My Village My Home: A Tool That Helps Communities Track Vaccinations of Individual Infants

The tool is designed to raise awareness and boost demand for immunization services. In India and Timor-Leste, assessments suggested improved vaccination timeliness and coverage when the tool was used. Pilot communities in India had 80% or higher coverage of identified and eligible children for all vaccines, compared to overall coverage in the respective districts during the same time period, which was much lower, at 49% to 69%. The MVMH tool was implemented in two low-coverage districts, Dowa and Ntchisi, in Malawi, starting in the last quarter of 2015. The process involved engaging a local NGO, Parent and Child Health Initiative Trust (PACHI), to assess the interest of traditional village heads and orient them on immunization and their tasks related to monitoring their communities' infants' immunizations. Health facility staff, particularly Health Surveillance Assistants (HSAs), were also oriented on the community monitoring activity. The process worked well in the great majority of communities, but difficulties arose in some cases due to community size or volunteer motivation. The village head and volunteer begin with a census of infants in their community, listing every child, in order of their birth, on the MVMH tool and recording the dates of vaccinations already received. They inform and motivate mothers and fathers about immunization during regular home visits and in meetings and other community activities. Many village heads have proposed local bylaws stipulating penalties for families whose children fall behind in their vaccinations. Official health information system coverage data do not show the impact of the community monitoring and other MCSP actions at district level, but immunization coverage appears to be nearly 100% in communities where infant tracking and monitoring using the MVMH tool is well implemented. An MCSP assessment of its immunization work in Malawi found that every child of over 40 mothers interviewed in eight communities was up-to-date on their vaccinations. The district health team conducted house-to-house surveys in 130 villages, and the results indicated that only 1.6% of infants had not commenced vaccination. Findings from the end line survey conducted in the two districts in 2017 showed that the percentage of children fully immunized has increased from 68% in the baseline in 2015 to 91% in the endline. Village heads and volunteers feel proud of their community coverage and feel responsible for ensuring children in their community are fully vaccinated. The results to date are promising, but not perfect. A minority of volunteers and HSAs are not as effective as they should be, and the issue of incentives needs attention. The quality of coverage data needs much attention so that the true impact of monitoring and other initiatives on coverage can be known. Immunization process indicators in the two districts improved in several areas from 2015 to 2017, including an increase in the percentage of children fully immunized.