Strengthening Implementation of Home-Based Records for Maternal, Newborn and Child Health: A Guide for Country Programme Managers

"For home-based records to have impact on MNCH [maternal and child health], an ongoing effort is required...to ensure that they are available, are being used correctly, and are valued by women, parents, caregivers, health workers and programme managers within the health system."

Countries have many different types of home-based records, which may cover single health areas (e.g., vaccination-only cards) or include more expanded content (e.g., integrated maternal and child health (MCH) handbooks). These documents are used to record an individual's history of health services received and can also provide basic health and development promotion messages. Despite the wide use of home-based records, implementation challenges persist, such as incorrect use of home-based records by health workers or low retention by women, parents, and caregivers, that impede home-based records' potential. With this guide, the World Health Organization (WHO), United Nations Children's Fund (UNICEF), and the Japan International Cooperation Agency (JICA) provide decision-making tools and activities, links to existing resources, and examples from countries that can be used to strengthen processes for planning, design, implementation, and monitoring of home-based records.

The guide is structured to support work on home-based record implementation to: review planning and implementation processes; identify information needed to better understand implementation gaps; and make decisions to address those gaps. Intended for programme managers responsible for maternal, newborn, and child health (MNCH), immunisation, and nutrition within ministries of health, as well as policymakers and stakeholders, the guide features activities and reflections for both the reader and the core team to apply the information shared to the specific country context at national and subnational levels.

The scope of this guide covers the steps in a programme management cycle - namely:

• Planning for activities that strengthen the implementation of home-based records: primarily focused on methods to understand and engage with the 3 user groups [(i) women, parents, caregivers; (ii) health workers; and (iii) programme managers], coordinate with stakeholders, and assess the strengths and weaknesses of the implementation of home-based records with information from routine monitoring or from a situation analysis (see Chapter 2 - Planning for successful implementation of the home-based record; Chapter 3 - Conducting a situation analysis; and Chapter 7 - Monitoring implementation of the home-based record).
• Selecting the content of the home-based record, including designing and pretesting any new or revised element of design or content (see Chapter 4 - Selecting content for the home-based record on the basis of technical priorities and user requirements; and Chapter 5 - Revising and testing the design of the home-based record).
• Strengthening implementation and the operational support processes, including conducting a pilot test for major changes to the home-based record, if needed, plus budgeting and funding, printing, distribution and stock management, capacity-building and supportive supervision, building awareness and promoting use, and coordination across health programmes (see Chapter 6 - Implementing the home-based record).
• Monitoring of implementation of the home-based record in order to track progress, improve implementation processes, and understand if the use of a home-based record is achieving its targets and contributing to MNCH programme objectives (see Chapter 7 - Monitoring implementation of the home-based record).

Each chapter explains a step in the process and includes examples, activities, templates, and decision-making tools that can be used to reflect on how to strengthen implementation of the home-based record. Links to further resources are provided throughout so the reader can obtain more in-depth knowledge on specific topics. The guide is modular and is meant to complement existing tools.

As the resource outlines, 8 success factors can help to ensure that efforts to strengthen the home-based record achieve their intended impact:

1. High-level support is established: Support and buy-in from key stakeholders within relevant ministries and departments are needed to ensure that the home-based record is referred to in national strategies and policy frameworks to increase visibility and strategic alignment.
2. Coordination mechanisms with stakeholders are in place: In order for stakeholders to contribute effectively, a clear definition of roles is important, and regular interactions and discussions are needed.
3. Home-based record content supports health priorities and objectives: The content of the home-based record needs to align with the national objectives and health priorities.
4. Printing, distribution, and resupply are planned and costed: Regular estimates of needs for home-based records are made and included in planning.
5. Budgets are accurately estimated, and sustainable funding is identified: The costs of producing the home-based record and the different operational support processes are identified, and funding is ensured in the government budget.
6. Health workers value the use of the home-based record: Health workers should have a regular supply of home-based records, which they use in their interactions with women, parents, and caregivers, and on which they record information.
7. Women, parents, caregivers, and community members value the use of the home-based record: Women, parents and caregivers should have access to the home-based record, should be able to use the information to make informed decisions about their health, and should retain the record for future reference (e.g., proof of vaccination).
8. Monitoring processes are in place to ensure that objectives are met, users' needs are met, and operational support processes are optimised: Necessary information should regularly be gathered, reviewed, and discussed by the core team to ensure informed decision-making about home-based records.

Web Annexes include:

• A. Blank templates (for printing) for activities included in this guide
• B. Sample interview guides for women, parents, caregivers, health workers and facility managers
• C. Monitoring and supervision checklist for implementation of the MCH record book