How do you find the overlooked? An e-tracking system brings Bangladesh closer to universal coverage

Bangladesh has introduced an e-tracking or electronic vaccination registry system that health authorities hope will already help reduce the number of “missed” unvaccinated children.

Such “zero-dose children” represent a relatively small minority in Bangladesh. Over the past 20 years, the country has made enormous progress in combating diseases that previously accounted for a large proportion of childhood deaths, and in 2023 the country recorded an impressive vaccination rate of 98% with the third dose of the basic diphtheria, tetanus and pertussis-containing vaccine (DTP3), a conventional replacement for vaccination protection in general. However, this small minority of unprotected children – a cohort often referred to as “invisible” – remains highly vulnerable.

“Actually, it works tremendously.”

– Dr. MD Feroz Alam, Deputy Health Officer Zone 6 of Dhaka North City Corporation

How do you find the “invisible” few? New technical monitoring systems can certainly be helpful. From 2019 to the end of 2021, EPI Bangladesh carried out the e-tracker deployment in Moulvibazar district and Dhaka South City Corporation (Zone 5). After the successful completion of the pilot project, the government started implementing the e-tracker system in the country from 2023 in the first phase in some places.

The system is relatively simple: Operators or vaccinators use a tablet device to integrate a child’s vaccination records — as well as key identifying information such as the guardian’s name, gender, guardian name, home address and cell phone number — into a central database. When a baby is registered in this system, it receives a unique identification number that allows it to be reliably tracked from anywhere in the country until the end of the routine schedule.

After completing a successful pilot, the government of Bangladesh has started rolling out the platform as a full-fledged and permanent registration system in various parts of the country. The aim is to cover all designated vaccination centers of the Expanded Program on Immunization (EPI) – part of the Directorate General of Health Services (DGHS) – by the end of 2025.

At the vaccination clinic at Lubana General Hospital and Cardiac Center, VaccinesWork met Abdullah Al Mamun, a businessman from Uttara Sector 11 in Dhaka, who reported he was optimistic after his 1.5-month-old daughter Tahiah Binte Abdullah was included in the tracking system. “Now we are relaxed and think that our baby will not miss any dose of the EPI vaccine. We are fortunate to be registered virtually as we also receive regular information updates,” he added.

SK Maruful Haque, who came to the same clinic with his 16-day-old daughter Anaya Binte Maruf, noted that he hoped it would be an advantage that his baby’s progress through the vaccination schedule could now be easily tracked from anywhere in the country.

Mohammad Jahid Hussain, Data Entry Operator at EPI Vaccination Center at Lubana General Hospital and Cardiac Center in Uttara Sector-13, said the acceptance of the new system in the community has improved over time. “Initially, some people were embarrassed and asked about the losses and benefits of registering in the system, but with the passage of time, most people are now enthusiastically registering their babies in the system. However, we face some problems if the server remains down at some point.”

Jahid Hussain said the babies’ guardians filled out a form to initiate the registration. “We enter the information into the e-tracking system to register online. The legal guardians receive a registration number with their paper book. Whenever they go to a center, the baby’s vaccination history can be tracked through the registration number,” he added.

Dr. MD Feroz Alam, deputy health officer of Dhaka North City Corporation (DNCC) Zone 6, said the e-tracking system was launched in Ward 51 of his zone in June last year. “The e-tracking system has simplified the vaccination activities. At the same time, it ensures that there are no zero doses, no dropouts and no missed communities to ensure vaccination for everyone. “Actually, it works tremendously,” he added.

Dr. Abul Fazal Md. Shahabuddin Khan, Program Manager (EPI), said the e-tracking system will be implemented in four districts: Narayanganj, Moulvibazar, Cox’s Bazar and Jamalpur, and eight urban areas: Dhaka North, Dhaka South, Narayanganj, Gazipur, Khulna, Rangpur, Sylhet, Cumilla and Chattagram.

“We have already completed training for the affected personnel in Rangpur, Rajshahi, Sylhet and Barishal divisions and 34 districts across the country. We hope that the training in the remaining districts and divisions will be completed as planned in a short time.” “We will implement the e-tracking system nationwide from June 2025,” Shahabuddin added.

Describing the utility of the e-tracker, Md Monjurul Islam Fuad, Assistant Program Manager (Field Service (EPI) at DGHS, said the system will track zero dose, dropout, exclusion and missed communities.

“As this system spreads across the country, zero dose, dropout and missed community(s) will be addressed.” Vaccination will ensure no one is left behind,”

– Dr. Tajul Islam A Bari, vaccine expert

“It will be helpful to reduce invalid doses at the municipal corporation level, set the target to ensure proper utilization of the vaccine and logistics and proper reporting in vaccination activities,” he added.

In conversation with VaccinesWorkThe vaccine expert Dr. Tajul Islam A Bari, a former manager of EPI, said: “As this system spreads across the country, zero dose, dropout and missed community(s) will be addressed. “Vaccination will not protect anyone,” he added.

The electronic vaccination registry allows health workers to monitor children’s vaccination progress, as the system is able to track children who need vaccinations, identify those who will be vaccinated and send SMS notifications to parents about upcoming vaccination phases send.

A study article published the results of the pilot in the Lancet in September 2023, noting that the e-tracker “opens the opportunity to better track vaccination coverage, dropouts and timeliness for Bangladesh.”