Leveraging evidence to improve child immunization in Haryana, India
Context
Immunization is one of the most cost-effective ways to improve child health and survival in developing countries. Yet, in 2018, a fifth of all children in India’s Haryana state still did not receive all the required vaccinations. To address drop-outs and improve vaccine coverage, 3ie funded the evaluation of a new programme in seven districts of Haryana between 2016 and 2019.
Researchers affiliated to the Abdul Latif Jameel Poverty Action Lab (J-PAL) South Asia worked with Haryana’s National Health Mission directorate to evaluate Teekakaran Protshakan Karyakram (encouraging immunization programme). The programme used a variety of ways to improve immunisation, such as leveraging social networks for information dissemination within the community, providing mobile recharges as incentives and sending reminders to caregivers.
Evidence
The study team found that spreading health messages through community-nominated information disseminators (immunization ambassadors) was a cost-effective approach to improving immunisation outcomes. Identifying ambassadors in the community by asking a simple and direct question and leveraging them to spread immunization-related messages in the community cost only US$4.95 per additional fully immunised child.
The mobile recharge incentive had significant effects only when the recharge amounts were higher for the last two vaccines a child should receive in her first year: the third dose of pentavalent and the measles vaccine. Where higher amounts were transferred for pentavalent 3 and measles, there was an 11.8 per cent increase in the rate of full immunization. There was no effect when the recharge amounts were uniform for all five vaccines. Thus, what mattered was how the recharges were transferred, rather than their monetary value. Even a large overall amount transferred through equal-sized recharges after every vaccine did not have any impact.
Targeted text and voice call reminders did not affect immunization outcomes.
Evidence impacts
Type of impact: Inform the design of other programmes
Where findings from the evaluation or review inform the design of a programme(s) other than the one(s) evaluated.
This is one of 3ie’s seven types of evidence use. Impact types are based on what we find in the monitoring data for an evaluation or review. Due to the nature of evidence-informed decision-making and action, 3ie looks for verifiable contributions that our evidence makes, not attribution.
Read our complete evidence impact typology and verification approach here.
Close windowThe evaluation highlighted the value of leveraging community social networks and prompted the Haryana state National Health Mission directorate, the Health Systems Resource Centre and the researchers to launch a partnership to pilot health information dissemination through community-identified immunization ambassadors in one of Haryana’s most challenging ‘aspirational’ districts. The government’s September 2019 memorandum of understanding with the J-PAL South Asia researchers also proposes working together to improve the use of administrative data to improve health, leveraging the government’s online mobile data platform for Auxiliary Nurse Midwives , known as ANMOL.
‘When such studies happen, you deliberate upon what works and what did not work. Something which is low cost and high impact, when that has been demonstrated to work so beautifully, why not use it?’
Type of impact: Inform the design of other programmes
Where findings from the evaluation or review inform the design of a programme(s) other than the one(s) evaluated.
This is one of 3ie’s seven types of evidence use. Impact types are based on what we find in the monitoring data for an evaluation or review. Due to the nature of evidence-informed decision-making and action, 3ie looks for verifiable contributions that our evidence makes, not attribution.
Read our complete evidence impact typology and verification approach here.
Close windowThe most effective approach according to the study has also informed the work of the nonprofit programme Suvita, which works in Bihar and Maharashtra in India. Suvita is implementing both SMS reminders to caregivers and community-nominated immunization ambassadors. Early results from the study prompted its founders to launch Suvita, focusing on recruiting immunization ambassadors as a highly cost-effective way to boost immunization uptake. The final results of the study then prompted Suvita to merge with another nonprofit, Charity Science Health, which had been focused only on delivering SMS reminders. This decision to merge the two organisations (and therefore run both programmes together) was a direct response to the study’s findings that combining immunization ambassadors and SMS reminders was a more effective and cost-effective approach than either approach in isolation.
Funders prioritize cost-effectiveness in their own decision-making, so we know that it has been a factor in much of the funding we have received to date - and we expect it will continue to be important for securing future funding to scale our programs
Suggested citation
International Initiative for Impact Evaluation (3ie), 2020. Leveraging evidence to improve infant immunisation in Haryana, India [online summary], Evidence Impact Summaries. New Delhi: 3ie.
Evidence impact summaries aim to demonstrate and encourage the use of evidence to inform programming and policymaking. These reflect the information available to 3ie at the time of posting. Since several factors influence policymaking, the summaries highlight contributions of evidence rather than endorsing a policy or decision or claiming that it can be attributed solely to evidence. If you have any suggestions or updates to improve this summary, please write to influence@3ieimpact.org
Last updated on 26th September 2022