Several types of Immunization cards are in use today. Following are a few examples : 

BMC provided immunization card:
For each child Government provides two immunization cards -
• One card for a home-based immunization record carried by parents and
• Another card which is with doctor for the clinic side record.

At primary healthcare centre which is run by the government, the procedure of immunizing the baby and entering relevant details in the immunization card takes about 10-15 minutes.

Health-worker weighs the baby. But they may or may not whether the baby is malnourished . Later, the card is checked for previous immunizations administered. Simultaneously the baby is examined for cold, fever etc. and whether it can receive immunization.

Once the baby is found to be okay, the immunizations are administered. Health-workers note the date of current immunization as well as date of next visit onto the card and inform parents about the same.

In certain clinics one person immunizes the baby while other person notes immunization data onto the home-based card as well as clinic side copy. At times, due to miscalculation in date of next visit or some other error, the health-worker ends up cancelling it.

Current cards don’t have spaces designed to accommodate errors. Moreover, due to the amount of crowd and in order to be quicker, in certain clinics the immunization card was filled only with most important details like date of vaccination and date of next visit. While other details such as height and weight of the baby, whether the baby is malnourished etc. were considered a time-consuming additional burden and were altogether skipped.

Thus cards tend to remain un-updated or not updated completely.

In other cases, parents forget cards or lose them. Although there is a clinic side copy of the immunization data for each child receiving free immunization under UIP, all these entries are manually made into a register and this database being physical is not easily searchable.

The hospital / or clinic does provide parents with a new card, sometimes against a small monetary fine. But parents are expected to recall the immunizations administered previously.

There is another scenario where children are brought for immunization by relatives or neighbors while the immunization card is left at home, in such cases calling someone at home and asking them what the last immunization was may not always yield relevant and accurate information, as people across varying literacy levels may not be able to read or pronounce vaccine names.

Some parents see the process of immunization as a burden as they have to take time out of their working schedules to go the PHC. Children who seemed otherwise healthy and happy just cry endlessly after receiving immunizations. They may also get fever and parents will not have the time to spare from their work hours to comfort their children.

Multiple types of immunization cards:
Currently multiple types of immunization cards are floating in India. Government issued immunization cards across states, Immunization card issued by Indian Academy of Pediatrics, immunization cards used in private hospitals and those sponsored by pharmaceutical companies.

On the other hand, BMC issues cards are made from non-laminated simple card paper and were non durable. During contextual inquiry at the primary healthcare centre, parents were seen bringing in torn cards or photocopies of the card as the earlier card had given away.Difference between Government and Non-Government immunization card:
The difference between BMC immunization card and non-government immunization card was observed in following:
• Paper quality and Durability of the card
• Information on the card - Number of vaccines
• Individual Vaccine related instructions
• Growth and development charts

Paper quality and durability of the card: 
The cards in case of private hospitals doubled up as files to hold papers together. As they were made from thicker paper and laminated, they lasted substantially longer even after immunizations were completed. The private clinic issued immunization files are often sponsored by pharmaceuticals and perhaps that explains their better durability.

Information on the card - Number of vaccines:
Private clinic immunization cards included all vaccines recommended by the Indian Pediatric Association and not just those administered for free under government's Universal Immunization Programme (UIP).

Individual Vaccine related instructions:
BMC immunization card does include instructions such as Hep B vaccine should be administered within 48 hours of child's birth and care to be taken in case of diarrhea. However, information such as a nodule will appear on child's arm where BCG vaccine was given is not provided on the BMC immunization card. The nurse immunizing the child thus ends up giving this instruction repeatedly to parents of each child that comes in for immunization. Moreover at present neither the private clinic nor the BMC issued immunization cards currently give any information specific to the significance of each vaccine and the disease it prevents.

Growth and development charts:
These cards also include growth charts (graphs that help visualize progress of baby's height, weight and head circumference) which were found to be absent in BMC issued immunization cards of Mumbai. However, the government immunization cards developed in collaboration with UNICIEF and distributed in states like Bihar, Chhattisgarh etc do include growth charts. Private clinic cards also include age wise milestones of baby's development, which are absent in BMC immunization card.

Ours is a Vaccination only chart [1]. Our prototype evolved in response to the insights obtained from need-finding exercises. It consists of mother’s and baby’s demographic information and a vaccine schedule. Further growth charts were added too.

BMC card

Ref. [1] - Home-based child vaccination records - A reflection on form by David W. Brown, Marta Gacic-Dobo, Stacy L. Young.