Revitalizing the home-based record: Reflections from an innovative south-south exchange for optimizing the quality, availability and use of home-based records in immunization systems

When (i) well-designed, (ii) available in adequate supply, (iii) adopted and (iv) utilized appropriately, home-based records (HBRs) complement facility-based records within routine health information systems by providing a standardized form for legibly recording an individual's vaccination history in an organized and consistent manner for future reference and review [6] with the potential to alleviate some of the risks (e.g., missed opportunities for delivering vaccination [7], unnecessarily re-vaccination [8]) associated with absent or suboptimal documentation within health facilities. [...]this is particularly the case in today's rapidly changing environment where immunization schedules are increasingly more complex with new vaccine introductions and requisite doses added as well as new delivery approaches, such as the use of periodic intensification of routine immunization and supplementary immunization activities (including campaigns for which the World Health Organization encourages doses be recorded on the HBR [10]) to deliver routine and supplemental immunization services (>200 vaccine introductions and campaigns occurred in low- and middle-income countries eligible for support from Gavi, the Vaccine Alliance during 2011-2015 [11]). [...]we must better understand the factors influencing interruptions in timely supply of HBRs (e.g., forecasting, financing, distribution); factors impacting long-term, responsible HBR ownership (e.g., document design, owner's understanding of purpose and value of the document) and appropriate utilization by health workers (e.g., document design, absent or lacking pre-/in-service training on the appropriate use; individual behaviour of health workers and institutional behaviour of the health system vis-à-vis use of and value towards HBRs).