Home-Based Records (HBRs) are an important data collection and monitoring tool used by parents, health workers, and health administrators to track a child’s vaccination history. JSI’s HBRs project, funded by the Gates Foundation, is currently testing ways to improve availability, use, and design of HBRs in four countries.
In Zimbabwe, the project is working closely with the Ministry of Health and Child Care (MOHCC) to promote the use of HBRs (known locally as Child Health Cards) to improve timely immunization and tracking in 10 health facilities in Manicaland Province. We also collaborated with the USAID-funded Maternal and Child Health Integrated Program (MCHIP) to support the Ministry of Health and Child Care to introduce My Village My Home (MVMH), a tool which MCHIP developed to provide a visual depiction of the immunization status of all infants born in a village. In addition to working closely with vaccinators, we have also focused on the role of village health workers (VHWs) and village heads in ensuring that all the children in their communities are up-to-date on immunizations.
During a recent supportive supervision visit, I met with Chamwaita Musaneya who is from a remote communal area in Chipinge district. She was chosen by the community to spearhead health promotion and disease prevention activities at the grassroots level and is the link between 150 households and the formal health system. Her duties include educating the community on the importance of getting children immunized, water, sanitation, and hygiene, HIV/AIDS, and malaria diagnosis, treatment, and referral.
Musaneya counsels parents on the importance of the Child Health Card as a primary record of the vaccines a child has received. She also has the responsibility of tracking all 65 children under five years of age in her area to make sure they are current on their vaccinations and to refer defaulters (children who have received at least one vaccination but have not returned for additional ones).
Although she has been a VHW for the past 13 years, it was only after an orientation on the importance of the Child Health Card and the MVMH tool that Musaneya realized that many children didn’t have all their vaccinations and there were other children she was not even aware of.
Following the orientation, Musaneya revitalized the VHW immunization register that she had not used in several years. Information from the register also needed to be transferred to the MVMH tool which is kept by the village head. “The village head now supervises me and together we make sure if there are any missing bricks [antigens] on the [MVMH] tool, then I have to give valid reasons for defaulting and immediately follow up with the children.” she said. “ If the child remains unimmunized for no good reason, then the parents get fined by the village head. In my village, the fine is a cock or a goat depending on the duration of defaulting.”
At the end of every month, Musaneya updates her register and the MVMH tool. She adds new births, lists transfers into and out of the community, and specifies reasons for children’s absence (e.g. travel or death of the child). Musaneya then discusses any defaulters with the village head who in turn consults with the caregivers who refuse to get their children vaccinated.
This partnership with the village head has made Musaneya’s job easier, as it had been difficult for her to convince people on her own to make sure their children are properly vaccinated. The village head has a lot of authority bestowed on him by the government and this gives him the power to enforce rules and regulations.
During scheduled monthly meetings, Musaneya takes her register to Mutema Clinic where she has an opportunity to compare the information in it with that in the MHMV tool and the health facility register. If the health facility register shows more children or some children who received additional immunizations, Musaneya then updates her register and the MHMV tool. Sometimes the health facility register needs to be updated based on information gained by tracking Child Health Cards. “I might also have seen Child Health Cards for children from my village vaccinated somewhere else but [who] are not in the [health facility] register.” explains Musaneya. “I inform the nurse so that she also updates records in the facility register.” The monthly register comparison allows for the harmonization of all the immunization tracking tools and enables all the health personnel to have the most up-to-date data.
To help ensure successful vaccination services and tracking within the community, all children have to possess a well-documented Child Health Card. In Musaneya’s village, all the children under 5 now have Child Health Cards which she can regularly cross-check to ensure there are no missing bricks on the My Home My Village tool resulting in a “weak house/community.”