Opportunities for Home-Based Immunization Records
By David Brown, UNICEF
Apr 9, 2015
The BID Initiative is on the brink of implementing a national electronic immunization system in Tanzania while countries yet to implement such a system often turn to home-based records for immunization programs. With scarce public health resources and the need for accurate data on immunization coverage, home-based records can be an effective way to track if children are receiving the vaccines they need. However, is there a need for a more durable, coordinated system for home-based records?
Home-based Records and market shaping opportunities moving forward
Home-base records constitute an inexpensive yet effective instrument for systematically documenting the immunization services received by an individual. A revitalized discussion of home-based records is taking place against the backdrop of a dynamic environment with new vaccine introductions that is also dealing with increasingly scarce health resources (human and financial), demographic shifts and calls for improved data quality including more frequent independent validation of immunization coverage through representative population-based household surveys (e.g., EPI cluster surveys, Demographic and Health Surveys, Multiple Indicator Cluster Surveys) to which home-based records are critical for obtaining documented evidence on vaccination history. While these discussions largely centre on gaining a better understanding of the factors related to whether records are made available to caregivers and low levels of retention in the household by caregivers, there is the need for a parallel discussion around how national immunization programmes might collectively ensure the variety of their needs with respect to procuring (perhaps (re-)designing as well) home-based records for their respective annual birth cohorts is matched by a diverse arena of support within a broad market capable of meeting those needs with appropriate quality and efficiency considerations.
The market demand for home-based records is fairly stable, at least on a year-to-year basis. Each and every year, national immunization programmes are charged with vaccinating an annual birth cohort (as well as vaccinating individuals at older ages) with a series of vaccinations recommended by the World Health Organization. During 2014, the estimated global birth cohort totalled nearly 140 million newborns and in theory (if all programmes were using physical rather than electronic home-based records), one would expect national immunization programmes to have procured at least this many home-based records with additions for records that may have been lost or destroyed. This level of demand (in theory) begs the question, are there opportunities at hand for groups of national immunization programmes, either regionally or sub-regionally, to either pool resources to procure durable, high-quality home-based vaccination records at the lowest price — not unlike what has been accomplished for vaccines by the Revolving Fund of the Pan American Health Organization for countries in the Americas or by Gavi, the Vaccine Alliance for low-income countries — or to leverage (sub-)regional markets in a more effective manner?
There is a growing understanding of the challenges that many national immunization programmes are routinely confronted with, such as sub-optimal home-based record designs that may impact on the function of the document, lacking awareness of or access to more durable options that could extend the life of a home-based record as well as complex multi-partner financing of home-based records. These issues are further complicated by lacking authority and decision-making power by some national immunization programmes over their own budgets, in particular how much is or is not spent on recording and monitoring of the immunization services their programme delivers.
Market shaping around home-based records may serve as a key enabler for ensuring national immunization programmes can exercise choice and control over a meaningful range of high quality options that meet their needs and aspirations. At present, there is little if any coordination across countries with regards to the production or procurement of home-based vaccination records. Certainly on one hand the lack of coordination can be understood since, unlike syringes or cotton swabs, substantial variations currently exist in home-based vaccination record content and design across countries. But, this does not have to be the case. Even if the variation remains, there may be advantages to coordinating efforts across countries with regards to accessing durable, water-resistant paper options or design/print services.
Moving forward, ensuring access to a stable supply of durable, high quality and affordable home-based records by all national immunization programmes is seemingly important and it will be critical to leverage the resources of global, regional and national partners as well as the experience of supply chain specialists and others with insights and experience in the market for immunization-related supplies. With an awareness of the successes, challenges, and lessons learned from market shaping around vaccines as well as in other areas, a vision that encompasses regional coordinating groups to stimulate, manage and shape markets for home-based vaccination records with the full engagement of the national immunization programmes from within the (sub-)regions seems within reach. The success of such market shaping will rely on strong partnerships and shared risks as well as a willingness by national immunization programmes to take the lead in a proactive and coordinated manner.
To those with much more expertise in the successes and failures of market shaping exercises that have taken place around vaccines and delivery equipment, I ask, what are your thoughts on the lessons learned that may be relevant for addressing this issue for home-based records?