide SIAs
Projected additional cost of adding GSM to district SIA budget
USD 6,960 (1%)

22. Limitations Technological limitations Ethics/privacy issues
GSM may not pinpoint household-level location in dense urban areas
Tracking may be inaccurate in rural areas with few cell- towers
Ethics/privacy issues
Tracking of personal devices
Possibility of tracking outside work hours

23. Conclusion Highly cost effective
Low initial investment/operational cost
Generates real-time actionable data
Improved geographic coverage of SIAs
Improved accountability of vaccinators
High degree of interest shown by District Health officials

24. Thank you