A Digital Data System is Making Vaccines Accessible to Children Across Kwara’s Communities
Mahdi Garba (Lead writer)
A typical day in Babatunde Grace’s life begins with checking her smart tablet to see how many caregivers are expected to bring their children for routine immunisation but have failed to do so. If any are found, she will give them a phone call to understand the reason for their absence
Grace, 35, is a resident of the Dangiwa Oke-Ose area in Ilorin, Kwara State. She volunteers with the Equitable Health Access Initiative (EHAI), where she tracks immunisation defaulters using data from the newly introduced Automated Digitised Immunisation System (ADIS).
“Before, no one would call them but with the help of EHAI, they have empowered us to call them, monitor them, visit them and enlighten them on the importance of immunisation,” the volunteer explains. “I want them [the caregivers] to know that immunisation is essential to all children because it helps to protect them against diseases.”
Nigeria faces a critical challenge: at least 2.3 million children are unvaccinated annually, and the country accounts for the highest number of zero-dose children in the world. Despite vaccines being the most effective way to protect children, build herd immunity, and prevent outbreaks, Nigeria’s vaccine coverage rates in children have historically been suboptimal and well below the 90% target rate.
Dr Timothy Akinmurele, the Chief Executive Officer (CEO) of EHAI, asserts that, in response, the Nigerian Government has prioritised scaling up immunisation coverage by strengthening Primary Healthcare (PHC), enhancing community systems, and leveraging digitisation. The ADIS, according to him, is designed to significantly reduce under-5 mortality and improve health outcomes by increasing immunisation coverage and reducing zero-dose and under-immunised children across the country.
“ADIS plays a vital role in achieving these national health priorities,” he noted.
Increasing immunisation coverage
Grace observed that introducing the ADIS system has effectively reduced the incidence of patients skipping vaccines. According to EHAI, tracking missed immunisation doses was inconsistent before the introduction of ADIS, but since its implementation, they have observed a clear downward trend. In October 2024, it recorded 604 cases of missed vaccinations, this decreased to 530 cases in November and 482 cases in December 2024.
While describing her role, Grace noted that before identifying a defaulting caregiver, it is important to found out the defaulting date and the tracking date. “For instance, a child is supposed to come for immunisation on the third of the month and I am now tracking the child on 13th, that means the child has defaulted for 10 days. The first thing I do is pick the card of the child and locate the address of the child’s parents or locate the phone number of the parents.”
The ADIS offers real-time data access, automated Short Message Service (SMS) reminders, and defaulter tracking to ensure no child is left out of their Routine Immunisation. The innovation is made possible through a collaboration with EHAI and the Kwara State Primary Healthcare Development Agency (KWSPHCDA) with funds from the Pfizer Foundation’s Global Health Innovative Grant (GHIG) 8 Programme, which seeks to overcome barriers that contribute to under-immunisation.
Benefits of going digital
Akinmurele, the CEO, highlights that EHAI is piloting ADIS across 12 Primary Healthcare Centres (PHCs) and the University of Ilorin Teaching Hospital in Ilorin East Local Government Area.
Within the first four months of 2024, they digitised and automated the paper-based immunisation registers and child health cards into an Electronic Immunisation Register (EIR). They also trained 65 healthcare workers, 12 data associates from the PHCs, and 24 community volunteers on the effective use of the EIR and its automated features.
All historical immunisation records from the paper immunisation registers have been securely migrated into a comprehensive database, which now captures the accurate data of over 15,000 children.
The CEO emphasises that healthcare workers receive automated line lists of children due for vaccination via email 24 to 48 hours before appointments, and then caregivers are notified of upcoming vaccination appointments through SMS reminders.
Community volunteers also receive defaulter lists through email, enabling timely follow-up and improving vaccination rates. Additionally, caregivers and community members receive Social and Behavioural Change Communication (SBCC) messages, promoting the importance of vaccines to drive immunisation uptake.
Akinmurele stressed the importance of empirical evaluation to gauge the effectiveness of the intervention. To this end, a baseline survey was conducted at the project’s onset, with plans for an end-line survey to assess its impact. Based on the preliminary findings, the introduction of ADIS has yielded promising results, with fewer cases of missed vaccinations and reduced waiting times for patients.
Reaching the underserved
For Adurat Kuburat, 31, the new system means trusting the immunisation process. When she started taking her baby for routine immunisation in October 2023, she noted how comfortable she felt knowing there would be accurate data on her baby at the primary healthcare centre in her community. According to her, the health workers are always proactive in asking the right questions, and she has not experienced any challenges while using the new system.
Comparably, another parent, Odeyemi Rebecca, who resides in Apado LGA, has been attending immunisation sessions since November 2023, stating that in a few weeks, she is expecting her certificate of completion of immunisation, verifying that she is not a defaulter. The digital system makes it quicker for parents to retrieve their records when they lose them, as their information is securely stored in the system.
“Especially for people in rural areas like us, that is the best. Many nomads are getting immunised [and] the ADIS makes it easier for the health workers to go the homes of the nomads and collect their data.”
Not without challenges
Mrs Salahudeen Felishola Yemi, the Officer-in-Charge at Apado PHC, expressed her approval of the ADIS system. She stated that at the initial stage, health workers underwent a comprehensive three-day training on how to use the digital system, after which they received smart tablets. However, she raised concerns about connectivity issues, particularly in rural areas like Apado, where internet access can be challenging. The supervisor noted that poor internet connectivity can sometimes impede healthcare workers’ effective use of the digital system, hindering their ability to efficiently provide quality healthcare services to patients.
Another challenge noted at the beginning of the project was when they noticed that the device was showing only the Bacillus Calmette–Guérin (BCG) vaccine until they complained to EHAI officials, who came to correct it. Mrs Yemi also recalls that when they started introducing the smart tablets to parents, they complained, suspecting the health workers would use their data for dubious purposes. But after they were explained to, they later understood.
Despite its achievements, Grace, the community volunteer, highlighted that some parents still have reservations about vaccinating their children. She revealed that, alongside conducting outreach programs and home visits, they had to go the extra mile by delivering vaccines directly to the doorsteps of certain individuals who were reluctant to visit the clinic.
Despite these efforts, caregivers regularly express concerns about the cost of transportation for subsequent visits, which impedes their ability to ensure the children receive the required immunisation. Grace and her colleagues must continue to provide personalised care and support to alleviate these concerns, ensuring all children receive the necessary vaccinations for optimal health and well-being.
“Some would say, ‘I don’t have money,’ ‘I have not eaten since morning, and you are talking about vaccines,’ Even when the child is sick, you have to convince them. Let them see the need for the child to be immunised”, Grace said. “A lot of parents out there need education for immunisation”
The volunteer also notes that when they go to some places, the language barrier often becomes a challenge.
If implemented properly across the country, innovations like ADIS can help improve immunisation coverage, efficiency, and equity in vaccine distribution to underserved communities. They will also enhance data quality, which will ultimately improve how decisions are made at the governmental level.
