Bill & Melinda Gates Foundation

Could Better-Designed Child Health Records Be the Spark That Starts a Prairie Fire?

February 08, 2014

Sometimes a 10-cent piece of paper is the difference between a life and a death. Child health records can play a vital role in keeping children around the world healthy.

Within immunization programs, records are needed to maintain health histories for children, identify those who need to be immunized, and find those who have missed immunizations or are off schedule. Unfortunately, child health records often suffer from poor accuracy, low availability and non-use.

In December of last year, the Bill & Melinda Gates Foundation funded Center of Knowledge Societies to conduct focus groups in Kenya, Indonesia and India in order to better understand why. Here is some of what they heard from health care providers in these communities

  • “Illiterate mothers bring multiple children with multiple cards; [these mothers] cannot link individual children to their [respective] cards…” –Health provider, Kenya
  • “I need more information about vaccine benefits.” – Caregiver, Indonesia
  • “If the information on the card was in images, it would be [easier] for us to understand.” –Caregiver, India
  • “[There is currently] no slot for indicating missed vaccines. [The ‘date of vaccination’ field] is left blank, mothers are told verbally to come back for it. This… might cause a child to miss a vaccine.” –Health provider, Kenya
  • “It’s difficult to calculate [date of next vaccination] on a phone calendar.” –Health provider, India

These same focus groups were also asked to evaluate high-potential submissions from the Records for Life contest that could help address some of these challenges. Launched last year, the Records for Life contest challenged the global community to re-design the child health record in order to better meet the needs of providers and caregivers, with a focus on immunization information.

More than 300 teams from 41 countries proposed ideas. Many of these designs suggested ways to make records clearer for parents, more flexible for health workers, and more durable. The Center for Knowledge Societies will be publishing a full report later this month, but early feedback from the focus groups and technical reviewers include the following insights:

  • Photographs of the child turn the record into meaningful family memorabilia, which could increase record retention; it will also help with identification of the child
  • Providers and caregivers preferred data to be laid out in one direction rather than in a matrix 
  • Providers and caregivers wanted a prominent “Date of next visit” data field; in a recent field visit in Zambia, one nurse was creating her own “Date of next visit” innovation because she viewed it as too necessary to leave off
  • To prepare for the transition to a digital system and enable retro-active data entry, block letters and scanning technologies were favored by the technical panel 
  • For health information, minimal text and detailed, realistic images were generally preferred.

The 10 finalists were reviewed by Melinda Gates, Co-Chair, Bill and Melinda Gates Foundation; Margaret Chan, Director-General, World Health Organization; Anthony Lake, Executive Director, United Nations Children’s Fund; Walt Orenstein, Associate Director, Emory University Vaccine Center and former Director of the United States Immunization Program; Robert Fabricant, Vice President of Creative, Frog Design; and Jocelyn Wyatt Co-Lead  and Executive Director , Based on their final selection, the grand prize winner was announced at the international Interaction Design Association Conference in Amsterdam on February 8, 2014.

Chairman Mao once said that just one spark can light a prairie fire. Whatever your views on Mao, his analogy is a powerful way to describe the catalytic work that we strive to do in the field. Are child health records that one spark? They might be if EPI managers become inspired by the potential of the child health record; if they begin to incorporate new ideas into how records are designed; If the new designs result in better immunization coverage, as suggested by preliminary research done by Hussain Usman in Pakistan; if the success of these new designs builds momentum to re-evaluate the design of health information systems more broadly; if the newly designed information systems lay the groundwork for an eventual transition to a fully digital system. Then yes, re-designing the child health record might be that one, tiny first change that opens the door for a series of wider, even more transformative changes.

To learn more about how you can get help get life-saving vaccines to children who need them, visit the Shot@Life campaign.

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