Grantee: Har Zindagi

Identifying inaccuracies in immunization e-records in Punjab, Pakistan

Aimen Shah , Project Manager, Har Zindagi - Every Life Matters
Polio vaccination at UC14 fasial cant Karachi.
17 July 2019

Bill & Melinda Gates Foundation and UNICEF are joining forces  by accelerating Innovation for strengthening Vaccination Systems -- starting with better collection and use of critical data. UNICEF’s Innovation Fund is supporting eight grant recipients of the Gates Foundation’s Grand Challenges Explorations Round 22 with its cutting edge piloting and scaling methodologies and tools.  Read more from Grant Recipient Har Zindagi, below.



Data is being increasingly used to improve vaccine delivery. However, data collection tools can be manipulated and tricked, allowing users to submit falsified data.

Pakistan is one of three remaining countries in the world where poliomyelitis (polio) is still categorized as an endemic viral infection. It accounted for 85% of the 359 wild polio cases that occurred in the world in 2014. Administering routine vaccinations in Punjab, Pakistan's most populous province with over 100 million people, is a big challenge.

Our team is working on creating a deep learning tool that automatically detects anomalies in electronic reports submitted by vaccinators.

Har Zindagi working on their tool
Har Zindagi

The tool will identify potentially  falsified reports, eventually improving the data quality used in vaccine program planning. In addition, our tool has the potential to be used in conjunction with government applications.

Punjab, Pakistan has successfully collected digital immunization records over the last four years, leading to huge gains in attendance and vaccination coverage rates.  However, a simple check of administrative data uncovers that 14% of digitally reported vaccinations occurred on a Sunday, when it is unlikely vaccinators were even working. This suggests a large scope for potentially falsified data. 

We propose to apply machine learning algorithms to the universe of digital records from Punjab to identify potentially falsified data, after which we shall conduct  ground truth audits in order to validate the algorithm before institutionalizing it into automated government practice. We believe that classifying incoming vaccination records as potentially falsified in real-time is novel in the immunization space, could save the cost and energy of randomized audits, and will allow vaccinator supervisors to dedicate their effort to tasks machines cannot do.

Har Zindagi working on their tool
Har Zindagi

Solution in Action

Even though an electronic vaccination program was already in operation in the Punjab province, and also yielding desired results in terms of increased attendance and coverage, when we talked to the end user, i.e. the parents/guardians, we realized the need for an upgrade to the existing system. 

It was specifically the low-literate mothers who noted that the immunization card was incomprehensible for them; they had no idea what the next due date was, the paper-based slip was easily forgotten or spoilt in doing everyday household chores, and they were unsure about what symptoms to look out for if any adverse effects after immunization occurred. This was the point when we decided to design something user-friendly for the end user, and then loop back that design into the existing electronic vaccination system for the vaccinators.

Team & Diversity

A team is only as good as its bond with each other. Not only is the team committed to each other and respectful of each other’s work, but it also deals with the target audience as if they were family. Vaccinator feedback has been great in terms of our team being empathetic, flexible, patient and truly understanding of ground realities and how to work with them. As individuals, there is synergy while working with different strengths and expertise. On one hand, we are on a first name basis with the vaccinators, and on the other, we never shirk from asking for or giving help amongst ourselves when needed. This level of cohesion and respect in the team makes it a very unusual project team.

Har Zindagi teaching their tool
Har Zindagi

The Way Ahead

Even before the project’s pilot came to its end, efforts for scaling up this huge success story were underway. The numbers and percentages aside, government officials needed little convincing in terms of sustainability and viability. However, procuring NFC enabled Android smartphones for the entire workforce (Punjab has almost 4,000 vaccinators spread over its 36 districts), and getting 2 million NFC chip embedded immunization cards printed, was a gargantuan task. 

Provincial budgets were reworked, the requisite machinery was set in motion, plan of rolling out Har Zindagi in phases was approved, and during all this, an election brought in a completely new government at both the federal and provincial levels. Notwithstanding, in the next five years, all of 36 districts will have a fully functioning Har Zindagi system, replacing the current Evaccs program. It will start with larger urban districts, and then next phases will include semi-urban districts, ending with rural ones.

 How will your solution help achieve change and improve the lives of children?

“Our country may not be at par with the developed world in a lot of aspects, but we will keep trying our best to give easier access to quality health care. We will never shy away from playing our role in making that happen right from when human life starts. If the foundation is correct, the subsequent years will be healthy as well.”