Job Aids for Immunization

This resource describes and provides illustrations of a series of job aids developed by the United States Agency for International Development (USAID)'s IMMUNIZATIONbasics project in India. It includes details on the format, sites for use, intended audience, and expected outcomes. It also contains examples of the pictorial job-aids (posters or stickers).

The rationale behind these job aids, which cover various aspects of immunisation, is that - if communicated in a user-friendly format for frontline health workers - job aids can effectively complement training to strengthen programme management, improve health worker performance, and enhance community demand. Such aids, according to USAID, have advantages over resource-intensive stand-alone classroom training: skills improved during training may erode over time, whereas (well-designed and -used) job aids continuously reinforce and consolidate skills. In short, job aids are a relatively low-cost and accessible way to assist and remind health workers and managers to carry out their tasks in accordance with well-defined guidelines. These aids can come in a variety of formats - ranging from posters, stickers, leaflets, and tear-out sheets, to CDs and computer programmes.

The first step in developing these aids was to assess, with the Ministry of Health and Family Welfare and other partners, the kinds of technical information required at different levels. The next step was to conduct a review of the existing immunisation-related material in the country and overseas. To avoid duplication, materials from several generic job aids designed by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), PATH, and others were adapted to the current Indian context. An interactive process was followed to allow end-users, national stakeholders, and international experts to review and provide input throughout the final design of the job aids.

The information that emerged from this process is presented either as a sequential checklist (e.g., on correctly reading a thermometer) or a decision-making algorithm (e.g., on safely disposing immunisation waste). The three types of job aids are:

1. Reminder job aid: e.g., high-visibility sticker pasted on ice-lined refrigerators to assist cold chain handlers in correctly storing vaccines
2. Assistant job aid: e.g., supportive supervision checklist for use during supervision visits to health facilities and session sites
3. Hidden job aid: e.g., session site poster discreetly reminding health workers of the 4 key messages for caregivers.
   

The examples included are grouped into the categories of: Cold Chain Job Aids, Immunization Safety Job Aids, and Tracking and Communication Job Aids. They reflect the effort to minimise common barriers in that they feature: use of basic design principles; digital photography, image scanning, and colourful computer graphics; simple pictorials to indicate clear actions; easy-to-understand supervision formats accompanied by support material and explanatory notes; minimum of text to facilitate use and understanding of the key messages; unified theme or presentation for each technical area; one detailed job aid devoted to each topic; translation to Hindi; and ability to be used in work settings.

According to the author, the effectiveness of the job aids depends upon several factors. First, training is needed on using the more complex tools for micro-planning. Second, their use requires the support of senior health officials in ensuring their wider dissemination (e.g., in immunisation campaigns, in training of health workers and medical officers, or in the community). Third, the effectiveness of these aids in the performance of health workers and managers of immunisation services needs to be measured. Finally, an online database or clearinghouse of any job aids produced would ensure their sustained use.

The utilisation of the materials has transcended local and programmatic boundaries. For instance, the Government of Madhya Pradesh has adapted the supportive supervision checklists for use in other child health settings, and several states in Nigeria have adapted the use of these checklists to the local context.