Impact evaluation of a digital pendant and voice reminders for improving immunisation adherence in Rajasthan, India

Publication Details

Ruchit Nagar, SD Gupta and Alok Mathur
Institutional affiliations
None specified
Grant-holding institution
None specified
South Asia
Health Nutrition and Population
Health Services, Preventive Health and Health Behavior
Gender analysis
Health Services, Preventive Health and Health Behavior
Gender analysis
Equity Focus
None specified
Evaluation design
Mixed Methods
Ongoing 3ie Funded Studies
3ie Funding Window


The study will evaluate the impact of providing a digital vaccination record in a wearable pendant or a sticker on routine immunisation in Rajasthan, India.


The infant mortality rate in Udaipur district of Rajasthan state in India is 47 per 1000 live births (Sample Registration System Bulletin, 2014) and the maternal mortality rate is 244 per 100,000 women of reproductive age (Maternal Mortality Ratio Bulletin, 2013). These figures indicate that a high demand for healthcare services particularly for maternal and child health is not being met.

Research questions

  1. Does engaging with expectant mothers through the Khushi Baby (KB) intervention improve routine immunisation of their children?
  2. How efficient and accurate is the KB intervention in comparison with the data collection process used by the Rajasthan state health ministry?


The KB system is an innovative intervention that uses technology to engage with communities for improving immunisation coverage. Depending on which trial arm they belong to, expectant mothers will either be given a digitally encrypted pendant strung on a black thread or a near field communication sticker (NFC) in an existing immunisation booklet. These will be given to expectant mothers at Anganwadi or public health care centres where they come for antenatal check-ups and routine immunisation care. The pendant is strung on a black thread to make it more culturally appropriate and acceptable. The reason for this is that some Indian communities believe that a black thread protects a child from nazar or the evil eye.

Both the necklace and the NFC sticker contain a microchip that encodes health-related information of both mother and child. This chip also allows health workers to digitally access and update the records of the mother and/or child using an mHealth app that is installed on their smartphone. The records can be accessed even in remote areas where there is no mobile connectivity or consistent syncing to a central server. Whenever possible, health workers will upload the data to a cloud-based dashboard and also access the database to manage vaccine stock and logistics for future visits to health centres. The ministry of health and other health officials will also have access to this database, whenever required.

Both the pendant and NFC stickers also provide visual reminders to parents or caregivers about the immunization of the child. The automated voice-call reminders will also be sent to mothers in local dialects before the next immunisation camp.

This is a randomised evaluation where randomisation happens at the village level. The sample size for this study is 318 villages. Villages will be assigned to one of the three cluster arms: 1) Care-givers are given an NFC sticker along with an immunisation booklet; 2) Care-givers are given a pendant as well as a voice-reminder call; and 3) Control group where status-quo will be maintained.

The study also includes a qualitative component. Focus group discussions and semi-structured surveys will be conducted with mothers and health workers. The focus group discussions will take place before, at mid-line and at the end of the study. In-depth interviews will be conducted with all stakeholders, including health officials.

Additional publications

Media coverage


Scroll to Top