ePolio (Eradication via ePolio)
Despite global success in Polio eradication, Pakistan remains one of the last pockets where the problem of Polio persistence has yet to be properly addressed. The present study is an attempt to identify the problems associated with the eradication of Polio in Khyber Pakhtunkhwa (KP) province; to examine the issues faced by Polio Health Workers in vaccination; to explore the factors that cause parents to refuse vaccination of their children; and to understand the perception of the patients affected and their views about polio.
The present study, more specifically, explored the use a digital platform to help mitigate some of the campaign-wide issues workers repeatedly encounter. The following persistent limitations are discussed:
The problem under investigation
Low socioeconomic classes, have neither awareness nor proper counseling regarding the vaccine — consequently, most of them are not vaccinated at all. The refusals were often due to apprehension about sterility, and the community examined for this study was concerned about the repetitive campaigns of immunization taking place in a short span of time.
Moreover, Expanded Program of Immunization (EPI) workers complained of payment delays, which in turn increased the burden due to a dwindling number of volunteers. Computerized data of locality was not available with the on-field polio workers.
Visits are documented with the help of a tele-sheet which is saved in the form of a hard copy — a system that is typically inconvenient to retrieve, usually leads to the documents being misplaced, and requires a substantial amount of time.
The management of the vaccination system is not controlled with efficient staff on the lower levels of the workers’ hierarchy. Despite the fact that experienced and qualified individuals are present in the chain of command, there is a scarcity of these workers on the level where the actual practical work is done has led to negligence and insufficiently vigilant supervision. If this system does not undergo significant changes, results of the study — and for the communities it examines — will not be in the positive in nature.
The present study explored the implementation of a new system of documentation to ensure responsible data retrieval from these communities, and strove to ameliorate some of the issues within the chain of commend by reducing the burden on on-the-ground workers. To achieve these goals, an Android application (ePolio) to document workers’ visits and integrate this data with the concept of geotagging, was developed. The app will allow us to pinpoint locations on the map with the help of GPS, available on other mobile devices.
A set of fields under study can be input by the volunteer and attached in Annexure A — a preliminary draft of the visit documentation within the system that can be modified according to the needs of the operation and subsequently incorporated into the app’s document history.
Each house can be marked with the help of latitude and longitude data and be tagged with respect to its status on whether or not the members of that house have been immunized. Information other than the address can be filled out on other fields which will be programmed into the app.
Returning to the main concerns:
When tele-sheet entry data is not available
Record keeping is solely based on the integrity of the volunteer because he is the only individual who documents the daily schedule. Due to the complications in the payments to the workers, the record-keeping is compromised, increasing the risk of error.
Changing volunteers for the same area for consecutive campaigns
Typically, in every campaign, the volunteer teams change. Thus, prior knowledge of the area — the transfer of data — is not available to the new teams, or is exceptionally difficult for them to acquire. Neglected areas, or those which are, for whatever reason, inaccessible — will not be properly tagged and will be repeatedly missed on successive campaigns.
Full coverage of the volunteer cannot be documented
One of our own colleagues who helped us develop this idea was motivated enough to do a follow up of the houses where there was a refusal to take the vaccine. It took him three days to find the house and we were not sure whether or not it was the same house.
Uniform resource allocation is not the answer
When properly tagged houses are known, resources should be allocated on the basis of increasing or decreasing demand; hence, they should not be wasted on areas that can be managed with low manpower or other requirements. This way, more manpower and time can be invested in covering areas which might have been missed in previous campaigns.
All the houses can be tagged and mapped (1) with the help of this app. This gives us an overview of the areas of interest. Looking at these two aspects simultaneously — taking a picture of the house and marking the location on the app with the help of mobile GPS — will enable us to easily identify the houses (2) for follow-up visits in subsequent campaigns.
Data entry (3) which can be accomplished with the touch of a finger, then enables workers to review all relevant data for that specific house in their field of study, including its immunization status.
