There are 27 million babies born in India every year—the largest number of any country in the world.
And while India has had the largest burden of under-five mortality, it’s made great progress bringing that rate down to the global average of 39 per 1,000 live births. This is in part due to vaccine efficiency and the success of the Ministry of Health and Family Welfare’s Universal Immunization Programme.
The Electronic Vaccine Intelligence Network, or eVIN, developed by UNDP India with support from the Gavi, the Vaccine Alliance, uses technology to help health workers ensure that vaccines reach every child, everywhere.
So what can eVIN tell us about designing a successful development tool in the 21st century?
Technology can close gaps in governance
India’s vast and diverse terrain makes reaching the poorest and most vulnerable a monumental effort, and there is poor real-time information.
UNDP developed a smart vaccine logistics system for the Government of India to monitor vaccine stocks and temperatures. It’s a mobile, cloud-based application that allows health workers to update information on vaccine stocks after every immunization session. These updates are stored on a cloud server so officials can immediately see which vaccines are available. It helps officials reduce waste and empowers health workers.
A recent evaluation of eVIN showed it saved 90 million vaccine doses reduced stock-outs by 80 percent, and gave an estimated future return on investment of nearly 300 percent. Clearly, eVIN shows how technology can be used to circumvent challenges posed by geography, terrain, and infrastructure.
No technology can succeed without people
India’s immunization teams comprise hundreds of thousands of cold chain handlers and frontline health workers. Before eVIN is rolled out, they are trained on the system so they are confident using the technology.
Digital record keeping has made vaccine handlers’ work easier. It has also created a sense of agency and shared responsibility. More than 50 percent of the health staff are women who haven’t used the technology before. They’ve embraced eVIN with enthusiasm and competency. Having a dedicated a vaccine manager also helps link health and immunization officers with the ‘last mile’ health workers.
Designing a project to endure
EVIN now reaches 20 states and territories in India and is on track to reach all 29 states by 2020. It’s being adapted in countries such as Indonesia, Malawi and Sudan. I don’t know of another UNDP project that symbolizes the central tenant of the Sustainable Development Goals of reaching the farthest first, and has been able to achieve this level of scale and sustainability. This makes eVIN a great example of how to capture ideas that work and can benefit not hundreds, not thousands, but millions.
Projects must be planned to expand from the outset. They must be created to operate without special funds or a personal stake. The government was clear that supply chain must be designed with scale in mind—partial intervention would not work.
UNDP worked closely with Indian state governments, regularly taking health officials’ feedback to improve and upgrade the software, and they’re now taking over eVIN funding. In fact, we are in the fourth version of the app. Standard operating procedures for the transport and storage of vaccines started out small, and became more defined as issues cropped up. Any scale-up strategy, once developed, should leave space for revision and adjustment, as parts of it can become obsolete, or new factors can illuminate other necessary requirements.
Sub-national governments also worked closely to support the planning of various immunization campaigns, surveys and introduction of new antigens. This helped build greater ownership, which is enabling a smooth transition for eVIN to government budgets. UNDP also worked with other UN agencies engaged on other components of the immunization programme, such as vaccine cold chain equipment, policy and research for eVIN’s effective roll-out and sustainability.
At each step, it was important to minimize the need for special organizational, financial and human resources that would not be available when the project was taken to scale. The solution was designed to be simple so it could be taught to last-mile health workers easily and quickly. Human resource and salary structures were designed with governments in mind. It required a planning process that attempted to build government capacities rather than impose additional burdens.
EVIN demonstrates that low-cost, smart technology combined with the right training of last mile workers, can create a transformative service that truly ensures no one is left behind.