GTA

Background Under the leadership of Family Welfare Division, GTA Foundation and UNICEF, jointly collaborated for the situational analysis of implementation of standalone home-based record (sHBR) in Madhesh province and integrated home-based record (iHBR) in Koshi province. A home-based record (HBR) is a health document used to record the history of health services received by individual. They complement the records maintained by health facilities and are an important component of maternal, newborn, and child health services, including immunizations and nutrition. Government of Nepal has been using various standalone HBR like maternal and newborn card, child health card, nutrition card (Integrated Management of Acute Malnutrition card), and health service card. From the fiscal year 2020/21, Koshi province piloted the Integrated HBR (iHBR) called AAMA booklet. AAMA booklet is a comprehensive handbook, including maternal and child health service records of the mother and her child, and the information on pregnancy, delivery, and child health. Inspired by the initiative in Koshi and the global recognition of the significance of effective HBR implementation, the Government of Nepal is taking steps to spearhead the expansion of iHBR approach. To support this initiative, a comprehensive situational analysis of standalone and integrated home-based records was conducted. By applying human centered principles and integrating behavioral insights, this study aimed to guide the formulation of evidence-based strategies and actions for the effective and sustainable implementation of HBR.

Objectives

• To analyze the factors forming the behaviors related to HBRs use among caregivers, health workers/volunteers and program managers.
• To identify the key barriers and enablers that influence the implementation of HBRs

Methodology

This mixed method study with a cross-sectional design was conducted on March - August, 2024. The study sites included iHBR implemented municipalities of Koshi province (Khandbari municipality, Dhanpalthan rural municipality, and Mai municipality), and sHBR implemented municipalities of Madhesh province (Siraha municipality, Janakpurdham sub metropolitan city and Ekdara rural municipality).The study comprised of 100 participants, including three categories of user groups of s/iHBR namely, caregivers, health workers/volunteers and program managers. Data collection was done using rapid inquiry method for caregivers and health workers/volunteers, and structured interviews for program managers. The analysis process involved internalizing findings through comprehensive review and story sharing, and developing themes using tailored journey to health service map to identify patterns and narratives.

Conclusion

This study assessed factors affecting implementation of standalone HBR in Madhesh province and integrated HBR in Koshi province, identifying key enablers and barriers. The findings highlighted need to ensure adequate s/iHBR stock at the health facilities, enhance quality of standalone HBR, provide comprehensive orientation to the health workers, enhance communication on HBR with caregivers, and scale up of iHBR implementation.