Experimental evidence on the role of reminders
Although the importance of vaccinating children to ensure their proper development is known worldwide, according to the World Health Organization, more than 1.5 million children die each year from vaccine-preventable diseases, representing 29% of total deaths of children under five. Most of these deaths occur in developing countries.
In the case of Guatemala, 86% of infants aged under one year receive vaccines; however, this number gradually decreases and at age four only 46% of children receive their vaccines. This means that a large percentage of children do not complete the vaccination cycle and therefore the immunization process is not concluded.
Moreover, in rural areas of Guatemala there is little acceptance of medical services which reduces the chance of children receiving all their vaccinations. The researchers assumed that this reality was partly related to difficulties in traveling to the community center and partly to cultural resistance.
Based on the situation described in the context, the Guatemalan government established the Coverage Extension Program (PEC) service which, through non-governmental organizations, provides preventive health services to mothers and children once a month in the different communities. In turn, these NGOs work with mobile medical visitors to promote the use of these health services.
The NGOs also collect information in isolated communities and create electronic medical records. These medical records show who the pregnant mothers are in the communities, which children need vaccines, among other things.
The experiment used a sample of 130 clinics for six months. For the most part, each clinic represented a community, although some covered two. The researchers randomly chose the clinics for the treatment and control group. For the communities in the treatment group, medical visitors had accurate information on which families had treatments scheduled for the next month and what specific treatment was needed. These data were taken from the PEC register allowing medical visitors to go house to house to remind people to go to the clinic during the two-day visit by the PEC doctors.
Because the PEC program already included medical visitors and part of their job was to promote health services, for the control group, the medical visitors did not have precise information from the program, but instead had to use their own records to track their patients, if they decided to do so.
To implement the intervention, software was developed which generates the patient lists, which were delivered to the medical visitors during the monthly meeting with the NGO.
Before starting, the researchers also conducted a survey in 1,200 homes to learn about parents' views on vaccination, family characteristics and access/use of health services.
Children in rural areas of Guatemala, aged 1-5.
Reduce the number of children who did not receive the complete immunization cycle, through incentives to parents not to forget to complete it.
Results
The experiment found that:
- Reminders are a cheaper instrument than others (such as conditional transfers) for increasing the level of vaccination.
- Reminders increased the likelihood of children finishing their vaccination treatment by 2.2 percentage points in the treated communities.
- This is a highly cost-effective intervention, which makes it a scalable option not only for vaccination-related interventions but for others, such as reducing malaria.