Our Work


Our simple bracelet is a communication tool designed to reinforce key vaccine messages for parents, and it has the potential to increase uptake and reduce dropout rates among rural and poor children, thereby promoting equity. It's also designed to strengthen and reinforce the existing health system, and we already have evidence of this: Every nurse we worked with in our pilot study recommended incorporating our program into national immunization protocol.

We are working to generate enough evidence to confidently recommend widespread distribution of our bracelets to governments and NGOs as a highly cost-effective solution for increasing vaccination. Very few vaccine reminders exist for low-income parents in developing countries, and only a handful of studies, most of which are too poor in quality to be generalizable, have been done to determine the effectiveness of those reminders. We aim to be one of the first to provide high quality, generalizable evidence of the impact of our bracelets in low-income settings. 

Phase I - Assessing Our Feasibility

With funding from the Bill & Melinda Gates Foundation, we recently conducted a feasibility study in Peru and Ecuador to see whether moms correctly used and preferred using our bracelets as vaccine reminders. We partnered with the Ministries of Health of Peru and Ecuador to distribute the bracelets to a small number of moms in a rural and urban area and track their behavior and preference for our bracelets. The mothers we worked with were typically indigenous, had low education levels, were sometimes illiterate, and low or very low income. The pilot study ran for 6 months in each country. Below are our key findings. 

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Phase II - Measuring Our Impact

We are currently preparing to do a larger randomized controlled trial and impact evaluation to determine the effectiveness of the bracelets on vaccine coverage and timeliness. We are looking to answer the question: Do children with bracelets get immunized fully and on time compared to children without bracelets? Our partners will include Ministries of Health, local NGO implementers, and universities. In addition to tracking the bracelets' impact, we will also determine the bracelets' cost-effectiveness compared to other vaccine reminders and their economic feasibility. 

To ensure local ownership in additional countries, we will create a new bracelet design for each country. We will adapt the colors, symbols, and layout to each local context based on pre-testing with parents so that each country's bracelet is custom-made to fit parents' needs, preferences, and cultural values. Based on moms' feedback from Phase I study, we will add more bracelet sizes to fit the child as it grows.

If you are interested in partnering with Alma Sana to determine our bracelets' impact, please contact our founder, Lauren Braun, at lauren@almasanaproject.org. 

 Photo credit: New York Times

Photo credit: New York Times