Using Defaulter Tracing Tracker Shelves Model Targeting Young and Adolescent mothers to increase Utilization of Immunization Services in Kwale County

Emmanuel Katama1, Elizabeth Omondi, Francis Nanga1, Happiness Oruko1, Felix Makasanda, John Kutna1

Background: Immunization defaulter tracing has been a challenge in most rural parts of Kwale County due to inefficient approaches such as unstructured tracing of defaulters especially the young and adolescent mothers, no proper tracking records and generally reactive defaulters tracing utilized to access lists of defaulters by Community Health Volunteers (CHVs) who are the primary actors. The CHVs are also not motivated in following up on defaulters because of the many processes and poor categorization of the defaulters. The delays put defaulters at risk of being denied basic rights to access immunization services. This abstract highlights the use of targeted defaulter tracing tracker shelves by CHVs to increase utilization of the immunization services among the young and adolescent mothers.

Description of Intervention: Before the intervention CHVs would trace the young and adolescent mothers’ defaulters whom they met by chance during the household visits. CHVs would at times run through the defaulters register and categorise the defaulters per antigen and timelines. The facility health care workers had little information on the true status of defaulters in the facility, and whether these were true defaulters or clients who had received services or transferred to other facilities and not accounted for in the facility. The model identified each of the shelve by the villages within the catchment of the facility, and CHVs oriented on its use in identifying defaulting children. This ensured that all these gaps were covered by ensuring children attend appointments at the right time by categorising the young and adolescent mothers defaulting children per village per CHVs for easy follow up. Defaulter shelves representing every village manned by CHVs within the facility coverage are established. The shelves will have colour-coded cards coloured to represent various situations; red for lost-to-follow-up, yellow for immunization defaulters traced and green means being on the right track, and blue for transfer outs. On a weekly basis, each CHV check for cards of defaulters within their shelves and trace them in the community. Feedback on defaulters traced will be reported during monthly community-facility feedback meetings.

Lessons Learnt/. The model will result in:

  1. Ease defaulter tracing at community level by avoiding a lot of paper work records since all details are written in the pluck cards.
  2. Motivated CHVs leading to improved efforts since they feel responsible for specific villages and young and adolescent mothers assigned to them and
  3. Ease in planning Interventions for targeted villages based on the number of defaulters.

Conclusions/next steps: The model is a simple, low cost and efficient process that reduces on time spent for planning, reduces on paper work and also forms as a motivation for CHVs who would compete on ensuring they do not have defaulters in their catchment. It will also enhance proactiveness in reminding the mothers of children due for immunization to reduce defaulter rate.

Abstract authored by Emmanuel Katama, Elizabeth Omondi, Francis Nanga, Happiness Oruko, Felix Makasanda and John Kutna.

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