Lwala Community Alliance: CommCare for Improving Vaccination Rates

Lwala Community Alliance in Kenya fights high rates of maternal mortality and Human Immunodeficiency Virus (HIV). Using a community-led health model and a custom CommCare-based mobile application, Community Health Workers (CHWs) register each pregnant woman or child under five years old into the formal healthcare system. The application then walks the CHW through the proper workflows for vaccinations, family planning, disease diagnosis and treatment, or a number of other requested services. The app also integrates directly with Salesforce to upload all data instantly, helping to pinpoint geographies with the lowest vaccination rates and begin the process again in those areas. So far, the program has reached vaccination rates of over 95% across a population of 60,000 people.

The problem

In 2007, western Kenya faced the compounded crises of rampant HIV transmission and drastically high maternal and child mortality rates. 82 children under five died per 1,000 live births, and HIV prevalence was between 16–20%, compared to a national rate of 6%. Efforts to institute healthcare initiatives began with paper-based solutions, but lags in data submission, typically up to a month, stifled efforts to provide quality care.

App overview

Lwala Community Alliance’s mobile application supports Community Health Workers across a population of 60,000 in an effort to support maternal and child health in the region. Registering every household into their healthcare system, the application walks the Community Health Worker through the proper workflows, for vaccination, family planning, or otherwise, and integrates directly with Salesforce to upload all data instantly. In turn, these data could be analyzed to pinpoint geographies with the lowest vaccination rates and begin the process again in those areas.

The app also helps program administrators to track the performance of their Community Health Workers and initiatives against specific indicators, for instance, the effectiveness of immunizations over time. The data are analyzed to improve the outcomes of the program but are also easily shared with the Ministry of Health to support policy change conversations.

Feature highlight

The Lwala Mobile app features a module called “Children Not Fully Immunized” where CHWs can easily access a list of children in their assigned households who have not received all of their necessary vaccinations (OPV 0, OPV 1, OPV 2, OPV 3, and Measles 18). Moreover, a CHW supervisor can see the list of all their CHWs’ children who are not fully immunized and can follow up on those cases to ensure compliance.

When a CHW navigates to the child’s immunization page, she can see the child’s vaccination history and past dates that were inputted. The CHW is also prompted when the child reaches a certain age and requires corresponding immunizations. For example, when a child is over two weeks old, the CHW will see a notification on the immunization page that reads “The child is now over 2 weeks old. Please enter their OPV 0 date.” This feature facilitates immunization tracking and CHW supervision to ensure that every child receives all of their immunizations and that no one slips through the cracks.

“Lwala’s CHWs are able to track children who are not fully immunized in CommCare and it prompts them to remind mothers to take their children to receive the remaining vaccinations. This is so important because children who are not fully immunized may be susceptible to permanent disabilities.”

Anthony Maina, Systems Administrator, Lwala Community Alliance

Implementation

The Lwala Community Alliance began its Community Health Worker initiative in 2012 with a paper-based data system that required entering data into Excel and eventually uploading it to Salesforce. After delays in data submission of up to a month, the organization began exploring mobile data collection, receiving tablets donated by a partner. After evaluating the many options, they selected CommCare due to its range of powerful but customizable functionality that their team would be able to develop, rather than relying on a platform’s development team.

The first version of the app, focused on supporting the project’s vaccination initiative, was rolled out to a handful of Community Health Workers and was updated based on user feedback before being released to the entire cadre of CHWs. Since that initial release, the Lwala Community Alliance has updated its app multiple times to support additional use cases, including pregnancy tracking and family planning.

Impact

The Lwala Community Alliance has had an amazing impact in Migori County, Kenya, including improved healthcare coverage and quality.

• Improved healthcare coverage. Lwala now covers all of North and East Kamagambo locations, providing healthcare to 60,000 Kenyans. They are in the process of expanding their impact to influence the way more than one million people access healthcare by 2020. In doing so, Lwala has immunized 95% of children in their communities, 67% higher than the regional average.
• Improved health-seeking behavior. Thanks to the guidance that their custom CommCare app provides, 96% of mothers in communities where Lwala operates deliver in a health facility. This is a significant improvement over the regional average of 53% and the 2010 baseline of 26%.
• Improved healthcare quality. A primary objective of Lwala’s program is to improve the health of mothers and their newborns. They have been very successful so far, reducing the child mortality rate from 105 to 29.5 per 1,000 live births. In addition, they have prevented transmission of HIV from mother-to-child in 98% of cases.

“Through the Lwala Mobile app, CHWs have maintained a 95% immunization rate. The app also eases the CHWs’ workload via the Task Module to simply track referrals and follow-ups for their priority clients.”

John Oyugi, CHW Supervisor, Lwala Community Alliance