Immunisation in sub-Saharan Africa - Recommendations - Zambia

from the report "Communication for Routine Immunisation and Polio Eradication: A Synopsis of Five Sub-Saharan Country Case Studies"

In October and November 1999, a series of case studies were carried out in five sub-Saharan countries. The broad objectives were to: document communication activities for polio eradication, routine immunisation and surveillance; exchange effective and innovative experiences; and provide recommendations for the improvement of communication interventions. The initiative was a collaborative effort undertaken by the Ministries of Health of visited countries, the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the Unites States Agency for International Development (USAID) and its subcontractors (BASICS, CHANGE and JHU-PCS). Visited countries were the Democratic Republic of the Congo (DRC), Mali, Mozambique, Nigeria and Zambia.

Recommendations:

1. Giving feedback to the community, district and province
   Besides serving the reporting purpose, EPI information should be used as a motivational and planning tool for the community. Feedback on the immunization coverage should be given to the community through the community based structures that exist as a way to assess their effectiveness in social mobilisation. In addition, such information can be used by catchment areas to compare among themselves and as a motivation technique to stimulate participation among communities. Improving feedback to the provincial and district levels on routine immunization and surveillance may assist in ‘capturing the NIDs /SNIDs competitive spirit' and encouraging continuous reporting of EPI data to the central level.
2. Improved collection of reliable data
3. Research and evaluation of cost-effective methods of communication During NIDs, many methods and channels are used as described above. This is done at great expense. It is important to conduct an evaluation of which methods are most effective.
4. Training of service providers and community mobilisers in interpersonal communication As the responsibility of health promotion and education is now being laid upon the health worker, it is extremely important that appropriate training be provided on interpersonal communication skills. It is often mistakenly assumed that health education and general interpersonal skills come naturally to health providers. This is often not the case, especially when the health providers are overworked, undermotivated and undercompensated for their services. In Zambia, a lot of community education is carried out by volunteers. They too need some communication skills. An added benefit will be the motivation provided through the training.
5. Reactivate the structures used during NIDs Most if not all structures used during NIDs tend to fade after the campaign. This is especially so at the national level. Ways should be found to reactivate them or sustain them for routine immunisation, surveillance and other child health issues. Key among these are the social mobilization and intersectoral committees.
   

   The following are some strategies for sustaining and motivating participation beyond the NIDs:
   

   • Use of non-monetary motivation such as letters to recognise people's participation
   • Involving members of committees in supervision, training and workshops
   • Including routine immunisation in regular agenda. It is especially important that the evaluation meeting held after the NIDs includes discussion on how to continue involvement of partners in routine immunisation and surveillance after the NIDs
   • Giving people regular feedback and updates on information on immunisation to sustain interest
   • Regular briefings of the media on all aspects – maintaining the partnership
   • identifying roles that the various partners (NGOs, schools, drama groups, local leaders etc.) can play
6. Maintaining services for the hard-to-reach populations CBOH and partners need to work with DHMTs to plan for sustaining services for the hard-to-reach populations discovered during NIDs. This would include support in district micro-planning and additional resources.
7. Capacity building for communication Build communication capacity by strengthening the structure, such as appointment of focal points in the provinces and districts, as well as by updating skills, especially at district level and especially communication planning skills.
8. Coordination of partners' efforts Partners need to coordinate better in order to maximize on resources. One way to strengthen this coordination could be an assessment at national and district levels to establish what is going on and who is doing what.
9. Communication for surveillance Health workers, especially at health centre level, need training on surveillance. Also using the potential that exists in involving the community in reporting cases.
10. Year-round messages and activities on immunisation Basic messages on immunisation need to be disseminated all the time, through multiple channels. Some of the efforts could include ensuring development and dissemination of educational materials and regular radio programmes.