ChanjoKE Immunization Implementation Guide
0.1.0 - ci-build
ChanjoKE Immunization Implementation Guide, published by Intellisoft Consulting Ltd. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IntelliSOFT-Consulting/ChanjoKe-FHIR-IG/ and changes regularly. See the Directory of published versions
User scenarios are narratives that describe how the different personas may interact with each other and are intended to give an illustrative idea of a typical workflow. This section is intended to provide an understanding on how the system would be used, and how it would fit into existing workflows.
| Key personas | |
| Laura is a 30-year-old business lady who recently moved to Elburgon town in Molo sub-county, Nakuru county, with her 18 months-old daughter, Mia. Laura is aware of the importance of childhood vaccinations and wants to ensure Mia is up to date with her immunizations.
Laura takes Mia to Elburgon(PCEA) dispensary, where they are new clients. On arrival, Sarah, the clerk at the reception desk asks Laura for her Mother and Child Health Vaccination Handbook (home-based record). Sarah then opens section 2 of the handbook that is written Mia’s details. These include her full names, sex and birth notification number. Sarah logs in to the Immunization system and queries Mia’s name. She finds two clients registered in the system by the name Mia. Sarah then inputs Mia’s birth notification number to try to find an exact match. She finds no record of a client with the exact name and birth notification number. Sarah proceeds to register Mia as a new client. She uses the handbook to extract Mia’s basic information, such as her name, date of birth, birth notification number and Laura’s contact details. Sarah asks Laura for details on where they currently live including the exact estate/village. Laura gives Sarah this information. Sarah then directs Laura to the Nurse’s room where they meet Rose. Rose has been working at Elburgon(PCEA) dispensary for the last four years as the nurse- Incharge. She is responsible for vaccine administration, documentation of vaccination data, compiling vaccination reports and educating clients on vaccination. Rose warmly receives Laura and Mia and enquires about Mia's health. Rose then logs into the immunization system and views the record data input by Sarah. Mias registration is incomplete as it lacks previous vaccination history. Rose goes through the vaccination handbook to see Mia's vaccination history. She notes that Mia has received all scheduled vaccines from birth. She inputs this information in the system including the dosages and dates when they were administered. She then confirms that all the registration details are correct before creating this as a new record. Mia is registered as a new client in the immunization system, and she is assigned a unique client ID number. The system notifies Rose that Mia is due for her 18-months vaccines; second dose of Measles-Rubella vaccine and vitamin A supplement, based on her previous vaccination history. Rose first gives Mia 200,000IU of vitamin A by mouth. She then takes the Measles-Rubella vaccine from the vaccine carrier confirms the expiry date and ensures that it’s safe to administer. She then gives 0.5mls of the vaccine as a subcutaneous injection on Mia’s right upper arm. Afterwards, she observes Mia for the next 30 minutes for any adverse reaction following immunization which she observes none. Rose then records these vaccination details in the immunization system, the facility register and in the vaccination handbook. As Mia completes her vaccination session, Nurse Rose informs Laura that Mia will need her next round of vaccination at 10 years. |
|
| Corresponding business processes(see Component 4) | This scenario refers to the following business processes:
|
| Key personas | |
| Ruth is 21 years old and Esther, her first baby, is 10 weeks old. Ruth completed primary school and has basic literacy. Her husband attended secondary school for three years, but he did not finish. They all live in a two-room house with intermittent electricity in a village near Asembo, Rarieda Sub-county, Siaya County.
Esther was born at Siaya District Hospital. She got her first round of immunizations (BCG and bOPV) shortly after birth. Ruth took Esther to Asembo clinic for her second round of vaccinations when she was 6 weeks old. The clinic assigned an ID to Esther. It takes Ruth just over an hour to walk to the Asembo clinic from her home. Ruth enjoys going to the clinic as it is a chance to talk to other new mothers and she gets helpful information from the nurse about keeping her baby healthy. Lucy is a nurse working in the Asembo clinic. She has 12 years of experience, and she has a diploma in nursing. Lucy is in charge of the delivery of scheduled vaccines as per the Kenya National Immunization policy Guidelines. Two other nurses also work in this clinic. The clinic sees babies for screening and monitoring to identify any children who are at risk and may require further intervention early on to prevent issues. She also provides some preventative care such as vaccines and other supplements. Lucy also spends time during each clinic doing health teaching about various child health topics. Ruth and Esther arrive at the clinic just after 9am, there are already 5 other mothers with their babies. When it is Ruth’s turn, she goes to the table where Lucy is sitting, and hands her the Mother and Child Health Handbook (home-based vaccination record) which she received during her first antenatal clinic visit. It contains Esther's name, date of birth and a record of each vaccine given, as well as her weight at that visit. Lucy uses the ID on the top of the book to look up Esther’s record on her tablet. She finds the record and can see in the system that Esther is due for 4 vaccines at this time; OPV II, DPT-HepB-Hib, PCV10 and Rotavirus. Lucy weighs Esther using the scale set up beside the desk, and she records her weight on both the book and in the IIS application on her tablet. She tells Ruth that Esther is gaining weight well, and they briefly discuss some questions Ruth has about breastfeeding. Lucy takes the appropriate vaccines out of the small vaccine carrier beside her table. Lucy had filled the vaccine carrier earlier that morning based on what she would typically need based on an average clinic day. She has access to more vaccines, but they are in the fridge in the storage room. She prepares each vaccine, making sure that it is not expired and that the small symbol on the vial indicates it is safe to give. Lucy gives each vaccine to Esther starting with the ones given by mouth. She first gives 2 drops of polio vaccine then 5 drops of Rotavirus vaccine. Lucy then prepares the injection sites for the next two vaccines by swabbing the upper left thigh and upper right thigh with an alcohol swab. She then gives the PCV10 vaccine as an intramuscular injection on the upper right thigh followed by DPT-HepB-Hib intramuscular injection on the upper left thigh. While Ruth comforts Esther, Lucy records the vaccines given in the application on the tablet, as well as on Ester’s home-based record. She also tells Ruth when to bring Esther back for her next vaccines, and she also writes this on Ester’s home-based record. Since the clinic operates everyday, Ruth understands that while she should try to come on the date given, it is not an actual appointment, just a guideline to come within a day or two of that date. |
|
| Corresponding business processes(see Component 4) | This scenario refers to the following business processes:
|
| Key personas | |
| As the nurse responsible for the under 5-clinic in Mikuyu dispensary, Machakos Town sub-county, Machakos county, Lucy has an estimate for the number of children that live in the area of her clinic that she needs to ensure are vaccinated. This number is estimated based on the population her clinic serves, as it is the only clinic in the area. Lucy works closely with Aminata, a community health promoter to find and encourage caregivers to bring their children to the clinic for vaccinations. Aminata lives in the village and is the wife of the school’s headmaster. She is well respected in the community, and she has been a community health promoter for the past 10 years. She is responsible for both children and pregnant women, and she regularly counsels them to ensure they attend clinics and get the care they need in a timely manner. Aminata has completed secondary school, and her training for this role has been both on the job, as well as some workshops that are held a few times a year.
At the clinic Lucy registers each child that came for their first vaccines into an electronic immunization registry (EIR) or immunization information system (IIS), that has been implemented to replace the large paper ledger book. The child’s name, sex, date of birth, parents’ name and some other identifying information was entered into the IIS system, and the IIS noted each vaccine that needed to be given. Lucy enters the date each vaccine was given in the appropriate place during the visit in which it was done. Now with an IIS in place, Lucy no longer takes several hours each week to determine which children need to be followed up with by reviewing her paper ledger each week and calculating overdue status based on dates logged. Lucy can see on her tablet the list of children who are overdue or late for their vaccines based on the vaccine schedules determined by national policies and their relevant contact information she may need for follow-up (e.g., caregivers’ name and contact info). She remind them when their child is due to come for the next vaccine. Lucy is hopeful that this will help reduce the number of children who are brought in late for their vaccines. |
|
| Corresponding business processes(see Component 4) | This scenario refers to the following business processes:
|
| Key personas | |
| John is the Mavoko Sub-county EPI. He is 35 years old and has a university degree in management. He has been the Sub-county EPI for his sub-county for the last 6 years. John is responsible for planning, supporting all of the facilities in his sub-county to manage their immunization programs, supervising and conducting reviews of data of immunization programs in the sub-county. He closely monitors the monthly reports that each facility sends and looks for potential issues that may require his attention, such as inaccurate data on the reports or situations where the overall vaccine coverage in a facility may be lower than their targets, or if they have had times where they do not have a vaccine in stock to run their clinics. John is also responsible for keeping a track of the target population of children in his sub-county and a sketch map of where that population is found. Johns sub-county, like the rest of the region, have had significant challenges due to the COVID-19 pandemic. Many parents did not bring their children for their routine vaccinations for fear of contracting COVID-19. As a result, John has noticed their coverage rates for most vaccines is much lower.
Even after the epidemiological situation of COVID-19 changed, there are still many children who are overdue for their vaccines. Last month, during a workshop, John and his colleagues were informed that they should plan for some local outreach campaigns as part of a coordinated national plan to address this issue. John and his team have conducted these outreach campaigns previously, typically one or 2 times a month during Child Health Week events or Immunization Days. Since this campaign will be larger due to the number of overdue vaccines, the National vaccine Immunization Program is working with other partners to offer additional support. John has the responsibility to review the plan made by the national government for the campaign in his region, review budget and supervise the implementation of the campaign. John works closely with stakeholders (coordination) and the community (communication) to implement the sub-county’s immunization plans. |
|
| Corresponding business processes(see Component 4) | This scenario refers to the following business processes:
|
User scenarios are helpful tools not only to better understand the context in which a digital tool would operate, but also to provide some insights into what key data elements would need to be recorded and accounted for in the database. Additionally, the context in which the tool would be used, illustrated by the user scenarios, provides insight into some functional and non-functional requirements that the system would also need. For example, in the table below based on the user scenarios described above, the first column highlights the key data elements that need to be recorded and/or calculated. The second column highlights some elements of decision-support logic that can be automated in the system. The third column displays some key functional and non-functional requirements that should be included in the system.
The table below provides an example of a breakdown of these three elements extracted from the user scenario above.
| Data Elements to be collected | Decision Logic to be embedded | Functional and non-functional requirements |
| Data Elements to be collected | Decision Logic to be embedded | Functional and non-functional requirements |
|
|
| Data Elements to be collected | Decision Logic to be embedded | Functional and non-functional requirements |
|
|