1. Use of cellular phone contacts to increase return rates for immunization services
Mokaya E1
; Mugoya I1
; Shimp L2
; Raburu J3
1
USAID’s Maternal Child Survival Program (JSI) – Kenya, 2
USAID’s Maternal Child Survival Program (JSI) - Washington,
3
County Health Team Kisumu County/Ministry of Health - Kenya
Competingtasks
Vaccinated
Elsewhere
SickChild/
Vaccine
SideEffects
NotKnowing/
ForgettingReturn
Date
NoReason
Cultural/Religious
Beliefs
Introduction
In Kenya, failure to complete the immunization schedule
by children who have previously accessed immunization
services is an obstacle to ensuring that most children are
fully immunized. Home visit approaches used to track
defaulting children have not been successful in reducing
the drop-out rate. This study tested the use of phone
contacts as an alternative approach for tracking
immunization defaulters to return for services in three
districts in western Kenya.
Methodology
Study conducted between May 2013 and March 2014.
Twelve facilities from three districts (purposefully
selected due to high defaulter rates and accessibility)
participated in the study. For nine months, children who
began immunization services (penta 1) in the twelve
facilities were followed up by the health facility staff via
mobile phone contacts. Reasons for defaulting
immunization, as reported by the caregivers, were
profiled (see graph).
Results
 A total of 5908 Children were enrolled and followed
up for a period of 9 months in the 12 health facilities.
 Ownership of a reliable contact (i.e. mobile phone/
number) was above 80%, with very minimal rural –
urban variation.
 The cost and time spent on tracking a defaulter via
mobile phone was on average Ksh 6 ($0.07) and two
minutes respectively, compared to Ksh 125 ($1.50)
and approximately four hours to track one defaulter
by home visitation.
 Competing tasks as well as the fears to vaccinate a
sick child (and vaccine-related side effects) were the
most cited reasons for caregivers defaulting
immunization appointments.
 A significant number of children categorised as
defaulters had been vaccinated in either a
neighbouring facility or in another district (and were
therefore “false defaulters”).
Conclusions and Recommendations
1. Use of phone contacts is a feasible option for tracking defaulters.
2. With proper planning, local facility funds can be used to finance this approach in a sustainable way (if
advanced funds are budgeted & planned).
3. Competing tasks are a leading cause of defaulting vaccination services — community messages are needed on
the importance of timely vaccination.
4. Forgetting the return date was not a major reason for defaulting.
5. Male involvement in immunization is vital — observation that when the recipients of the call were males, the
children were more likely to be returned to the facility faster.
6. Need for a forum for health workers to share and exchange details of apparent defaulting children.
7. Assurance of confidentiality of caregivers’ contacts — not to be used for any reason other than vaccination
services, especially when the contacts were third party.
8. Dependency — caregivers’ reluctance to respect return rates — waiting for health worker to call; therefore
need to have multiple message channels.