Using Cell Phone Calendars to Increase Childhood Vaccinations

Communities in low-income urban areas often have poor access to and low use of health care services. This can result in delays or departures from the standard childhood immunization schedule, leading to increased under-vaccinated and zero-dose children and a less-than-optimal service experience. Factors including long working hours, being uninformed of or forgetting an appointment, lack or loss of vaccination card, and other socio-economic determinants (e.g., lack of presentable clothing or transportation to attend a vaccination session), contribute to under-vaccinated and zero-dose children.

In response, JSI teams in the Democratic Republic of Congo developed a program to promote the use of cell phone reminders for vaccination appointments. JSI staff, in collaboration with the Expanded Programme on Immunisation and community health workers, facilitated several sensitization sessions during health facility immunization days. During these sessions, facilitators demonstrated how to use the cell phone calendar app to remind caregivers about vaccination appointments (on smart and non-smartphones). By saving the date of their child’s next vaccination appointment to their cell phone calendar, caregivers will be automatically alerted in advance of their upcoming appointment, resulting in fewer missed or forgotten appointments. Caregivers, health care providers, and community members also learned about the importance of vaccinating children and following the vaccination schedule. In cases where mothers lack access to cell phones, community mobilizers make home visits to remind them not to miss their vaccination appointments. These approaches build on previous efforts to strengthen health worker skills and improve use of home-based records.

To date, this program has been rolled out in two establishments in each of the three health zones of the Kinshasa Provincial Health Division. Over the last year, sensitization sessions were conducted at three-month intervals in each zone. In all health centers, the use of calendar reminders has a positive impact on caregivers returning for follow-up immunization sessions. As shown in the graphs below, an average of 63% of mothers own or have access to a cell phone. Across all health centers, at least 85% of caregivers who got phone reminders returned for their next vaccination appointment.

The success of this program is a valuable lesson in how to affect behavior change at an individual level by meeting clients where they are and without the use of high-technology solutions. By using the calendar app on a basic cell phone, caregivers can complete their child’s full vaccination schedule on time. This cost-effective and low-resource intervention could be replicated at greater scale in communities that have higher cell phone ownership or access. Additionally, caregivers are more likely to return for services when cell phone reminders are combined with positive interactions with community mobilizers and health workers and use of home-based records.

By Viviane Mihali Bambule and Emily Kitts