Conducting a Situational Analysis and Engaging Stakeholders on Home-based Record Availability and Use

Home-based records (HBRs), or child immunisation cards, are a data collection and monitoring tool serving multiple purposes for the caregiver, health worker (HW), and health system. Research has found that the HBR is often underutilised or insufficiently used by HWs and caregivers and therefore does not always fulfill its intended purpose as a tracking and reporting tool. Yet as more vaccines are being incorporated into national EPIs (Expanded Programmes on Immunization), this record of which particular antigens an individual has received is increasingly important. This document from JSI's Coordination and Implementation of Child Health Record Redesigns Project outlines the importance of conducting a situational analysis and the process behind it.

The resource covers the following topics, with instructions provided in a stepwise fashion:

• Why a Situation Analysis Is Needed
• Conducting the Desk Review
• KAP [Knowledge, Attitudes, and Practices] Study or Operations Research on HBR
• Engagement and Discussions with Stakeholders and Partners
• Using Results of the Situational Analysis - The Importance of Agreement and Process
• Annex 1: Summary of HBR Findings
• Annex 2: Interview Guides for Key HBR Users
• Annex 3: Tool to Review Quality and Completeness of HBRs

In text boxes throughout, the reader will find country HBR operations research examples and country findings from stakeholder discussions.

"Following are some suggested strategies for improving HBR availability, monitoring and use....These strategies can be used to help guide further HBR-related interventions and activities at various levels of the health system and with health staff, CHWs [community health workers], volunteers, civil society organizations, private sector facilities, and partners.

1. Strengthen MOH [Ministry of Health] and partner efforts to (a) assure that HBRs are printed and disseminated at all levels for zero stock outs and (b) that the HBR are distributed to all pregnant women/newborns...;
2. Conduct field monitoring/supervision of HBR availability and use with facilities;
3. Assure health system and HW monitoring and tracking of HBR use with communities and CHWs (including providing job aids on HBR and training/refresher training on use of the HBR and its importance and value for the different audiences);
4. Conduct key informant discussions and periodic exit or household interviews with caregivers - to see if HBR is available, if they understand content, and if HBR is up-to-date with content that is to be entered by HW;
5. Include in HMIS [health management information system] and immunization data reporting/review the correlation of HBR data with registers and defaulter lists (spot checks, monthly review, DQA [data quality assessment])."