REVITALIZING THE HOME-BASED RECORD An initiative within the global immunization community

Transcription

1 REVITALIZING THE HOME-BASED RECORD An initiative within the global immunization community 10 th International Conference on Maternal and Child Health Handbook 2016 November 25 Tokyo, Japan

2 a reminder children need to be protected from vaccinepreventable disease through timely vaccination important for healthcare workers to deliver and caregivers to keep legible, complete records of the vaccinations that a child receives this is particularly true given recent increases in the number of vaccinations in recommended immunization schedules over the past 15 years (see figure next slide) evidence suggesting documentation of vaccinations on cards goes back to 19 th century with smallpox WHO s Expanded Programme on Immunization, 1974

3 Number of vaccines/antigens introduced in national immunization schedules compared to July Selected antigens are : Diphtheria, Tetanus, Pertussis, Measles, Polio - universal use Hepatitis B, Heamophilius Influenza type B, Pneumococcal conjugate Rotavirus Rubella 0 2,650 5,300 Kil 5 antigens (DTP, Measles and Polio) 6 antigens 7 antigens 8 antigens 9 antigens 10 antigens Not applicable Not available Data Source: WHO/IVB Database, as at 29 September 2016 Map production: Immunization Vaccines and Biologicals, (IVB), World Health Organization Date of slide: 29 September 2016 The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved 2015

4 decisions need information decision making in primary care requires appropriate data are available (or delivered) in a timely fashion to properly authorized users when the user needs the data routine administrative immunization information sources are often inconsistent, incomplete, and/or inaccurate for frontline health workers delivering immunization services, each child s health record (eg, vax hx) must be readily available, complete and accurately reflect prior care received as well as indicating what remains home-based records provide one important solution

5 home-based records fill gaps when the document is well-designed and of durable form resistant to harsh environments readily available in the right quantity, in the right place at the right time appropriately utilized by health workers, meaning that it is legibly completed at the time of service delivery to reflect the care delivered and is returned with appropriate counselling and education about what services were delivered, what to expect (ie, side effects or complications) and when to return for next visit; widely adopted, valued and understood by individuals or their caregivers in order to empower and facilitate their engagement in primary health care services.

6 understanding HBR functional design 2013 online HBR repository review of HBRs Records for Life crowd sourcing HBR redesign qualitative research focus groups with health workers, caregivers visual literacy, iconography, relationship with HBR, facilitate unique id, format and layout, form material, colour, transitions to digital, etc, etc

7 Records for Life Grand Prize Winning Design David ODonnell Elena Valen.ne Andrew Bates Nick Maschinski Arielle Deane Tiffany Huang Amy Guterman On behalf of GravityTank

8 WHO Practical Guide for HBRs 2014 WHO working group formed to take some of what was learned in Records for Life contest and put together a practical guide for country programmes 2015 document published, but it is a living document and will evolve as we learn from experiences in the field Available on WHO at monitoring_surveillance/ routine/homebasedrecords/

9 we continue to learn: taking the knowledge from Records for Life and HBR Guide to the field Colombo, Sri Lanka workshop, March 2016 Afghanistan, India, Nepal, Pakistan, Sri Lanka (exemplar) participants guided through user centred approach focused on learning local context and gaining first hand knowledge through observation and active discussion to identify problems and then explore, develop and implement user centric solutions prototype development and implementation plan

10 we continue to learn: taking the knowledge from Records for Life and HBR Guide to the field process is being repeated in the WHO African Region with selected countries in February 2017 outcomes are focused on transferring the process of a usercentred approach to root problem identification and solution exploration, development and implementation documentation of the Colombo exercise can be found at:

11 merging public health and user centred design approaches to address HBR needs public health approach ~ using evidence to define problem ~ identify factors that increase risk and/or are protective ~ develop and test preventive strategies ~ assure widespread adoption (policy, programme) human centred design is user centred problem solving ~ structured, systematic information gathering ~ empirical measurement and testing prototypes with users ~ iterative design with repeated design, modify and testing process The evolution from design to design thinking is the story of the evolution from the creation of products to the analysis of the relationship between people and products, and from there to the relationship between people and people. Tim Brown, Change by Design

12 merging public health and user centred design approaches to address HBR needs survey data shows current ownership problems ~ understanding the motivations / incentives and value placement on HBR among those who retain document ~ understanding how caregivers are using the HBR and what their needs are to ensure functional design meets needs country reports and survey data show stock-out problems ~ addressing supply side challenges to prevent stock-outs field observations identify problems with HBR durability; cost of durable paper / protective options often cited ~ explore market shaping of durable paper products at regional and sub-regional levels research highlights importance of communication and trust between health worker and caregiver ~ understanding health worker processes and needs with regards to recording, counselling and education

13 developing a business case for investment in home-based records (EPI perspective) HBRs often not deemed critical part of immunization service delivery, not a programme priority short-run costs of HBR printing are often cited as underlying reason for suboptimal stock availability unfortunately, short-run perspective may overlook potential cost savings that could be achieved ~ reduce waste (e.g., avoidance of unnecessary revaccination vis-à-vis cost of fully vaccinated child) ~ improve efficiency (e.g., avoid missed opportunities for vaccination vis-à-vis cost of investigating and responding to disease outbreaks) HBRs and hypothetical cost savings due to avoidance of revaccinating children. J Vaccines & Immunization $ avings $

14 short-term activity draft roadmap for future activity around understanding and improving availability, adoption / utilization, functional design needs ~ research, implementation, policy uptake draft a common sense business case ~ as global level seeks additional resource partnerships ~ to facilitate dialogue of programmes with investment challenges develop advocacy kit to facilitate a common outward message and vocabulary when communicating among ourselves in immunization, child survival and global health more broadly ALL of this activity is moving forward sensitive to the ongoing WHO guidance development process with eye towards feeding into it

15 resources WHO Home-based records and Practical Guide document routine/ homebasedrecords/ Home-based record repository Home-based record ownership (ever/current) tracking Open HBR wiki TechNet Forum (Technical Network for Strengthening Immunization Services) Bill and Melinda Gates Foundation Records for Life Contest Combined.pdf

16 Thank you Image credit: UNICEF/BANA /Siddique