Immunization Communication Monitoring (for East & Southern Africa)

This PowerPoint presentation informed the discussions at a multi-agency workshop whose purpose was to help communication experts and Expanded Programme on Immunization (EPI) programmes in countries work more effectively to monitor their immunisation communication activities and to demonstrate/measure outcomes and impact of the communication interventions on assisting with addressing coverage needs and drop-outs, particularly at the district level.

In addition to outlining the purpose of the meeting, which was held in Johannesburg, South Africa, June 16-20 2003, the presentation outlines: background (monitoring of the communication component in EPI were lacking), the meeting's objectives (to develop capacity to monitor communication to improve coverage at the district level) and sub-objectives, and the meeting's agenda.

It also includes a slide exploring the question: Why monitor and evaluate EPI communication programmes? One focus: using EPI data for programming and communication strategies to assist in addressing coverage and drop-out problems. Immunisation challenges are also outlined, such as finding ways to use immunisation as vehicle for other population-based interventions and reaching the unreached. Immunisation programme systems and components are illustrated; one of these relates to communication and behaviour change. Also included in the presentation is a list of 5 operational components necessary to reach every district (RED), such as regular meetings between community members and health staff in order to link with service delivery.

Suggested actions for EPI partners working at the district level include:

• Disseminate and utilise tools and processes with partners (e.g., actively participate in Inter-agency Coordination Committees (ICCs) and communication sub-committees involving non-governmental organisations (NGOs) and partners at district levels).
• Consider mechanisms like memorandum of understanding (MOU) and "social contracts" with Ministries of Healh (MOHs) to become more involved in service delivery (advocacy and mobilisation).
• Draw on health sector reform/decentralisation for greater NGO and district-level involvement.
• Put in place better monitoring to support immuniation improvement and demonstrate contribution at the district level (monitoring drop-outs, capacity building, self-monitoring).

Additional slides provide data to help the reader understand EPI problems, such as the reported dropout rate by districts, Madagascar, 2001. A dropout analysis suggests communication activities such as: Improve health worker interpersonal communication (IPC) skills; increase use of vaccination cards as health information tools (e.g., return dates); improve knowledge, attitudes, and practices (KAP) of the community on vaccination services and schedule; and negotiate with communities on outreach. A flow chart to identify priority areas and strategies is provided, as is a list of communication responses to programme priorities: analysis and discussion of communication approaches and activities to support each category (access and/or utilisation issues); group work on using district coverage and drop-out data (example from Uganda) and reviewing the feasible communication strategy; development of example communication monitoring indicators; and use of indicators for behavioural measurement.

Subsequent slides focus on communication responses, including improve IPC skills of health workers, involving the community in tracking dropouts, strengthening community linkages with outreach services, and improving feedback on communication support to the district EPI programme. For each of these responses, an activity is outlined, along with an output indicator and an outcome indicator. The use of both quantitative and qualitative methodologies is recommended.

According to the presentation, participants in the meeting left with an improved understanding of the importance of and need for communication monitoring indicators. That said, there is a need to increase country capacity to develop, monitor, and utilise communication indicators. Also, the presentation nodes that additional advocacy is needed with ICCs to ensure the integration and functioning of immunisation communication. There is also a need for technical assistance to countries, as the process of having EPI communication specialists work with data, albeit useful, needs to be directed.

The presentation concludes with some observations and next steps - e.g., "Workshop format and agenda to be developed as a guideline for subsequent workshops for West and Central Africa and as a tool for countries."

Click here for the 25-slide presentation.