Finding Zero-Dose Children in Mali with Household Surveys

by | Nov 17, 2022

Premise was created to solve big challenges. Sometimes the challenge comes from the problem itself, while other times it comes from the context in which the problem must be solved. 

Gavi, the Vaccine Alliance, came to Premise with a problem: to ensure routine childhood immunizations and prevent outbreaks of diseases like measles in Mali, they needed to understand 1) the prevalence of zero-dose children in the country, and 2) why and where children were going unvaccinated or under-vaccinated. 

The context makes that problem all the more difficult.

Mali is a country of 20.86 million people, over 50% of which live in rural, often hard-to-reach areas. In recent years, the country has experienced significant instability, with multiple coups and internal conflict. At the start of 2022, only 29% of Malians had access to the internet. Given the challenging context, a national survey in Mali would be difficult.

The complexity of the situation demonstrates how Premise is uniquely positioned to provide insights in the most challenging environments.

Premise is conducting face-to-face household surveys across the entire country, using a randomized representative approach. In doing so, Premise will be able to provide Gavi—and the Malian Ministry of Health—an up-to-date estimate of how many children have not received their routine immunizations, where, and why.


A vaccination card photographed by a Premise Contributor. Contributors can submit photos and video to validate the interviews have taken place with a person of the intended demographic.


Contributors also submitted photos of interviewee houses to confirm the site of the household interview.


Surveying an entire country

Premise has a network of over five million people in 140 countries who are paid to conduct surveys, interviews, and observation tasks. In the last 30 days, over 6,000 of these “Contributors” in Mali have made data submissions. 

To survey the country, Gavi is using face-to-face interviews. Trusted and trained Premise Contributors are tasked with visiting households and interviewing people—in this case, caregivers of children under five—to complete a survey. This is similar to traditional data collection methods that rely on contracted enumerators, but with Premise, partners can easily deploy Contributors already living in the area, so there are no logistics associated with contracting enumerators or coordinating travel. 

As the scale of the data collection continues to expand across the country, important trends are already emerging. Lack of information and lack of time are turning out to be more determinant factors in a child not being vaccinated than vaccine skepticism. Additionally, families are asked how they heard about vaccination programs for their children. Radio has emerged as being the most impactful messaging platform ahead of TV, family, and health professionals. Surprisingly, very few respondents note seeing information about vaccination for children on billboards or receiving information from community officials. These insights have important implications with respect to how social and behavior change communication (SBCC) actors should develop communication strategies.


Premise is using a phased approach and will ultimately collect data across all of Mali—an unprecedented accomplishment and a hard-earned one, especially given the context. The groundbreaking crowdsourced data collection will continue until national coverage is reached. 

By using Premise, Gavi and local stakeholders will be able to have a comprehensive vision of the state of childhood vaccination in Mali by means of reliable data. Including GPS information, detailed responses to the household survey administered to Malian families by Premise Contributors, while also protecting families’ personal information. 


Premise and Gavi

Premise was named an INFUSE Pacesetter by Gavi, the Vaccine Alliance, which served as the genesis for Premise’s support of Gavi’s work in the global health space in West Africa. Gavi is working with a consortium of local stakeholders with support from the Clinton Health Access Initiative and Dalberg. Premise serves as a key data collection tool, enabling Gavi to provide greater visibility into vaccine storage conditions, vaccine availability, and attitudes and trends around vaccination to the Malian and Ivorian Ministries of Health. 

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