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Supporting community village health teams and local leaders on the defaulter tracking project strategy

AFENET took part support supervision activities in Bukomansimbi, Nakasongola, and Hoima districts in Uganda to support and implement Defaulter tracking project activities. This was held in conjunction with district health teams, and village health teams (VHTs) alongside residents of the Uganda Field Epidemiology Training Program (FETP). The support supervision visits were held at various childhood immunization health facilities to review child registers, identify and line list defaulter children and zero children for community follow-up.

As recommended by the World Health Organization (WHO) immunization delivery should continue as an essential health delivery service, especially during the COVID-19 pandemic period. Despite the widespread disruption of essential health services in Uganda by the COVID-19 pandemic, leading to reduced availability of and demand for immunization services. This project aims to support the implementation of defaulter tracking activities to strengthen planning, implementation, and monitoring of catch-up vaccination using a primary health care platform and a health systems approach to ensure safe and effective delivery of all essential immunizations during and after the COVID-19 pandemic period.

Prior to deployment, a refresher training was also conducted at the AFENET secretariat for 18 field epidemiology training program (FETP) residents and alumni, as well as National Stop Transmission of Polio (NSTOP) officers who were trained to support the field deployment. During this training, the team reviewed the project activities, data collection tools, data entry electronic platform, and their team roles. The trainees were then paired and assigned districts, where they worked with the district health teams and village health teams.

During the field supervision exercise, the district frontline workers were taught to identify and follow-up zero dose and defaulter children. As recommended by the Ministry of Health, (MOH), the child register (CR) is used as a primary data collection tool and the means to track defaulters and unreached children. The CR is also used to record details of the child and family, as well as vaccine doses, received dating back 5 years to identify children who had defaulted, for follow-up. They also generated a line list of defaulter children for follow-up. All VHTs were equipped to record data accurately. The team faced challenges of poor data quality stemming from missing and incomplete child registers, as well as incorrect and accurate data entry at some of the health facilities visited. In some instances, immunization data was not adequately organized or easy to locate hence more time lost in the identification of defaulters and zero-dose children.

Summary statistics collected during this deployment revealed the following;

Number of Health facilities visited that offer immunization services

83 (100%)

Type of Health Facility

HCII (41, 49.4%)
HCIII (34, 41.0%)   
HCIV (7, 8.4%)   
Hospital (1, 1.2%)   

Observed a child register at the health facility

83 (100%

Health facility has an up-to-date child register as of the last vaccination session

Yes (76, 91.6%)
No (4, 4.8%)   
Reported Not   Observed (3, 3.6%)   

Healthcare workers at the health facility able to generate a due list for those to be vaccinated (defaulter tracking)

Yes (20, 24.1%)
No (60, 72.3%)   
Reported Not   Observed (3, 3.6%)   

Health facility ever conducted a defaulter tracing activity

Yes (11, 13.3%)
No (72, 86.7%)