Reaching and Adapting Immunization Services Effectively to Reach Zero-Dose Children in the Sahel (RAISE 4 Sahel)

Strategic Approaches
To ensure that every child receives the full complement of life-saving vaccines, RAISE for Sahel seeks to adapt and tailor immunisation strategies that prioritise a client-centred, evidence-based, and equitable approach to service delivery to missed communities. Emphasis is also placed on integration with other interventions and on gender mainstreaming and social inclusion, with an added focus on persons living with disabilities.

Recognising the highly dynamic environments in fragile and conflict settings and the vulnerability of zero-dose populations, RAISE 4 Sahel seeks to emphasise agile implementation guided by adaptive management and learning while supporting health system resilience. The project also seeks to strengthen community systems, including differentiated service delivery, by testing new innovations and learning across countries and regions to contribute to increasing vaccination rates in the most challenging locations in the Sahel.

Implementation
The project uses ZIP's IRMMA framework (Identify - Reach - Monitor - Measure - Advocate) to develop community-tailored intervention activities to reach every child with a full course of vaccines: 

Identification: RAISE 4 Sahel completed rapid community vaccination planning assessments and introduced zero-dose children identification logs and the Commcare Vaccine Solution Application (a highly adaptable open-source mobile health platform that can be customised to meet a variety of vaccine administration and management needs). Given the impact of the COVID-19 pandemic and the ongoing socio-political crisis in its implementing regions, the RAISE 4 Sahel team triangulated subnational data, both within immunisation and preventive health programmes, and mapped and analysed the concentration and distribution of zero-dose children to understand behavioural and social drivers of missed communities. These baseline surveys enabled the team to understand where the zero-dose communities are, what their immunisation behavioural patterns are, and why government routine strategies inadvertently miss them. These studies helped the team design contextually tailored strategies for different communities.

Reach: RAISE 4 Sahel designed tailored delivery strategies for missed communities grounded in contextually relevant and integrated immunisation services. Vaccination services commenced in zero-dose focus communities and engaged key stakeholders to facilitate access to community mobilisers and vaccination teams. Supply-side and demand-side barriers are also addressed through a gender lens.

To increase community uptake of services, the project deploys innovative and tailored strategies developed to engage communities. For example, formative research has provided behavioural insights that have helped improve the service experience of caregivers and ensure that services meet their needs. The project pays particular attention to addressing gender-related barriers that hinder access to immunisation.

Monitoring and Measuring: The project has designed tools and also uses the Commcare Vaccine Solution Application to collect, monitor, and assess progress. It trained vaccination cluster teams on data collection and triangulation to enable them to use multiple indicators to assess whether zero-dose communities are correctly identified and reached. The project also uses community-based monitoring systems with regular data reviews, implementation research, and coverage surveys and assessments.

Advocacy: To catalyse rapid progress on immunisation equity and ensure that it is sustained, grassroots community-based organisations (CBOs) were engaged. In addition, faith-based partners, influential women, traditional authorities, community leaders, and humanitarian actors provided complementary responses, while new context-specific partnerships were also developed to create demand and mitigate identified barriers.

Learning Agenda: Within the RAISE 4 Sahel consortium, CORE Group is responsible for implementing a communication, knowledge-sharing, and advocacy strategy that aligns with ZIP's IRMMA framework. As technical experts, CORE Group supports the country secretariats in developing tools and information products to inform stakeholders about progress in improving immunisation coverage among zero-dose and under-immunised children living in fragile contexts in the Sahel.

Collaborating with country secretariats, CORE Group also leads on the ZIP learning agenda to generate evidence-based knowledge products and best practices to enhance regional and global learning. Finally, CORE Group supports the secretariats in developing and disseminating advocacy messages via campaigns to raise awareness of the need for immunisation in zero-dose children in fragile and conflict settings.

The Zero-dose Immunization Program (ZIP)
These 5.2 million children are not receiving life-saving vaccinations due to no or limited access to the health system as a result of conflict, climatic events such as drought and seasonal floods, and movement of populations for different reasons. These communities are often characterised by food insecurity, violence, displacement, refugees, and cross-border migration.

ZIP was launched by Gavi, the Vaccine Alliance, to help governments reach these vulnerable children. The programme consists of two projects, RAISE 4 Sahel and REACH, led by two consortia of organisations with expertise in operating in complex contexts. To achieve its objectives, Gavi is partnering with non-traditional and diverse partners such as non-governmental organisations and local civil society organisations to reach families and children in areas that governments cannot access, such as cross-border settings and conflict areas.