The feasibility of using mobile-phone based SMS reminders and conditional cash transfers to improve timely immunization in rural Kenya

BACKGROUND: Demand-side strategies could contribute to achieving high and timely vaccine coverage in rural Africa- but require platforms to deliver either messages or conditional cash transfers (CCTs). We studied the feasibility of using short message services (SMS) reminders and mobile phone-based conditional cash transfers (CCTs) to reach parents in rural Western Kenya. METHODS: In a Health and Demographic Surveillance System (HDSS)- mothers with children aged 0-3 weeks old were approached to determine who had access to a mobile phone. SMS reminders were sent three days prior to and on the scheduled day of immunization for 1st (age 6 weeks) and 2nd doses (age 10 weeks) of DTP-HepB-Hib (Pentavalent) vaccine- using open-source Rapid SMS software. Approximately \$2.00 USD was sent as cash using mPESA- a mobile money transfer platform (2/3 of mothers)- or airtime (1/3 of mothers) via phone if the child was vaccinated within 4 weeks of the scheduled date. Follow-up surveys were done when children reached 14 weeks of age. RESULTS: We approached 77 mothers/ 72 were enrolled into the study (26% owned a phone and 74% used someone else's). Of the 63 children with known vaccination status at 14 weeks of age- 57 (90%) received pentavalent1 and 54 (86%) received pentavalent2 within 4 weeks of their scheduled date. Of the 61 mothers with follow-up surveys administered at 14 weeks of age- 55 (90%) reported having received SMS reminders. Of the 54 women who reported having received SMS reminders and answered the CCT questions on the survey- 45 (83%) reported receiving their CCT. Most (89%) of mothers in the mPESA group obtained their cash within 3 days of being sent their credit via mobile phone. All mothers stated they preferred CCTs as cash via mobile phone rather than airtime. Of the 9 participants who did not vaccinate their children at the designated clinic 2(22%) cited refusals by husbands to participate in the study. CONCLUSION: The data show that in rural Western Kenya mobile phone-based strategies are a potentially useful platform to deliver reminders and cash transfers. Follow-up studies are needed that provide evidence for the effectiveness of these strategies in improving vaccine coverage and timeliness.