Feasibility of using defaulter tracing in urban communities – What are your thoughts?

[Siwiti, Jacob]

Dear all,

 

Here is an issue requiring your input.

 

We have learnt that in peri-urban and rural communities, defaulter tracing makes successful use of community health workers, door-to-door visits as well as mobile phone text reminders. These community settings to a large extent still have the characteristics of friendly neighborliness where health workers know which clients are neighbors and can therefore enquire about a defaulting client from their neighbor. In urban settings these methods pose practical challenges such as large catchment areas, unplanned settlements and nomadic communities, making it difficult to locate a client through door-to-door visits. Additionally, large populations in these types of settings makes, the cost of sending SMS reminders prohibitive.

 

Given these challenges, what are your experiences and advice regarding the feasibility and use of defaulter tracing methods in urban communities?

 

Regards

Jacob Siwiti

Senior Business Systems Analyst

BID Initiative

[Danovaro, Dr. Carolina (WDC)]

Dear Jacob,

You are absolutely right on the challenges urban (and periurban) communities pose, plus as they tend to have more children than projected by censuses, therefore the coverage sometimes doesn't "look" as bad. To the latter, Paraguay did LQAS surveys in periurban areas in 2003 and this difference with admin data was quite apparent, as many communities didn't pass and should have passed if the coverage had been to the level reported (I don't think there is a sharable document, it was just a LQAS report).

The city of Bogotá in Colombia has an electronic immunization registry and contacts defaulters through a call center. I am not aware if a cost analysis on this approach has been made. They also map defaulters and plan targeted home visits, which they find more efficient than just trying to mop-up neighborhood by neighborhood in search of defaulters. Again, not formal evaluation to the efficiency of this approach has been made (to my knowledge).

Guatemala is conducting a study on SMS reminders in parts of the capital city.

Mexico was planning to have a hot line to receive calls about people been turned away when going for vaccination, to pick up in real time supply issues or problems regarding denying vaccination due to lack of affiliation to a particular insurance or institution. It doesn't deal directly with defaulters, but it would pick up on barriers in real time. 

Finally, ImmunizeIndia is a free SMS service, open to anybody who enrolls via SMS, sponsored by the Indian Academy of Pediatrics. The SMS costs are picked up by a large phone carrier as a public-private partnership.

I think more operational research is needed to learn what works best and most cost-effectively. A list of studies done or ongoing should be created and shared.

Carolina

M. Carolina Danovaro, MD, MSc

Regional Immunization Advisor

Department of Family, Gender and Life Course/Comprehensive Family Immunization Unit (FGL/IM)

Pan American Health Organization,

525 Twenty-third St, NW, Washington DC 20037 - USA

Tel. 1-202-974-3856 E-mail: dano...@paho.org Web: www.paho.org/immunization

---

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Sent: Wednesday, May 06, 2015 9:50 AM
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Subject: Feasibility of using defaulter tracing in urban communities – What are your thoughts?

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Thank you.

[Mark Thomas]

Carolina,

Can you provide contact information for the Bogotá and Guatemala defaulter tracking initiatives? I'd like to reach out to see what they've observed and to understand their evaluation methods.

Cheers,

Mark

On Sunday, May 10, 2015 at 6:30:44 PM UTC+7, Danovaro, Dr. Carolina (WDC) wrote:

Dear Jacob,

You are absolutely right on the challenges urban (and periurban) communities pose, plus as they tend to have more children than projected by censuses, therefore the coverage sometimes doesn't "look" as bad. To the latter, Paraguay did LQAS surveys in periurban areas in 2003 and this difference with admin data was quite apparent, as many communities didn't pass and should have passed if the coverage had been to the level reported (I don't think there is a sharable document, it was just a LQAS report).

The city of Bogotá in Colombia has an electronic immunization registry and contacts defaulters through a call center. I am not aware if a cost analysis on this approach has been made. They also map defaulters and plan targeted home visits, which they find more efficient than just trying to mop-up neighborhood by neighborhood in search of defaulters. Again, not formal evaluation to the efficiency of this approach has been made (to my knowledge).

Guatemala is conducting a study on SMS reminders in parts of the capital city.

Mexico was planning to have a hot line to receive calls about people been turned away when going for vaccination, to pick up in real time supply issues or problems regarding denying vaccination due to lack of affiliation to a particular insurance or institution. It doesn't deal directly with defaulters, but it would pick up on barriers in real time. 

Finally, ImmunizeIndia is a free SMS service, open to anybody who enrolls via SMS, sponsored by the Indian Academy of Pediatrics. The SMS costs are picked up by a large phone carrier as a public-private partnership.

I think more operational research is needed to learn what works best and most cost-effectively. A list of studies done or ongoing should be created and shared.

Carolina

M. Carolina Danovaro, MD, MSc

Regional Immunization Advisor

Department of Family, Gender and Life Course/Comprehensive Family Immunization Unit (FGL/IM)

Pan American Health Organization,

525 Twenty-third St, NW, Washington DC 20037 - USA

Tel. 1-202-974-3856 E-mail: danov...@paho.org Web: www.paho.org/immunization