HOME BASED RECORD [HBR] IN

IMMUNIZATION PROGRAMMES
to combat
Impact of “ANISOSIS” Syndrome
Academic Society Meeting
06-12-2017
by
Dr Narayana Holla; M.D
Asso Professor, Dept of Community Medicine
KVG Medical College, Sullia.
1
 Problem Extent
1. Globally in 2016, 1 in 10 infants not reached, of the 90,1 in 10
did not complete the 3rd dose. (WHO / UNICEF estimate).

2. In India, among the reached, at least 1 in 10 inadequately

vaccinated due to “NIS incompatible schedule”.

3. To a large extent, problem 1 can be effectively solved by

using the tool “IMMUNOGRAM” operating through supportive
supervision (SS-A) approach - documented.

4. To a large extent, problem 2 in the private sector can be

solved through an appropriate WHO compatible “HOME
BASED RECORD (HBR)” – the Combo-Card – (India specific:
ongoing). 2
What is HBR? (Home Based Record): as per WHO
1. It is a medical document,
2. Issued by service provider either
a) while registering the ANC in the field / facility for tracking
from the “womb” – holistic and ideal [Comprehensive
MCP / Taayi-card provided by Govt]
b) on birth at birthing facility [Vaccination Plus card] or
c) on vaccination session site – “Vaccination only card”
3. on which vaccination dates were recorded.
4. maintained in the household
5. to be brought to the vaccination service delivery point at
every visit. 3
 Types:
1. Comprehensive cards – like Mother and
Child Protection card / Taayi-card – issued to the
mother while registering the pregnancy.
2. Vaccination plus cards – in which, messages
/ normal parameters for promoting & monitoring
child heath are printed in addition to vaccination
details.
3. Vaccination only card with only vaccination data.
4
 Characteristics….1
• Simple – easy to understand / language(s).

• Informative + additional health promotive messages.

• Handy and smart – size / pages / sheath / color.

• Comprehensive: include country / state / district

specific vaccines.

• Coverage: infancy to adolescence.

• Consistent: No frequent change in the pattern /

display / core content (Standardized) / availability. 5
 Characteristics….2
• Strengthen RI Programme: include “Taayi–card No.” for
reporting through HMIS & uploading MCTS for improving
coverage,

- linkage No (M.R. No.) for linking with facility based Master

Register,

- Due Date & Date of Vaccination for tracking & monitoring,

- compatibility with NIS.

• Include country specific optional vaccines.

• Facilitate communication: Identification details, Phone

numbers. 6
WHO Vaccine Position
Table for
Global Reference..1

7
WHO Vaccine Position
Table for
Global Reference..2

8
 IAP schedule in gnat format,
NIS compatible version is anticipated. 9
 Chart
for
Display
for
I.E.C in
regional
language
11
 WHAT IS

HAPPENING IN THE

COMMUNITY?
12
ANISOSIS (Dissimilarities amongst cards)

No two cards match with

1. each other,
2. National Immunization Schedule,
3. IAP Schedule (2016).
IMPACT OF “ANISOSIS”..1

14
 IMPACT OF “ANISOSIS”..2

Full Immunization of Children (FIC) below

one year, is the key performance indicator
for review and comparison.

15
IMPACT OF “ANISOSIS”..3

16
 IMPACT OF “ANISOSIS”..4

Such cards are innumerable.

~20 lakh infants in India & ~1.5 lakh
infants in Karnataka, vaccinated in the
private sector are stricken by this
“syndrome” due to lack of standard
vaccination card / record. 17
MITIGATION..1
HBR (Taayi-card) supplied by the
Govt has
1.Sl number for uploading to
MCTS,
2. Vaccines of NIS,
3. Cells for recording due date for
timely mobilization and
vaccination date for monitoring.
No scope for including
optional vaccines;
sharing with private sector
as of now.
18
COMBO-CARD: to combat “ANISOSIS”

19
MITIGATION..2 (Combo-Card)

20
MITIGATION..3 (Combo-Card)

21
 Benefits of Combo-Card
Contentment to

1. the caregivers

2. beneficiaries and the

3. service providers
implementing the programme.
22
 Combo-Card issued to replace confusing
vaccination card issued by private facility.

A post graduate mother could not conclusively tell whether IPV 1 st dose was
administered to her baby at 6 weeks in a private facility but marked as given.
23
Way forward..1

24
 Way forward..2
Hope the RI players of the country -- regulatory
authorities, the development agencies & the
stake holders of the country will perceive this
problem and address the issue by standardizing
the HBR, especially for the private sector as
Government sector is having comprehensive
card / record though without optional vaccines
[protocol barriers over helm child health].
25
 Acknowledgement
• Smt A.S. Sajitha, ANM, RHTC Sampaje for perceiving this long standing problem
and suggesting the long lasting solution on 28-05-2015.

• Doctors- Sharanya, Chaitra, Bhavani, Vindya, Pavitra, Dinesh, A.G. Kulakrni,

Girija, Shivana Gauda, Lalitha, for their contributions in making and fine tuning.

• Dr Kaushik Banerjee & Dr David Brown for their supportive reciprocation.

• Dr Khaji, Ex DD Immunization for naming this Hybrid card as “COMBO-CARD”

and disseminating to the districts for sharing with the private sector.

• Smt Shobha – treasurer AOLE [Academy of Liberal Education] for suggesting to

make an appropriate immunization card for issuing to caregivers.

• Management for printing the card.

• Caregivers who participated in focal group discussion.

• WHO’s Practical Guide for the design, use and promotion of Home Based
Records in Immunization Programmes & vaccine position table.
26
 Dissemination workshop in the
Academic Society Meeting: 06-12-2017

In the regular Academic Society Meeting, impact of

dissimilar (anisotic) vaccination cards on the
beneficiaries, community and the nation – hence the
need for a standard HBR were presented.
27
 Dissemination workshop in the
Academic Society Meeting: 06-12-2017

On behalf of all the ANMs of the country, A.S. Sajitha, now working as
Staff Nurse in the dedicated vaccination clinic of KVG Medical College
is felicitated for perceiving this as a along standing problem and
suggesting me to solve this issue on 28th May 2015 which resulted in
the birth of “COMBO-CARD” as HBR for the private sector in India.
Medical Director, Treasurer AOLE, Dean, Principal, HODs – Pediatrics
& OBG distributed the COMBO-CARD to the mothers.
28
 Viewers’ opinion
On Wednesday 6 December 2017, 9:44:30 PM IST, David BROWN
<david.brown@ brownconsultingroup.org> wrote:
Dear Dr Holla,
Very nice presentation. Thank you for sharing current thoughts and activity from
your group.
Cheers.
David
On Thu, 7 Dec 2017 at 16:04, santosh soans <drsoans@yahoo.co.in> wrote:
Dear Dr Holla,
Very good initiative. Congratulations. I wish you a very best.
with regards,
District Surgeon Belgaum District <dsbelgaum@gmail.com>
To:narayana holla 8 Dec at 8:17 PM
Dear captain Holla,
CONGRATS!!!!! Hope ALLAH make GoI and Karnataka understand your Immunogram
efforts
Dr Husensaheb. Khaji
District Surgeon Belagavi 29
Extra Slides for
continuation

30