JSI’s Home-Based Records (HBR) project worked from 2015-2018 to explore the improvement of availability and use of home-based records (also known as child health cards or vaccination cards) through operations research in four countries. The project supported the redesign, monitoring of stock management, data triangulation and use, and capacity building of health workers in Benin, the Democratic Republic of Congo (DRC), Nepal and Zimbabwe. During the project period, findings, best practices, and tools developed from activities and discussions with these four, as well as other countries, have been documented. These resources are intended to support other countries as they explore more effective uses of their own HBRs.
Home-based records 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 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).
In 2015, JSI received a two-year grant from the Bill & Melinda Gates Foundation to explore opportunities to improve the availability and use of HBRs in four countries: Benin, DRC, Nepal and Zimbabwe.
As more vaccines are incorporated into national immunization programs (with multiple antigens being given at each contact), these vaccination records 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 during the course of the project, 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 use of HBRs from service delivery and data quality assurance perspectives. A situational analysis of the current status of HBRs in each country was completed, followed by the design and implementation of activities targeted towards individual challenges identified by each country.
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