Author: Coscar Zvamashakwe, JSI 

Home Based Records (HBR) are an important data collection and monitoring tool used by parents, health workers, and health administrators to know which immunizations a child has received to-date along with other health history. JSI’s HBR project (funded by the Bill & Melinda Gates Foundation) [KK1] is currently testing ways to improve availability and use in 4 countries along with looking at the process of redesigning HBRs. 

In Zimbabwe, the project is working closing with the Ministry of Health and Child Care (MOHCC) to promote the use of HBRs (known locally as Child Health Cards) to improve timely immunization and tracking in 10 health facilities in Manicaland Province. We also collaborated with the USAID-funded Maternal and Child Health Integrated Program (MCHIP) to support the Ministry of Health and Child Care to introduce My Village My Home [KK2] (MVMH), a tool which MCHIP developed to provide a visual depiction of the immunization status of all infants born in a village. Along with working closely with vaccinators/health workers, we also have focused on the role of Village Health Workers (VHW) and village heads in ensuring that all children in their communities are up to date on immunizations. 

During a recent supportive supervision visit, I was able to meet Chamwaita Musaneya, who is from a remote communal area in Chipinge district, Zimbabwe. She was selected by the community to spearhead health promotion and disease prevention activities at the grassroots level and is the link between the community and the formal health system. She serves 150 households and her duties include educating the community on the importance of getting children immunized, personal hygiene, water and sanitation, HIV/AIDS, malaria diagnosis, treatment, and referral, amongst others. Chamwaita counsels parents on the importance of the Child Health Card as a primary proof of record and history of which vaccines a child has received. She also has the responsibility of tracking all 65 children under five years of age in her catchment area to make sure all of their vaccinations are up to date and also to refer defaulters (children who have received at least one vaccine but have not returned for the additional vaccines). 

Although she has been a VHW for the past 13 years, it was only after an orientation on the importance of the Child Health Card and the MVMH tool for community tracking of immunization status that Chamwaita realized that many children were not up to date and that there were children she was not even aware of.

Following the orientation on Child Health and MVMH held at the health facility that she reports to, Chamwaita revitalized the VHW immunization register which she had not used in several years. Information from the register was needed to also be transferred onto the MVMH tool (which is kept by the Village Head). She explained that “The Village Head now supervises me and together we make sure if there are any missing bricks [antigens] on the [MVMH] tool, then I have to give valid reasons for defaulting and immediately follow up the children. If the child remains unimmunized for no good reason then the parents get fined by the Village Head. In my village, the fine is a cock or a goat depending on the duration of defaulting.”

At the end of every month, Chamwaita updates her register and the MVMH tool, adding new births, transfers into the community and transfers out, and specifying reasons for children’s absence (e.g. travel or death of the child). She then discusses with the Village Head if there are any defaulters refusing to get their children vaccinated. If caregivers remain adamant not to vaccinate their children, they are then consulted by the Village Head. This close partnership with the Village Head has made Chamwaita’s job easier, as it had been difficult for her on her own to convince people to get their children vaccinated. The Village Head has a lot of authority bestowed on him by the government, and this gives him power to enforce rules and regulations. 

To help ensure successful vaccination services and tracking with the community, all children in the village have to be in possession of well documented Child Health Cards which are well kept and legible. In Chamwaita’s village, all of the children below 5 years now have Child Health Cards which she can regularly cross-check to ensure that there are no missing bricks on the My Home My Village tool resulting in a “weak house/community”.