Behavior Profile: Timely Birth Dose
Health Goal: Improve maternal and child survival
Providers administer timely birth dose vaccines
n countries where applicable, percentage of newborns vaccinated within 7 days of birth with BCG, zero-dose OPV, and HepB-BD

Behavior Analysis

Strategy

BEHAVIOR AND STEPS

What steps are needed to practice this behavior?

Providers administer timely birth dose vaccines

  1. Stay up-to-date on birth dose vaccine protocols
  2. Maintain access to daily supply of birth dose vaccines
  3. Properly store birth dose vaccines
  4. Identify newborns in health facilities and communities
  5. Counsel mother and family about birth dose vaccines
  6. Administer birth dose vaccines per national immunization program guidelines
  7. Document administration of birth dose vaccines immediately and correctly

FACTORS

What factors may prevent or support practice of this behavior?
Structural
Accessibility: Providers do not provide timely birth dose vaccination because of stockouts
Accessibility: Providers do not provide timely birth dose vaccination because vaccination services are separate from labor, delivery, and neonatal services (and are not available 24/7)
Service Experience: Providers do not provide timely birth dose vaccination due to the absence of appropriate policies and standard operating procedures, including integration into essential newborn care and other institutional mechanisms
Service Experience: Providers do not provide timely birth dose vaccination because reporting forms do not allow for recording of timeliness or of birth dose vaccination
Social
Norms: Providers do not provide timely birth dose vaccination because of norms around multi-dose vial use even when policies change
Norms: Providers do not provide timely birth dose vaccination because of the low priority accorded to vaccination of neonates before discharge
Internal
Attitudes and Beliefs: Providers do not provide timely birth dose vaccination because they do not agree about the benefits of early vaccination
Knowledge: Providers do not provide timely birth dose vaccination because they do not know that illness, low birth weight, and other conditions are not contraindications for birth dose vaccines

SUPPORTING ACTORS AND ACTIONS

Who must support the practice of this behavior, and what actions must they take?
Institutional
Managers: Make birth dose vaccination prior to discharge and at community level a child health priority
Managers: Prioritize, plan, budget for, staff, and supervise facility- and community-based timely birth dose vaccination
Managers: Expand and improve outreach services to identify and vaccinate newborns
Managers: Provide, confirm understanding and ability of, and supportively supervise implementation of clear guidance on birth dose vaccination, including benefits, dosage, method, timing, contraindications, and documentation
Logistics Personnel: Actively monitor vaccine stocks, related commodities, and cold chain viability within and beyond health facilities
Policy Makers and Managers: Institute and widely disseminate birth dose vaccination policies and standard operating procedures that facilitate timely vaccination of all newborns, whether or not born in health facilities
Health System Decision-Makers: Update immunization and maternity/delivery forms to include birth dose vaccinations and timeliness
School Administrators: Teach routine immunization, including birth dose vaccination, in pre-service training for all health care providers

POSSIBLE PROGRAM STRATEGIES

What strategies will best focus our efforts based on this analysis?

Strategy requires Communication Support

Enabling Environment
Financing: Secure and implement adequate financing for pre-filled injectable birth-dose vaccines, heat-stable vaccines, and outreach services (including community-based vaccination where needed)
Institutional Capacity Building: Increase capacity for vaccine storage, handling, administration, reporting, and recording, and simplify the supply chain by using heat-sensitive labels to allow storage of vaccine outside the cold chain and pre-filled injectable vaccines for home births
Policies and Governance: Develop, update, and disseminate (with on-the-job training) policies and SOPs to maximize timely birth dose vaccination, including integrated services, community outreach, and community-based vaccination
Systems, Products and Services
Products and Technology: Exploit digital technologies to improve patient and vaccine supply record keeping, enable sharing of birth and other data between health facilities and community health workers, and prompt providers to administer timely birth doses as part of their labor, delivery, and newborn care routine
Products and Technology: Invest in single-dose, heat stable BCG and HepB birth dose vaccines and delivery technologies
Quality Improvement: In conjunction with integration of birth-dose vaccination into newborn care services and expansion of community-based vaccination, provide pre-service and in-service education and training on timely birth dose vaccination to maternity and newborn health providers, routine and supplemental immunization service providers, traditional birth attendants, and community health workers
Quality Improvement: Organize maternity and immunization services to facilitate 24-hour, 7 days per week, and holiday access to all birth dose vaccines and to personnel trained to administer them, including improving coordination between the services and ensuring vaccination shortly after birth (instead of just before discharge).
Demand and Use
Communication: Inform providers about their birth dose immunization rates, caregiver feedback, the benefits of birth dose immunization, newborns due for vaccination, and factors affecting immunization rates
Communication: Lead by example in providing timely birth dose vaccination to all facility-born infants regardless of their number or the day or time of their birth
Communication: Engage providers in reflection and discussion of the benefits of and updated protocols for timely birth dose vaccination, including cost-benefit analysis of opening a multi-dose vial for a single newborn