Reorganizing Child Registers to Improve Immunization Services

Health workers in the country traditionally used record sheets to record child vaccination data, which were then summed up monthly and entered into the Ministry of Health's District Health Information System. However, this method had several limitations, including the inability to verify or correct individual vaccination records, and a lack of information on which child was vaccinated, from what village, when, at what age, or where. As a result, health workers and village health teams (VHTs) struggled to trace children to ensure they received full immunization. With the addition of more vaccines to the vaccination schedule, the accuracy of verbal histories became increasingly unreliable. To address these challenges, the Maternal and Child Survival Program (MCSP) introduced a simplified child register system in over 400 health facilities across 12 districts in Uganda. The new system organizes child registers by village, with the number of pages allocated to each village based on the estimated number of children under one. This approach has significantly improved data quality, with discrepancies between doses of DTP1 recorded on tally sheets and child registers decreasing from 91% to 30% in 2015-2016, and from 63% to 26% in 2016-2017. The reorganized child registers have also streamlined the process of determining which vaccines a child needs on a given day. According to health workers, the new system has reduced the time required to verify vaccination records from 10 minutes to less than one minute. The widespread adoption of the reorganized child registers has been rapid, with health workers recognizing the benefits of improved data quality and reduced workload. The organization of child registers by village has also enabled health workers to ensure that every child in every village receives immunization services. The success of this initiative has been attributed to the collaboration between MCSP with local health facilities and districts, which has emphasized the importance of child registries and simplified the process of implementation.