Policy Brief: Carrying of Home-Based Vaccination Records to Health Facilities for all Children below 5 years to Reduce Missed Opportunities for Vaccination

Affiliation: 1Uganda Public Health Fellowship Program, Kampala, Uganda

Executive Summary

Reducing Missed Opportunities for Vaccination requires health workers to screen all children below 5 years, reporting at health facilities, irrespective of the reason for visiting the health facilities. Screening for vaccination status is done basing on evidence provided by the Home-Based Vaccination Records (HBVRs). Currently, there is no policy guidance in Uganda on carrying of HBVRs by caregivers during every visit to health facilities. A policy enforcing carrying of HBVRs would enable health work-ers to screen for vaccination status and vaccinate all children that are not up to date with their vaccination schedule

Introduction

Immunization ranks high among the most effective preventive measures against infectious diseases. In Uganda, the routine immunization schedule provides free vaccination for over 10 childhood illnesses. These vaccines are provided at specific intervals as guided by age of the recipient. A record of the vaccines received by the child is made in a Home-Based Vaccination Record (HBVR), which could be a Child Health Card (CHC) or Mother Child Passport (MCP)1. HBVRs are provided to caregivers either during the Antenatal Care (ANC) of the mother or at first contact of the child with immunization services, and are required at subsequent immunization sessions until a child is fully vaccinated, as per the Uganda vaccination schedule. This HBVR provides information on the vaccination status of a child, nutrition and growth monitoring, vitamin A supplementation and deworming status2. The HBVR can be used to; record health services received by the mother during ANC, at delivery and post-delivery, type of vaccine a child has received and the date for the next vaccination3. HBVRs are also known to be motivators for the caregiver to achieve the immunization milestones of the child4. Uganda has set routine immunization coverage targets of 90% at national level and 80% at district level. However, despite the availability of free vaccination services, routine immunization coverage for the various antigens has remained sub-optimal, which has led to failure to reach the required coverage for building the herd immunity necessary to prevent disease outbreaks. The low routine immunization coverage is attributed to a number of reasons, including Missed Opportunities for Vaccination (MOVs). An MOV is defined as any contact with health services by a child or an adult who is eligible for vaccination and with no contraindications, but which does not result in the individual receiving all the vaccine doses for which he or she is eligible5.

Context and Importance of the Problem

A December 2018 UNEPI assessment of MOVs in 19 districts in Uganda found that, of all children below 2 years that had visit-ed health facilities, 87% had an unknown vaccination status, because their HBVRs were unavailable for screening. Reducing MOVs requires health workers to screen all children reporting at health facilities, especially those below 5 years, identify those not up to date with their vaccination schedule and vaccinate them. Screening of these children is based on the information in the HBVRs, which provide documented evidence of the child’s vaccination status. The compulsory carrying and screening of HBVR has been implemented since 2017 by Kangulumira H.C IV in Kayunga district. This practice has led to a reduction in MOVs and an overall increase in vaccination coverage at this facility, currently at 95%. Similarly, caregivers reporting at this facility are now keen to ensure all children are vaccinated since it’s a key requirement for receiving any other health related care for this child at the facility.

Critique of Policy Options

The World Health Organization (WHO) recommends that health workers use every opportunity to screen children below 2 years and ensure vaccination services are provided for those not fully vaccinated5. However, implementation of this recommendation requires caregivers to carry vaccination related HBVRs during every visit to a health facility, irrespective of the reason for this visit6. Currently, caregivers are encouraged to bring these HBVRs, especially during immunization sessions. However, there is no official policy that can be used as backup for health workers, to enforce the carrying of HBVRs and for this reason, caregivers do not prioritize these HBVRs when seeking health care for children, unless the required care is vaccination related. We seek to address this gap by ensuring that caregivers of children below five years of age always carry HBVRs when bringing children to seek any health care services, vaccination related or not.

Policy Recommendations

The MoH and health workers should enforce and ensure that all caregivers with children below five years of age carry with them HBVRs, during every visit to the health facility, irrespective of whether the reason of the visit is to seek vaccination services or not. Similarly, health workers must adopt HBVR screening as part and parcel of diagnosis and treating of children below 5 years.

References

1.Child_Health_Card_UGANDA.pdf.
2.Kisanga, A. FACTORS INFLUENCING UTILIZATION AND RETENTION OF CHILD HEALTH CARDS AMONG CARETAKERS OF CHILDREN 12-23 MONTHS IN RURAL REJAF, JUBA