Redesigning the Child Immunization Health Card for Punjab Pakistan
Redesigning the Child Immunization Health Card for Punjab Pakistan
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The Challenge
Pakistan has one of the highest infant mortality rates in the world. One child in every 11 (87 per 1000 live births) born in Pakistan dies before turning 5 years old. It has been shown that immunization plays an important role in reducing infant mortality rate. In Pakistan, immunization is mainly managed by the Expanded Programme on Immunization (EPI) with support from the GAVI Alliance, the World Health Organization (WHO) and UNICEF. There are a number of issues associated with the immunization process in it’s current form. Some of the issues being faced include: a paper-based immunization card which is susceptible to weather damage, loss, or negligence by guardian, a non-intuitive immunization card design which is not geared towards low-literate users, a paper-based register backup of immunization records that is harder to collate, prone to human-error and difficult to extract information in real-time. Furthermore, there is no central system countrywide for retrieving a child’s data due in case the family moves from one place to another. Overall statistics collected from the current setup are not very accurate, and hard to monitor and evaluate.
Our Solution
In order to cater to the aforementioned problem, we have set out to redesign the immunization card and combine it with a digital record system. As the immunization process in Pakistan consists of six vaccination visits, we designed a new card in which we have six carbonless copies of the original card. Upon each visit, one row is filled on the original form and the entire carbonless copy page directly below is torn off and sent to the Tehsil Headquarter (middle tier administrative unit) for scanning. The data is sent to a central server, from where the vaccination history portion of the form is remotely accessible by vaccinators through SMS/USSD, and advance SMS based reminders are sent to families and vaccination centers (based on the HMIS/Center ID number mentioned on the form). The cumulative data is made available through a web-accessible interface to policy makers to get statistics regarding immunization coverage.
Impact: Piloted with 20,000 children, the Punjab government later adopted the NFC-enabled card features and is still in use today with updated vaccine schedules.
Methods
The methods in this paper involved a qualitative, iterative design process grounded in user research. The team conducted semi-structured interviews with 69 parents across six districts in Punjab (Lahore, Murree, Sargodha, Nankana Sahib, Sheikhupura, and Sahiwal) to assess how they used and understood the existing immunization card, focusing on clarity of instructions, comprehension of the immunization schedule, and visibility of the next visit date. In addition, five vaccinators at different Basic Health Units were interviewed to identify administrative challenges in filling cards and registers. All interviews, conducted in Urdu and lasting 15–30 minutes, were documented on paper. Based on the problems identified, the researchers iteratively designed three prototypes of a redesigned immunization card and gathered feedback from parents and vaccinators after each iteration to refine usability, clarity, and durability
Redesigned Card Mockups
Read more about this project in our research publication:
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