Razia Mahmodi still remembers the first polio vaccine she received while growing up in Afghanistan.
The vaccination team forgot to reach her home during a routine house-to-house vaccination campaign, so when her father returned home from work that evening, he rushed her to the nearest home-based clinic to receive it. Her father was relieved that his daughter was protected from the disease, still endemic in the country.
Now, Razia works as a data management scientist in polio eradication for her country and is making great strides for the future of vaccine campaign data management technology in Afghanistan.
Razia studied computer science at university and then worked as a data manager for the World Health Organization (WHO) Polio Eradication Initiative (PEI). Her shift towards healthcare data management came from a long-held desire to do something that would improve public health in Afghanistan.
In relecting on her journey to become a data manager, she recalled a moment in her adult life that shaped her convictions about healthcare saving her country. She had started working and was supporting her family financially, when she suddenly fell sick. Up until then, she had always valued the importance of education as a transformative force for a better future; but as she lay in bed, missing work and worrying that she was not making the money her family relied on, she realized that health was just as, if not more important than everything else. She became resolute that she would play her part to improve Afghanistan’s health. So she turned her focus towards a disease that had long plagued her home country’s population.
Afghanistan is one of two countries in which polio transmission is ongoing and endemic. Political instability, humanitarian crises, and a weakened healthcare system have contributed to polio's continued existence in the country. Polio eradication efforts were further hindered in 2018 when house-to-house vaccination campaigns were suspended in Taliban-controlled areas, resulting in increased transmission and cases of wild poliovirus cases. Thanks to efforts and negotiations from Polio Eradication Initiative (PEI) partners with the Taliban and de-facto authorities, house-to-house campaigning has resumed and been implemented in more regions, although there is still a need for these activities in several districts in the Southern region.
According to Razia, vaccination campaign data management has also faced its fair share of challenges, further impacting polio eradication efforts. Under the traditional system, campaign monitors and frontline health workers went house-to-house to fill out paper checklists with household data that were then sent back to provincial data managers to enter into spreadsheets. Often, checklists would contain errors if monitors completed forms incorrectly.
Data entry operations also suffered logistical barriers. Razia explained that entering such large amounts of data was tedious, time consuming, and prone to human error. Data managers also required a few days to format checklist data into spreadsheets, which delayed identification of vaccine campaign problems that could have otherwise been addressed in the field.
When the WHO, Centers for Disease Control and Prevention (CDC), and Afghanistan’s National Emergency Operation Center (NEOC) came together in 2020 to develop a new system for managing polio vaccination data, Razia saw an opportunity to be part of a project that could transform the landscape of polio disease prevention efforts in the country.
In 2021, she began her work with the Afghanistan Polio Management Information System (APMIS), an online data system to input, store, manage, and visualize monitoring data of polio immunization efforts in Afghanistan. With TEPHINET's support, Razia and an international team of scientists, developers and informaticians worked diligently to develop the APMIS system, with implementation beginning in the Eastern region of Afghanistan in 2022.
Razia explained that APMIS offers a web-based management system that streamlines the process of both inputting and exporting polio vaccine data, addressing most of the barriers that previously slowed down data management efforts. The user-friendly interface conducts logic checks to reduce errors and promote data quality. The role-based system allows monitors to only enter data for their assigned clusters, further preventing data overlap or incorrect data entry.
The APMIS web-system also has a complementary Android app, which is used by campaign frontline workers to collect real-time data. In rural, hard to reach areas where internet connectivity is limited, field workers can input data into the app offline and then submit it once connectivity is available. All inputted data, once synchronized from the mobile app, can then be exported by data managers from the web system for additional analysis and data visualizations.
While the APMIS team continues to improve the system, Afghanistan’s constantly evolving political climate, continues to create challenges for campaign data monitoring efforts. When the United States military withdrew from Afghanistan in 2021 and the Taliban took over, many points of contact for the program were lost as people fled the country. Razia was one of them. Just 30 days after starting her job with APMIS, she too had to leave. She explained that the APMIS team had to adapt and establish new working relationships to continue project activities, as well as working through partnerships with NEOC and international bodies like UNICEF and WHO, both of whom are still allowed to continue operations within Afghanistan.
Although the APMIS team re-established relations with staff on the ground, other limitations have become apparent as the project now had to navigate a new Taliban-governed Afghanistan.
Razia explained that women serving as field monitors are a great asset in the data collection process, especially during house-to-house visits where women and children are home to answer the door while male family members are away at work. They are a familiar face and comforting presence, aiding in both collection of vaccine data as well as dissemination of campaign information. However, with recent restrictions on their movement, many female workers have difficulty traveling freely to homes without male accompaniment or proper headwear. These restrictions also prevent many women from participating as field monitors, out of worry.
Nonetheless, PEI partners continue to support female team members and polio eradication efforts continue to develop in spite of logistical road blocks.
Razia is optimistic that during upcoming 2023 National Immunization Days, APMIS can be expanded from its current implementation in Afghanistan’s Eastern region to the entire country. She hopes that this expansion and the value APMIS provides program staff will help lead the charge in polio eradication efforts in Afghanistan once and for all.
Razia says Afghans always say something when checking in on one another or chatting about everyday life difficulties. She said “They say it's fine, as long as you're healthy, everything's going to be fine.”