EPI Sindh and IRD Pakistan Launch ‘Choti Khushi

EPI Sindh and IRD Pakistan Launch ‘Choti Khushi Immunization Incentive Support Program’ for Low Immunization Coverage Districts in Sindh, Pakistan

Karachi (Muhammad Yasir) The Honourable Health Minister Dr. Azra Fazal Pechuho inaugurated the “Choti Khushi” Immunization Incentive Support Program today for low immunization coverage districts in Sindh province, Pakistan. The launch took place at the Khalid Jamil Dispensary in Karachi where the Health Minister was accompanied by representatives from the Sindh Expanded Program on Immunization (EPI), the Provincial Health Department, UNICEF, WHO, and other public health organizations. The Program aims to provide mobile-based small conditional cash incentives (up to PKR 1,200) to caregivers of children aged 0-23 months in 7 low-coverage districts of Sindh: Karachi East, Central and West, Hyderabad, Sujawal, Kambar, and Jacobabad. These districts are marked by the lowest pentavalent-3 and measles-1 vaccines coverage. IRD Pakistan has launched the Choti Khushi program in close collaboration with EPI Sindh and Federal EPI, with support from the Government of Sindh’s Health Directorate and the Maternal Newborn and Child Health (MNCH) program.

The Choti Khushi program will provide mobile-based conditional cash incentives for caregivers of around 1.2 million children of 0-23 months of age in the 7 low-coverage districts annually. For every immunization visit completed, caregivers with a registered pre-paid mobile number on any mobile network will receive mobile airtime of 200 PKR, which will add up to 1,200 PKR if all six essential immunization visits are completed. Caregivers can avail this facility at all public and private immunization centers across the seven selected districts. The facility will also be available via EPI outreach activities.

Addressing the inauguration ceremony, Dr. Azra Pechuho said, Introducing incentives for immunizations is a powerful, evidence-based strategy to increase demand and uptake for routine childhood immunization services and timelines in low and middle-income settings. It is the best investment we can make for our future generations.

The Choti Khushi Immunization Incentive Program is based on evidence generated by IRD through a large-scale Randomized Control Trial conducted during 2017-20 in Karachi, Pakistan, with 11,200 children to test the effectiveness of mobile phone-based incentives in low

immunization settings. The trial provided insights on incentivizing health services to overcome financial barriers faced by caregivers and empower them towards health-seeking behaviors. The study created a system to incentivize childhood immunizations to facilitate caregivers’ health choices.

Speaking about the Program Dr. Subhash Chandir, Program Director of the IRD Maternal and Child Health Program, said, “Parents play a vital role in making decisions about immunization of children. Choti Khushi-Immunization Incentive Support program is based on our decade-long research, highlighting that the small amount conditional cash transfers help overcome the barriers to vaccination like transport cost. These small yet critical cash transfers provide a form of social incentive to caregivers and promote behavioral change favoring immunizations. The program will help improve coverage and equity in these 7 low-performing districts of Sindh and bring them at par with the rest of the Province and Country. The Program will render Sindh one step closer to achieving the global Immunization Agenda 2030 (IA2030) of leaving no child behind.”

Since the 2017 scale-up of the Government of Sindh’s Electronic Immunization Registry (SEIR; aka ZM-EIR), 100% of the EPI estimated annual live birth cohort is enrolled on the SEIR, giving the EPI real-time immunization data to monitor program performance and coverage. SEIR has helped EPI-Sindh track and immunize missed children, especially during the Covid-19 pandemic. The SEIR will facilitate the Choti Khushi Immunization Incentive Program across the seven districts.

The Choti Khushi Immunization Incentive Support program aims to ensure that no child is left behind and is protected against all vaccine-preventable diseases for a healthier and stronger future.

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