Results from a Survey of National Immunization Programmes on Home-Based Vaccination Record Practices in 2013

"Although immunization status is recorded in facility-based registries (electronic or, more often, paper-based) in many countries, the home-based record remains an important tool for documenting immunization services received by much of the world's annual birth cohort."

As part of a series of activities conducted by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) to further understand the availability and utilisation of home-based records (HBRs), in January 2014, WHO and UNICEF sent a 1-page questionnaire to national immunisation programmes in 195 countries to gather information on the use of HBRs during 2013. The questionnaire sought information on type of record used, number of records printed, whether records were provided free of charge or required by schools, whether there was a stock-out and the duration of any stock-outs that occurred, as well as the total expenditure for printing HBRs during 2013.

The authors explain that an HBR is a document (more often paper than electronic) issued to an individual person by an official authority (e.g., a national, provincial, or district health department) and retained by the individual or their caregiver, on which vaccinations received by that individual through routine immunisation (RI) services and supplementary immunisation activities (SIAs) from all health care providers are recorded. "Home-based records foster coordination and continuity of immunization service delivery between service providers, facilitate communication between health workers and caregivers and support public health monitoring."

Analysing the surveys sent from the 138 countries whose HBR were completed and eligible for this analysis, the researchers found that HBR types varied across countries: vaccination-only cards: 23.1%; vaccination plus growth monitoring records: 22.4%; child health books: 34.7%; combination of these: 19.5% countries. HBRs were provided free of charge in 89.8% of respondent countries. HBRs were required for school entry in 44.9% of countries. Nearly a quarter of countries reported HBR stock-outs during 2013. Computed printing cost per record was <US$0.50 in the 69% of countries that provided information on this measure.

An excerpt from the Discussion section of the report follows:
"The availability of electronic immunization registries will increase as the global immunization community further engages with the growing momentum of technology innovation and integration in public health to improve child immunization recording and monitoring of immunization status, but parallel paper-based health record systems are likely to remain for the foreseeable future in many countries as the transitions to registries will be incremental and take time to be fully implemented. Even when fully implemented electronic immunization registries are in place, a role may remain for home-based records as a durable resource for caregivers in those instances where different national systems are not able to communicate with each other....Home-based records offer a simple, appropriate and relatively inexpensive means to foster coordination and continuity of immunization service delivery while facilitating communication, promoting childhood immunization, educating caregivers about their child's immunization status and stimulating demand for services that complement facility-based recording practices. As such, on-going discussions of sustainable health system strengthening, immunization system performance improvement and data quality improvement are encouraged to incorporate home-based records as a part of their strategic efforts."