Engaging Communities with a Simple Tool to Help Increase Immunization Coverage

"Use of a simple, publicly placed tool that monitors vaccination coverage in a community has potential to broaden program coverage by keeping both the community and the health system informed about every infant's vaccination status."

This article describes an approach that aims to raise awareness and boost demand for vaccination. Developed in India, the My Village Is My Home (MVMH) tool, known as Uma Imunizasaun (UI) in Timor-Leste, is a poster-sized material used by volunteers and health workers to record the births and vaccination dates of every infant in a community. (See Related Summaries, below). In brief, MVMH is a large, poster-sized record on which every infant in a community has his or her own row, with spaces for the child's name, date of birth, and dates of each vaccination. Introduction of the tool in 5 districts of India (April 2012 to March 2013) and in 7 initial villages in Timor-Leste (beginning in January 2012) involved the training of local volunteers to list all infants' names and birth dates and to record the date of each vaccination. They learned the ideal vaccination schedule and the required intervals between successive doses of polio and pentavalent vaccines, as well as to know how to tell when a child was eligible or late for a particular vaccination. As part of this training, they were encouraged to motivate caregivers of such infants to take them to community health centres, health posts, monthly integrated health outreach services, or mobile clinics to receive those vaccinations.

In 3 districts of India, the researchers analysed data on vaccination coverage and timeliness before and during use of the tool; in 2 other districts, analysis was based only on data for new births during use of the tool. In Timor-Leste, the researchers compared UI data from the 3 villages that had the most complete data (vaccination registers) with data for the same villages from the previous year. In both countries, they also obtained qualitative data about perceptions of the tool through interviews with health workers and community members.

Assessments in both countries found evidence suggesting improved vaccination timeliness and coverage. In India, pilot communities had 80% or higher coverage of identified and eligible children for all vaccines. In comparison, overall coverage in the respective districts during the same time period was much lower, at 49% to 69%. In Timor-Leste, both the number of infants identified and immunised rose substantially with use of the tool compared with the previous year (236 vs. 155, respectively, identified as targets; 185 vs. 147, respectively). "Qualitative feedback indicates that use of the tool helped increase awareness of vaccination and a sense of shared responsibility between health services and communities. Everyone involved - local health workers, volunteers, and caregivers - felt very positively about the tool and its impact on vaccination in the communities, although some vaccinators in Timor-Leste noted that updating the tool entailed time and extra work for them."