The Home-Based Health Passport: A Tool for Primary Health Care

Abstract

In Zambia, home-based patient records were introduced on a pilot basis in Sesheke district in 1991. First, health workers attended a one-day training session on how to use and maintain the home-based health passports. The passports were available on a fee basis. The sale of health passports created a revolving fund to address health-related stationery (e.g., referral slips) shortages. (These health passports contain curative and preventive records. Health passports for under-five children have a growth chart on its cover while those for older children and adults do not. Health workers enter the immunization status of women and children in the passport.) Four and 16 months after the passports were introduced, household and health facility surveys were conducted to determine the views of patients and health workers about the passports. By four months, 68% of the respondents purchased a passport. This had increased to 91% by 16 months. The average number of passports per household rose from 3.4 to 5.8 between the two surveys. By 16 months, only 16 people (9%) did not have a passport. The price prevented two people (1%) from buying the passport. No one had lost a passport. 16% at four months and 14% at 16 months kept their records at the hospital, largely because they did not want their passport to be damaged (e.g., rain damage). A plastic cover would protect the passport against damage. Confidentiality was not a problem for patients, but health workers were concerned about it. Many respondents (36% at 4 months and 30% at 16 months) considered the passport to be expensive. Between the two surveys, knowledge on the purpose of the growth chart on the children's health passport increased from 38% to 48% (p 0.05). This evaluation was so positive that health passports have been introduced in all districts in Western Province.