Coordination and Implementation of Child Health Record Redesigns (Home-Based Records)

Dates: 2015-2018

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) 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).

As noted in the recent research by David Brown and others, “the child immunization card is too often underutilized or inappropriately used by parents and health care workers and therefore does not always fulfill its intended purpose.” Multiple problems have been identified including:
1) shortages and stockouts in records, resulting in infants/caregivers that never receive a HBR;
2) 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
3) HBRs not being filled out accurately or completely by the health worker.

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).

JSI Research & Training Institute, Inc. received a two-year grant from the Bill & Melinda Gates Foundation to explore opportunities to improve the availability and use of HBRs.

JSI will generate evidence and provide guidance to promote advocacy for and country-focused experiences on the policy/stakeholder pathway for redesigning home-based records as well as for low-cost interventions to strengthen card availability and use beyond the design. This project is documenting past successful redesign efforts (to better understand the processes previously used by selected countries that have successfully redesigned their home-based records) as well as surveying and working with countries for their inputs on the needs and processes to be followed for a HBR redesign. It will include a package of materials for countries undergoing (or planning to undergo) the HBR redesign process, including a report on past HBR redesign experience and lessons learned, an easy-to-follow model to help guide countries, and supplementary materials such as a checklist, stakeholder roadmap, and simple, adaptable templates for improving HBR use. These materials will be tested in at least two countries where JSI will coordinate the redesign process. To complement the redesign process, JSI will also test non-design elements to improve HBR availability and use in an additional two countries.

These findings will be used to create a country-centered HBR mainstreaming and valuing approach, to emphasize and strengthen the link of these often paper-based tools for caregivers and individual infants to improvements in routine immunization reporting and community linkages with services from facility levels. This learning will be shared by the implementers, including representatives from the countries themselves, for global and cross-country experience sharing. This activity will provide supplemental and country-tailored guidance as a complement to the recently released WHO tool on “Practical guide for the design, use and promotion of home-based records in immunization programmes” and the Gates Foundation’s work around “Records for Life.”


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