Public Health
Using ‘reminder bracelets’ to improve immunization coverage in Ethiopia
By Jonny Barty & Kirobel Begashaw
GAVI estimates that in the countries it supports, one in five children ‘drop out’ of the schedule between their first and third dose of DPT, while 10 million children do not receive a single dose of DPT at all.

In Ethiopia, Acasus has launched an innovative EPI Reminder Bracelet to improve this situation, by increasing caregiver engagement in EPI, reminding caregivers of the EPI schedule, and enabling health workers to identify and avoid potential ‘drop-outs’ in communities before they happen. 

The bracelet contains 15 colour-coded and detachable beads, representing the EPI schedule. One colour is used for each antigen, with each bead representing each individual dose. For example, there are three ‘Penta’ beads, all of which are green (compared to the two Measles beads, which are black). 

Each bead is labeled with the name of the vaccine, and numbered to show the week it should be received. Three non-detachable beads spell out the word ‘MOM’ in bold lettering.


Caregivers are given the bracelet when they bring their child to receive their first vaccination. Each time their child is vaccinated, the corresponding bead will be removed from the bracelet. The numbers on the remaining beads remind them when to bring in their child for future vaccines.

Once a child has received all vaccines and each bead has been removed, caregivers are left with a valued piece of jewelry that spells out ‘MOM’, and shows their community that their child has been fully vaccinated. 

The bracelet also has several uses for health workers. It can help to assess a child’s progress when paper EPI-cards are lost, while removed beads can be used to support data collection activities in facilities.

It can also be used by health workers during visits to communities to identify and prevent potential ‘drop-outs’, while increasing opportunities to have conversations with mothers on EPI and child health.  



Reminder Bracelets for EPI have proven to be successful in other countries, such as Peru, Ghana, and Vietnam2. This new approach builds on these efforts in several ways: 

  • The dynamic bead-removal process keeps caregivers engaged in EPI over time

  • Community-level peer-pressure is leveraged to encourage caregivers to ‘complete’ the bracelet

  • The bracelet has been designed to promote high uptake and impact. The colours are bold and aligned with Ethiopian styles, while beads have long been a popular staple of African jewelry design 

  • The visual style and minimal use of text ensures that all mothers can understand the bracelet. Given literacy rates of just 44% for new mothers in some parts of Ethiopia3, this is critical 

  • Each bracelet costs just ~$2.8, and is produced in Addis Ababa. This ensures the cost-effectiveness and general sustainability of the approach, while also supporting local economies and craftsmanship 

To-date, this approach has been launched in four Woredas in Afar and Oromia regions of Ethiopia, with 200 bracelets given out so far. 15 health workers in these Woredas have been trained to support the roll-out, alongside the distribution of colorful posters to increase community awareness of the approach. 


Over the coming months, Acasus will continue to monitor the bracelet’s impact and refine the approach before launching it at scale in Ethiopia and elsewhere.


1. Gavi

2. Almasana Project

3. Research Gate


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