In this guide
What counts as a defaulter
A defaulter is a patient who has missed a scheduled visit and not come back: a mother who missed her ANC or PNC date, or a baby who missed a vaccine. The earlier you notice, the easier the return. A baby traced three days after a missed vaccine usually comes the same week. A baby traced after two months often has had the vaccine elsewhere, and the family has moved on with it.
Set one simple rule for your facility and write it down. A rule that works for most private facilities: a patient is overdue from the day after the missed date, and a defaulter if still not seen 7 days later.
Why private facilities lose defaulters
- No community link. Public facilities can ask a community health promoter to visit the home. A private facility usually has only a phone number, and sometimes not even that.
- Nobody owns the list. Nurses see the patients who come. Nobody is responsible for the ones who do not.
- Registers do not show gaps. A register records visits that happened. Finding who is missing means reading back through pages, so it rarely happens.
Step 1: the daily overdue list
Every morning, one named person produces the list of everyone whose visit date was yesterday or earlier and who has not been seen. With a paper register this means keeping a "next visit date" column and scanning it daily. With a spreadsheet it is a filter. Record for each patient:
| Column | Why it matters |
|---|---|
| Name and phone (plus an alternative contact) | Phones get lost and numbers change. A second contact saves many traces. |
| Service and visit due (e.g. ANC 4, PNC 1-2 weeks, Penta 2) | Tells the tracer what to say and how urgent it is. |
| Due date and days overdue | Sets the step on the ladder below. |
| Preferred language | English or Kiswahili, asked at registration. |
| Contact attempts and outcome | Stops two people calling the same mother, and shows what works. |
Step 2: the tracing ladder
- 2 days before and on the morning of the visit: a reminder with a simple reply option. Prevention is cheaper than tracing. See the reminder templates.
- Day 1 overdue: a friendly message. "We missed you yesterday. Would you like to come on {day}? Reply 1 for yes or 2 to choose another day."
- Day 3 overdue: a phone call from a nurse. Ask what got in the way; the answer is often money, transport or a sick relative, and a new date solves most of them.
- Day 7 overdue (now a defaulter): a second call, and the alternative contact if there is no answer.
- Day 14 overdue: final message, then record the outcome. For high-risk cases (for example a mother with raised blood pressure, or an unvaccinated baby), escalate to the clinician on duty for a decision, including linking with the local community health unit.
Keep every message free of clinical details. Phones are shared. "Your next clinic visit" is enough.
Step 3: record the outcome
Every trace ends with one outcome code, so the list never grows forever:
- Returned: came back, with the date.
- Rebooked: agreed a new date. Goes back on the list if she misses it.
- Seen elsewhere: got the service at another facility. Ask where and why; this is your most useful feedback.
- Moved: relocated. Close the case.
- Declined: does not want further visits. Respect it and stop messaging.
- Unreachable: all contacts failed after the full ladder.
Step 4: the weekly review
Once a week, the person running the list and the nurse in charge spend fifteen minutes on three numbers: how many patients became overdue, how many were brought back, and the most common reason for missing. The reasons tell you what to fix. If most mothers say "no money for transport", reminders will not help much, but a clinic day closer to payday or bundled visits might.
What to automate
The phone calls on day 3 and 7 should stay human. Everything else can be automated: building the overdue list, sending reminders and day-1 messages in the right language, collecting replies, and counting outcomes. That is exactly what HealthBridge's MCH system does over WhatsApp, so your nurses only make the calls that need a person. See the complete mother and child follow-up guide for how tracing fits the whole journey.
See the report owners receive every month
A real sample of the monthly retention report: returning patients, no-shows, ANC completion, immunisations and the patients slipping away. Fictional facility, real format. Free, no follow-up calls.