A simple tool used by community health workers significantly increased immunization coverage in India.

Mother and recently immunized child with immunization card.
While proven to protect against many deadly diseases, routine immunization was not the norm in eastern India. In Jharkhand state, only 8 percent of children under age one received a full schedule of immunizations in 1998.

The government of Jharkhand chose this issue as its priority to improve child health. After the launch of a 2005 immunization campaign with technical support from JSI and funding from the state government, USAID’s IMMUNIZATIONbasics and then MCHIP projects provided continuous technical support beyond the campaign for state-wide capacity building. By using JSI’s specially-designed routine immunization micro-planning tool, Jharkhand saw a significant turnaround on routine immunization within 10 years. Survey-confirmed coverage rates for all vaccines are now more than 80 percent in many districts in the state.

How change happened
One of JSI’s health systems strengthening principles is a focus on health data quality. In this case, a simple tracking tool that required no electronic technology was the key.

JSI developed the tool, My Village, My Home, for existing community workers (anganwadi workers) to use to routinely register all births at the village level, track immunization of infants, and follow up with families to complete the immunizations. The tool, in the form of a simple graphic, democratized health data by making the information available to the community and simplifying the tracking of infants due for immunizations. Most importantly, it engaged the community in the program. This tool is displayed publicly in the village, so that all residents understand the need to start and complete all immunizations for their own children’s health and for the collective health of the community.

During the IMMUNIZATIONbasics project, the tool was tested and revised. By 2006, the number of infants receiving a full schedule of vaccinations in Jharkhand had increased by a factor of four to more than 34 percent.

It was a giant first step, but not enough. Two-thirds of children were still not fully immunized, communities were not fully aware of the need for routine immunization, and the performance of the health system still needed to be strengthened.

In 2011, JSI adapted and modified the MVMH tool through its work on the MCHIP project. The My Village, My Home chart became more complete so that a village could track the entire course of routine immunization each infant requires on one sheet. The tool now ensures that health workers who visit the community for outreach services know the names of each child who needs immunization and can follow up with those families to reduce "left-outs" and drop-outs. The tool helped turn a population-based intervention operating at district and block levels using demographic data into a name-based intervention in villages.

Results
JSI initiated the intervention in Jamtara and Deoghar districts to capture all 2012-2013 births. During the 12 month period after the MVMH tool was introduced, coverage rates for each of the vaccines reached more than 80 percent in these two districts, and only 2 percent of infants were entirely unimmunized, even while India as a whole struggled with a full immunization rate of only 61 percent.

After witnessing the success with the intervention, the government of Jharkhand has used its own resources to provide the MVMH tool to the health centers in every district.


Read the journal article Engaging Communities With a Simple Tool to Help Increase Immunization Coverage in Global Health: Science and Practice.