Geographic Scope: Worldwide
Countries: Benin, Democratic Republic of Congo, Nepal, Zimbabwe
Client(s): Bill & Melinda Gates Foundation
Service: Technical Assistance
Technical Expertise: Health Systems Strengthening, Immunization, Maternal, Newborn & Child Health
Home-based records (HBRs) (also known as: child health cards, maternal-child health booklets, vaccination cards, or other names) are an important data collection and monitoring tool serving multiple purposes for the caregiver, health worker, and health system. These records can: aid health workers in documenting and tracking which vaccines have been given to a child; empower a parent or caregiver to play a role in the health of their children and to have documented information on their child’s vaccination history; and serve as public health monitoring tools on vaccination coverage through household and other surveys (with increasing importance, now that more vaccines/antigens are in the system).
JSI Research & Training Institute, Inc. received a two-year grant (2015-2018) from the Bill & Melinda Gates Foundation to explore opportunities to improve the availability and use of HBRs through operations research in four countries: Benin, Democratic Republic of Congo, Nepal, and Zimbabwe.
Findings, best practices, and tools from these activities, and discussions with other countries, have been documented. These resources are intended to support other countries as they explore more effective uses of their HBRs.
As more vaccines are being incorporated into national immunization programs (with multiple antigens being given at each contact), this record of which particular antigens an individual has received is increasingly important—both for personal record-keeping as well as for cross-checking during surveys and other monitoring or evaluation visits (notably given potential challenges with parental recall).
Multiple problems have been identified including:
- shortages and stockouts in records, resulting in infants/caregivers that never receive a HBR;
- lack of information or emphasis on the importance of the card to caregivers, resulting in caregivers losing, damaging, or forgetting to bring HBR to the health facility; and
- HBRs not being filled out accurately or completely by the health worker.
The goal of this project was to systematically collect and review available data and contextual information in order to understand how HBRs are used and viewed by each of the key user groups. Priorities for program interventions were identified to improve the availability and utilization of HBRs from immunization service delivery and data quality perspectives. A situational analysis of the current status of HBRs in each country was undertaken followed by the design and implementation of activities targeted to the challenges identified for each country. Key areas of focus included:
- redesigning HBRs
- stock management
- data triangulation and use
- capacity building of health workers
Summaries of our activities and finding in all four countries are available here:
- DR Congo
Visit our resources page to watch a 5-minute overview of our learnings and the importance of HBRs and to download other technical resources, documents, and tools.