Big Ideas Winners Aim to Digitally Track Vaccinations in Rural India

Despite India’s robust government immunization program—which provides 11 different vaccinations free of cost—immunization rates remain low, particularly among poor populations.

 By Sybil Lewis

Emmunify Pic 1_CaptionDespite India’s robust government immunization program—which provides 11 different vaccinations free of cost—immunization rates remain low, particularly among poor populations. According to a 2015 University of Michigan study, only 57 percent of children younger than three in India are fully vaccinated. A nationwide survey conducted by UNICEF in 2009 found that many children are not fully immunized because their mothers and caretakers did not understand the vaccines, did not know where to get them, did not feel they were needed, or found vaccines shortages at health clinics.

With this in mind, three UC Berkeley MBA students— Anandamoy Sen, Erik Krogh-Jespersen, and Sanat Kamal Bahl—and Julia Walsh, a Cal professor of maternal and child health and international health, began in 2012 to rethink potential solutions. The team decided that the Indian vaccine deficit was due not to lack of supply, but to an information problem—and could best be addressed through a cellular vaccination tracking technology, which they called Emmunify.

Emmunify Pic 2b_Caption“When we looked at household surveys in Uttar Pradesh that asked why children were not getting vaccinated, we found the major problems were the families didn’t know the importance of them, didn’t know when they were supposed to go, and when they did go there were tremendously long wait times and possibly no vaccines,” said Professor Walsh, co-founder of Emmunify. “So when a mother does a mental cost-benefit analysis of waiting to get the vaccination or working for a day, she does not see the benefit of the vaccine.”

Another challenge to universal immunization is the paper record keeping system in India; records are often easily misplaced, resulting in missed or duplicated vaccinations. The most recent National Family Health Survey in India found that only 38 percent of mothers were able to show their child’s vaccination card.

To address these challenges, Emmunify plans to provide a portable electronic medical record that digitizes and stores immunization records, replacing cumbersome paper records. It also plans to send SMS reminders to families about when their next vaccinations are due and where they are available.

Emmunify got its start through the UC Berkeley’s 2012 Hacking Health competition, which awarded Sen, Krogh-Jespersen, and Bahl the grand prize of $2,000 to build a prototype. With Walsh as their faculty adviser, the team then won first place in the 2013 Big Ideas@Berkeley competition in the maternal and child health category and used the $8,000 award money to send two team members to the New Delhi slums in July 2013 to test Emmunify’s usability and feasibility. By partnering with Aarushi Charitable Trust, an organization of community health workers in the New Delhi slums, Emmunify was able to conduct stakeholder interviews with health workers and focus groups with mothers.

Emmunify Pic 3_CaptionThe Emmunify team aims to implement a multi-step process. First, a village health worker would use a portable, battery-powered tablet with Emmunify’s software to register a family’s health information and assign each family an ID number, which is programmed onto a portable chip (RFID tag) placed on the family’s phone. Once the family is registered, it will receive SMS or voicemail reminders about upcoming child vaccinations. When the family arrives at the clinic, its RFID tag will be scanned to confirm and update immunization records, preventing duplication. The final step is to store the health information from the tablet onto the Cloud, where an application will generate and send future automated messages.

Anandamoy Sen, Emmunify’s co-founder and mobile technology professional, said the organization’s main innovation is its adaptability to India’s rural health context. He noted there have been other prototypes of electronic record vaccination systems, but they require a Wi-Fi connection, which is scarce in rural villages, and use bulkier hardware that is easily damaged. What sets Emmunify apart, he said, is its offline design. An Internet connection is used only to send information to the Cloud; during the registration and vaccination process, no Internet, phone service, or electricity is required.

Much of what Emmunify aims to do is enabled by India’s robust mobile phone market. According to a 2010 UN report, for every 100 people there are approximately 45 cell phones. Emmunify can rely on SMS reminders because the RFID tag placed on families’ phones is designed to operate on any type of mobile.

Emmunify may be attractive to health care providers due to its simplicity and cost effectiveness.

“Paper [vaccination] cards are estimated to cost about a US$1.25 per child, whereas the tag is inexpensive, costing US$0.25-0.50 each,” said Professor Walsh. “We also can buy consoles and tablets for the health workers at less than US$100 each.”

Walsh noted that developing the necessary software and cloud analytics is the most challenging and costly aspect of Emmunify’s technology. The software—the tablet-chip interface, the tablet-cloud interface and cloud analytics, and the automated family reminders—will be interconnected. To date, the team has completed the RFID tag and has progressed with the user-interface for the health workers console. But they are still working on the Cloud-console software and analytics.

The potential impact of a technology like Emmunify extends beyond the health benefits of vaccinations. “If you are fully vaccinated, you will be better nourished, do better in school, stay in school longer, and have the chance to get out of poverty,” Walsh said. “We estimate that in places like the New Delhi slums and the poor populations of Uttar Pradesh or Bihar, if you vaccinate an additional hundred kids, you save two lives.”

In the long run, Sen said health information stored in the Cloud could help health clinics forecast supply and demand for vaccinations, preventing shortages that have deterred mothers from getting their children vaccinated.

The Emmunify team has always known that cooperation with and buy-in from the Indian government is essential. The government plays a large role in the administration of vaccinations through its Universal Immunization Programme, which since 1978 has provided vaccinations of preventable, yet life-threatening, conditions to children free of charge.

In October 2010, the Indian government implemented a voluntary Universal ID program (UID), which stores citizens’ biometric data and assigns them a unique identity number, with the goal of improving and reducing corruption in the distribution of public services. Emmunify does not plan to integrate with the UID program because, said Sen, many rural clinics do not have the scanning technology to obtain biometric UID data and the UID program does not include the vaccination reminder software. However, Emmunify may use the national ID as a verification method for families’ RFID tags.

Next steps for Emmunify include registering as a nonprofit and pilot testing. Emmunify recently won third place in the 2015 BigIdeas @ Berkeley Scaling Up competition, receiving a $5,000 award that will help the team test all of Emmunify’s technology—from the chip to the SMS reminders—with families in the New Delhi slums in early 2016.

Emmunify’s technology may not be limited to India. Walsh said Emmunify is working closely with DHIS 2, an open source information system functional in 30 countries, including eight Indian states. Once the pilot test is complete, Emmunify plans to adapt its software to be compatible with DHIS, allowing for the possibility of expansion into other countries.

Calling All Changemakers: Big Ideas Turns 10

When the Big Ideas student innovation contest launched 10 years ago, it was a novel concept: give teams of students with potential breakthrough ideas small sums of money and a variety of supports and see what happens. Over the past decade, a lot has happened.

News-Sidebar-image_CategoriesWhen the Big Ideas student innovation contest launched 10 years ago, it was a novel concept: give teams of students with potential breakthrough ideas small sums of money and a variety of supports and see what happens. Over the past decade, a lot has happened.

Big Ideas has gone on to seed scores of high impact projects—from the Cellscope, which turns the camera of a mobile phone or tablet computer into a high-quality light microscope, to the Cal Climate Action Partnership, a coalition of UC Berkeley students, staff, and faculty now pushing to achieve carbon neutrality on campus by 2025. The contest has jump-started successful companies like Captricity, which sells data capture software to digitize hand-written forms, and Back to the Roots, which creates sustainable food products from coffee grounds and other food waste. It has also given the first precious funds to nonprofits like We Care Solar, which provides solar-powered suitcases for use in maternity hospitals and clinics, and Acopio, a supply chain information platform for Latin American coffee farmers.

For many student innovators, Big Ideas served as the first step in turning a grand hunch into a viable proposal. Since 2006, the contest has provided support to student teams who have gone on to secure over $55 million in additional funding for their for profit, nonprofit, or hybrid ventures.

This year’s contest launches September 8. It will provide up to $300,000 in awards, and will build on a well-honed tradition of coaching teams through eight months of pre-proposals, mentorship, and final submissions. The tenth anniversary contest will also provide more competition categories to more students. Contestants will be able to submit their ideas to the newly introduced “Financial Inclusion” category and the newly extended “Energy & Resource Alternatives” category, sponsored by the University of California Carbon Neutrality Initiative.

Big Ideas is one of the biggest inter-campus efforts in the University of California and the nation. It brings together such entities as the Blum Center for Developing Economies at UC Berkeley, the United States Agency for International DevelopmentUSAID’s Higher Education Solutions Networkthe Center for Information Technology Research in the Interest of Society (CITRIS), All Children Reading: A Grand Challenge for Development, the UC Berkeley Food Institutethe UC Global Food Initiative, the UC Carbon Neutrality InitiativeMichigan State University’s Global Center for Food Systems Innovationthe Associated Students of the University of California, and the Berkeley Energy and Resources Collaborative —as well as over 200 judges and 50 mentors.

As the contest enters its tenth year, its reach encompasses 18 universities, including the entire University of California system and the USAID Higher Education Solutions Network, as well as 650,000 students—making the Big Ideas Contest one of the largest student innovation competitions in the world.

“When I first got involved as Big Ideas judge in 2006, the contest was a campus-based competition open to 30,000 UC Berkeley students,” said Phillip Denny, who manages the contest on behalf of the Blum Center for Developing Economies. “Now the contest is open to a population equivalent to a medium-sized U.S. city. The results in terms of the creativity of ideas and social impact really show.”

The contest’s first information sessions will take place at 6:30 pm on September 9 and September 29 in Blum Hall, B100. A live webcast will be also be available on the Big Ideas website for students participating from other universities.

This year’s contest categories include:

From September to March, when the final proposals are due, teams have the opportunity to attend information sessions, idea generation and networking events, writing workshops, editing blitzes, and office hours with Big Ideas advisors in person and online. In addition, finalist teams will be matched with mentors with expertise relevant to their project from a range of social enterprises, academic institutions, nonprofits, and businesses.

Unlike many business competitions, Big Ideas is multidisciplinary — attracting engineers, science majors, public health majors, as well as MBA students — and is focused on supporting a variety of social ventures including for-profit enterprises, non-profit organizations and community-based initiatives. The contest challenges students to step outside of their traditional university-based academic work, take a risk, and use their education, passion, and skills to work on problems important to them.

For more information about rules, categories, resources, funding, and contact information, please visit the Big Ideas website at

Big Ideas@Berkeley Winners Visualize an End to Cervical Cancer

Prompted by funding and recognition from the Big Ideas@Berkeley contest, a group of Cal students headed by Mechanical Engineering graduate student Julia Kramer is seeking to establish a sustainable training program called “Visualize” for midwives in Ghana.

By Carlo David

Prompted by funding and recognition from the Big Ideas@Berkeley contest, a group of Cal students headed by Mechanical Engineering graduate student Julia Kramer is seeking to establish a sustainable training program called “Visualize” for midwives in Ghana. In a country where only five percent of women have been screened for cervical cancer, Visualize aims to create a system in which midwives receive the essential skills and tools to perform a visual inspection of the cervix with acetic acid (vinegar). The inspection method, known as VIA, is a low-cost and effective way to screen for cervical cancer, but it is not widely used in Ghana and other countries due to a lack of training and awareness.

Julia Kramer and Maria Young pioneered the VIA training program in Kumasi and Accra, Ghana in June 2013.
Julia Kramer and Maria Young pioneered the VIA training program in Kumasi and Accra, Ghana in June 2013.

Kramer and Maria Young first conceived of the project as undergraduates at the University of Michigan. “We were part of a group of five engineering students who spent eight weeks in Ghana for a cultural immersion and design ethnography experience,” said Kramer.

At Michigan, she and her collaborators developed the first few prototypes of a VIA training simulator, based on design requirements they developed at two major teaching hospitals in Ghana. At Berkeley, Kramer teamed up with fellow Mechanical Engineering and Haas School of Business students Abhimanyu Ray, Karan Patel, and Betsy McCormick, to develop the midwife VIA training concept. Visualize’s faculty advisors include public health professional Kyle Fliflet and Mechanical Engineering Professor Alice Agogino, who is chair of the Development Engineering graduate group.

Kramer explains that her project was motivated largely by interactions with midwives, nurses, and doctors in Ghana, along with substantial data supporting the need for more cervical cancer screening. Annually and worldwide, 275,000 women die from cervical cancer. Eighty percent of deaths occur in developing countries, which often do not have the medical infrastructure to diagnose and treat cervical cancer. VIA has been proven to serve as a low-cost alternative to methods like the Pap smear. A 2008 International Journal of Gynecology & Obstetrics study found that VIA could reduce mortality rates by 68 percent. Through midwife-administered VIA tests and subsequent treatments, the Visualize team estimates it can avert 150,000 deaths per year.

Based on their experiences in Ghana, Kramer and her colleagues believe midwives, rather than doctors or other medical professionals, are the best means to implement their public health solution. “Midwives have and can be trained for this procedure,” said Agogino. “As a matter of fact, because such an intimate procedure requires interpersonal communication skills, midwives are better suited than licensed medical doctors.”

The VIA method is not only cheaper than a Pap smear—if properly performed, it also can be equally effective. The method works as follows: a midwife performs a preliminary pelvic examination; she inspects any pre-existing abnormalities; she applies a small amount of table vinegar in the cervix; if acetowhite lesions appear, cancerous cells may be at work.

A Ghanaian midwife holds a visual aid of the cervix.
A Ghanaian midwife holds a visual aid of the cervix.

If there are signs of pre-cancerous cells, the midwife may perform cryotherapy, a procedure that freezes off cervical abnormalities and eradicates cancer cells. In a 15-year controlled trial of 151,000 women ages 35-64 in Mumbai, India, the mortality rate in the cryotherapy treatment group was reduced by 31 percent.

There are, however, unique challenges and financial hurdles to implementing Visualize. According to Agogino, “One of the biggest challenges is identifying infrastructures that already exist for training midwives, so the midwives can eventually train other women in Ghana.” Indeed, the Visualize team is exploring whether it is viable to incentivize women to recruit and train other women, particularly to reach remote areas.

Communication may also be a challenge for Kramer and her team. “There’s an ever-present challenge of working in a culture I’m not part of,” explained Kramer. “It’s hard to travel back and forth to Ghana and it’s difficult to bridge the communication gap using email or Skype.”

A group of Ghanaian women undergoing training with the use of a box that serves as a replica for the VIA training simulator.
A group of Ghanaian women undergoing training with the use of a box that serves as a replica for the VIA training simulator.

Kramer and her colleagues also must walk a fine line between American and Ghanaian public health and other cultures. “Since one of the main goals of this project is empowerment, we want to remain very careful about overstepping our bounds and ensuring mutual respect,” explained Kramer.

The Visualize team plans to use various media—television, radio, billboards—to market the availability of midwives for cervical cancer screenings. In addition, the team is collaborating with the Ghana Ministry of Health and Ghana Health Services to vet and publicize its efforts. So far, response from Ghanaian government agencies has been positive. Visualize has found several partners, including the Kumasi Nurses and Midwifery and Training College and the Ministry of Health. Its next step is to identify the location of its first training program.

Ultimately, Kramer said her project is about respectfully furthering social change. “Young people can and should take a more active role in addressing conditions of global poverty,” she said. “But we have to be humble and realistic about our role in societal progress. We have to respect cultural traditions and boundaries and be aware that our presence carries connotations beyond our control.”

The project will be running a fundraising campaign from September 14 until October 14. For more information, go here: