Using “Tracking Bags” for effective follow-up at Saroa subcenter in Mandi

If micro planning is at the heart of the Universal Immunization Programme (UIP), then managing and implementing it with effective follow-up is the mind and soul of the programme. With an annual birth cohort of 26 million, a large proportion of children remain deprived of full immunization. These are children who would otherwise be easily covered if checked upon regularly as per the National Immunization Schedule. 

The National Family Health Survey (NFHS-3) reported the large disparity between BCG (vaccine administered against tuberculosis) coverage at 78.2% and the national Full Immunization Coverage at 43.5%. Immunization registers, and more importantly, the Mother and Child Protection (MCP) cards, are critical for effective follow-up of eligible children. Immunization registers receive some amount of the health workers’ attention, but they too, are often left behind due to their bulky size. Moreover, immunization cards, particularly counterfoils, are often neglected. 

Based on these field observations, this issue is being addressed in the “Immunization Handbook for Health Workers”. It includes instructions for health workers on tracking and follow-up of due beneficiaries and dropouts.

A hill town comes up with a unique innovation to address the issue of drop-outs

Himachal Pradesh’s success in implementing UIP was possible not only due to effective micro planning, but also involved effective follow-up at the ground level. Saroa is a remote, high-altitude village located about 40 km from the hill town of Mandi. It has a subcenter, which reports one of the highest immunization coverage in the area and is an example of how using a simple “tracking bag” has made follow-up easier and more effective. 

A cloth tracking bag, comprising of 14 pockets, provided the basis of preparing a session-wise name-based list of due beneficiaries for sharing with health workers, especially the AWW/ASHA/Mobilizer. It helped estimate the logistics required. The first 12 pockets indicated each of the 12 months of the year. Counterfoils were filled in the pocket indicating the month when the next vaccine was due. For example, if a child received Penta 1 in January, Penta 2 was due in February. Thereafter, the counterfoil was updated and placed in the pocket for February.

When the Penta 2 dose was administered in February, the counterfoil was updated and moved to the pocket for March, when Penta was once again due. The 13th pocket was meant for placing counterfoils of beneficiaries who had left the Health Worker’s catchment area or expired. The 14th pocket was for filling counterfoils of fully immunized children.

At the end of each month, cards remaining in the pocket for that month represented dropouts who needed to be followed up or moved forward to the next month’s pocket.  This simple act  ensured that due follow-ups were completed, and no eligible pregnant woman or child was deprived of vaccines.