
Leveraging evidence to improve child immunisation in Haryana, India

Context
Immunisation is one of the most cost-effective ways to improve child health and survival in developing countries. Yet, in 2018, a fifth of all children in India’s Haryana state still did not receive all the required vaccinations. To address drop-outs and improve vaccine coverage, 3ie funded the evaluation of a new programme in seven districts of Haryana between 2016 and 2019.
Researchers affiliated to the Abdul Latif Jameel Poverty Action Lab (J-PAL) South Asia worked with Haryana’s National Health Mission directorate to evaluate Teekakaran Protshakan Karyakram (encouraging immunisation programme). The programme used a variety of ways to improve immunisation, such as leveraging social networks for information dissemination within the community, providing mobile recharges as incentives and sending reminders to caregivers.
Evidence
The study team found that spreading health messages through community-nominated information disseminators (immunization ambassadors) was a cost-effective approach to improving immunisation outcomes. Identifying ambassadors in the community by asking a simple and direct question and leveraging them to spread immunisation-related messages in the community cost only US$4.95 per additional fully immunised child.
The mobile recharge incentive had significant effects only when the recharge amounts were higher for the last two vaccines a child should receive in her first year: the third dose of pentavalent and the measles vaccine. Where higher amounts were transferred for pentavalent 3 and measles, there was an 11.8 per cent increase in the rate of full immunisation. There was no effect when the recharge amounts were uniform for all five vaccines. Thus, what mattered was how the recharges were transferred, rather than their monetary value. Even a large overall amount transferred through equal-sized recharges after every vaccine did not have any impact.
Targeted text and voice call reminders did not affect immunisation outcomes.
Evidence impacts
‘When such studies happen, you deliberate upon what works and what did not work. Something which is low cost and high impact, when that has been demonstrated to work so beautifully, why not use it?’
Type of impact: Inform the design of other programmes
Where findings from the evaluation or review inform the design of a programme(s) other than the one(s) evaluated.
This is one of 3ie’s seven types of evidence use. Impact types are based on what we find in the monitoring data for an evaluation or review. Due to the nature of evidence-informed decision-making and action, 3ie looks for verifiable contributions that our evidence makes, not attribution.
Read our complete evidence impact typology and verification approach here.
Close windowThe evaluation highlighted the value of leveraging community social networks and prompted the Haryana state National Health Mission directorate, the Health Systems Resource Centre and the researchers to launch a partnership to pilot health information dissemination through community-identified immunization ambassadors in one of Haryana’s most challenging ‘aspirational’ districts. The government’s September 2019 memorandum of understanding with the J-PAL South Asia researchers also proposes working together to improve the use of administrative data to improve health, leveraging the government’s online mobile data platform for Auxiliary Nurse Midwives , known as ANMOL.
Type of impact: Inform the design of other programmes
Where findings from the evaluation or review inform the design of a programme(s) other than the one(s) evaluated.
This is one of 3ie’s seven types of evidence use. Impact types are based on what we find in the monitoring data for an evaluation or review. Due to the nature of evidence-informed decision-making and action, 3ie looks for verifiable contributions that our evidence makes, not attribution.
Read our complete evidence impact typology and verification approach here.
Close windowThe most effective approach according to the study has also informed the Suvita project of Development Consortium, a non-profit organization registered in India. Suvita, operating in 7 states of India as on March 2022, is implementing and testing both SMS reminders to caregivers and community-nominated immunization ambassadors. Prior to the study, the project's precursor, Charity Science Health focused only on SMS reminders. Suvita’s website mentions that discussions with various representatives of the research organisation which conducted the Banerjee et al. (2019) study, some initiated at 3ie’s workshop on immunization evidence program, led the project to choose combining immunization ambassadors and SMS reminders for testing in Bihar as a more effective and cost-effective approach than either in isolation.
Suggested citation
International Initiative for Impact Evaluation (3ie), 2020. Leveraging evidence to improve infant immunisation in Haryana, India [online summary], Evidence Impact Summaries. New Delhi: 3ie.
Evidence impact summaries aim to demonstrate and encourage the use of evidence to inform programming and policymaking. These reflect the information available to 3ie at the time of posting. Since several factors influence policymaking, the summaries highlight contributions of evidence rather than endorsing a policy or decision or claiming that it can be attributed solely to evidence. If you have any suggestions or updates to improve this summary, please write to influence@3ieimpact.org