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  1. Optimize.WHO
  2. Immunization information systems & coverage monitoring
  3. Thursday, 26 September 2013

by Sean Blaschke and Lilian Nabunnya, UNICEF

On April 26, 2013, health workers at 3,240 health facilities in Uganda were sent the following short-message service (SMS) text message:

Does your Health Unit have a cold chain fridge for vaccines? Please answer YES / NO. If you have a fridge but it is not working, please tell us about it.

Within 48 hours, responses from 1,862 health facilities had been received. It was revealed that 391 facilities did not have vaccine refrigerators, and in those that did, 194 were not operational. Just 73 percent of health facilities that responded to the survey had working vaccine refrigerators—well below the World Health Organization/United Nations Children’s Fund target of 90 percent.

The arrival of this information was timely. Just one day after the SMS survey was sent, the Uganda National Expanded Programme on Immunization (UNEPI) introduced pneumococcal conjugate vaccine (PCV) to the routine immunization schedule, and with a nationwide polio campaign beginning in September, a functioning cold chain was more important than ever.

The survey provided UNEPI with an up-to-date list of the 194 health facilities with nonoperational refrigerators and the 391 health facilities with no refrigerators at all. The information was just a few days old, provided specific information on the nature of each problem, and included the contact details of the health worker who reported it.

Armed with this information on cold chain gaps, UNEPI and its partners met with staff at the National Medical Stores to address the problem. Tapping into a database of more than 16,000 registered health workers, UNEPI was able to contact thousands of health facilities, capture the results, and analyze them within 48 hours.

Gathering this sort of accurate and up-to-date information using traditional pen- and paper-based reporting systems would have been extremely difficult and expensive. But by using an SMS system to distribute and collect responses, the total cost of the survey came to less than US$150.

The survey was managed by mTrac, a software application that uses SMS technology to track stock levels of essential medicines at health facilities in Uganda. Using their mobile phones, health workers provide the Ministry of Health with up-to-date information on drug supplies and disease outbreaks. Officially launched in December 2011, the system had now been deployed across the entire country. Each week, health workers at more than three thousand health facilities use their mobile phones to send information on stock levels and disease outbreaks. This information is then collected and validated by a central server. The data are made available to Ministry of Health and district health office staff using a browser-based web application. The system provides staff with timely, accurate figures with which to plan and monitor programs. It also enables donors and other partners to track the effects that their funding is having in real time, while identifying any bottlenecks or other issues as they occur.

The SMS survey on vaccine refrigerators was just one of several surveys sent using mTrac to assess the preparedness of health facilities for the introduction of the new PCV vaccine. The first was intended to measure the awareness amongst health workers of the forthcoming PCV immunization campaign. A simple question was asked: had health workers heard about the immunization campaign? Within 24 hours more than three thousand responses from approximately two thousand health facilities had been received.

Despite attempts to raise awareness on national radio and television, just 38.4 percent of health workers replied that they had heard about the PCV campaign. The survey revealed this lack of awareness was not the same in every district—some were significantly higher and lower than the average. In June 2013, this information was shared during an EPI partners meeting chaired by the UNEPI program manager; as a result, partners agreed to support districts with the lowest awareness.

The following week, a survey was sent asking health facility workers whether they had received their PCV stickers and put them on their cold chain storage fridges. It was found that only 25 percent of health facilities had carried out this activity. Again, data showed the districts with the highest and lowest number of health facilities that had completed this activity.

Another survey was then sent to more than ten thousand health workers from approximately 3,200 health facilities asking them about stockouts of key vaccines. The responses were alarming: 57.2 percent of health facilities replied that they were currently experiencing a stockout of at least one essential vaccine. The cause of the stockouts was subsequently investigated by UNEPI, the National Medical Stores, and district officials. The investigation revealed that additional vaccine management training was required, and as a result, vaccine management training has now been conducted.

The availability of timely, accurate, and complete health information is critical for the planning, accounting, monitoring, and evaluation of activities and interventions in the health sector. mTrac had proved itself an affordable and sustainable solution that is helping the Ugandan Ministry of Health to improve services and prevent stockouts.

To learn more about mTrac, please visit the mTrac website or email Sean Blaschke ( and Lilian Nabunnya (

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