A Cross

A Cross-sectional Study on Recording and Reporting Status of VHW EPI Register in Udayapur District Nepal.

Text Box: Summary: There is 6% difference found in Village Health Workers' (VHWs) reporting and recording of regular immunization program in Udayapur. 25 EPI registers used by VHWs from 25 Village Development Committees (VDC) were cross checked and compared with the data what they have already sent in Health Management Information System (HMIS) report. There are some problems of both over and under reporting.

Key Word: EPI register, data difference, Udayapur

Background: HMIS data is a subject of being authentic, easy access but some time it comes with unbelievable figure. Many surveys have been done in certain time interval by different organizations suggest that there is something difference between HMIS data and survey data. Health workers themselves admit that there is some problem in recording and reporting while conducting regular immunization camps. An attempt has been done to verify the VHW's recording and reporting status through cross check of their Expanded Programme on Immunization (EPI) registers in Udayapur district.

Method: Study and verify the HMIS data and Immunization register, Interview, Focus Group Discussion (FGD).
Tools: Immunization register, HMIS report, Guidelines
Data Processing: Excel in computer, manual

There are 44 VDCs in Udayapur districts. VHW or/and MCHW are conducting 3-5 EPI sessions every month in their respective VDCs. Of them 25 Immunization registers from 25 VDCs were taken for cross checking and verification of data in the district workshop. Monthly data of BCG, DPT3, BCG3, Measles, TT2 and drop out rate of BCG Vs Measles, DPT1 Vs DPT3 was taken by random sampling. Data by month and by antigen was randomly selected. Total frequency of different antigens recorded from 25 Health Posts (HP), Sub Health Posts (SHP) was 773. Likewise, HMIS reporting by these Health Institutions (HIs) of respective month and antigen was 822. Hence, difference between recording and reporting in number is 49 i.e. 6%. And the figure as such discovered is almost likely with the figure which was found in Baseline Survey Report: Udaypur district, 2000¹.

A study conducted by Ministry of Local Development, District Development Committee Udayapur, UNICEF and New Era in 1999, Baseline Survey Report: Udaypur district, 2000[1] suggests that BCG coverage in Udayapur district is 83% during 2056/57. Whereas, HMIS/ ERHD[2] report indicates the coverage of BCG during 2056/57 was 90% in Udayapur district. Hence, data difference between HMIS report and baseline survey is 7%.

· A VHW said "Recording some times becomes not exact because clients come in a group and get hurry to back as soon as possible. That time I used to give them vaccination first and count the number at the end."

· Another VHW said "Sometime client comes just after when I have closed my bags to return back from the post and some time I meet them on the way, that time I don't mark on my immunization register. Later I try to remember the number that's why exact number may not be recalled."

· A VHW frankly said "My boss always asked me about the less number or poor coverage in spite of my hard work. There are no children left but coverage is still low. That time I have been forced to have over reporting. That's how number may vary in my register and my report"

· A VHW said "I have to give vaccination for another district, Sindhuli, so I am getting more than 100% achievement."

· Another VHW said, " I have a cluster that is located beside a jungle where I am unable to cross due to security problem. But the cluster has been covered by Siraha district, that's why I am always getting low coverage"

· It is solely researcher's initiative and no more external support has been taken.

Conclusion: The error in VHW's recording and reporting in this cross-sectional study is 6%.

So, there is still room for improvement where VHWs are having knowingly or unknowingly somewhat error in recording and reporting.

Recommendation: VHWs, immunization posts and registers are to be regularly supervised and monitored by SHP, HP & District Health Office (DHO). Verification of Immunization registers and follow up is a subject to be included while reading/making HMIS reports by SHP, HP, DHO.

Acknowledgement: I extend my sincere thanks to Mr. Tank Prasad Chaudhary (PHI) and Mr. Chedi Prasad Yadav for their help in collecting documents and tabulation of data.

[1] MLD, DDC/ Udayapur, UNICEF, and Baseline Survey Report: Udayapur district, 2000.
[2] ERHD/HMIS, Annual report of Eastern region Health Directorate, Dhankuta, 2056/57