Immunisation in Nepal

Editor's Note: Wing-Sie Cheng was, at the time of authorship, Chief, Communication, Advocacy & Life Skills Section, UNICEF Nepal

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The goals

90% universal coverage by FY 2006 – 2007

Certification of polio eradication by 2005

MNT Elimination by 2005

Reduce measles mortality by 95% and morbidity by 90% from pre-immunisation period by 2005

Introduce HepB vaccine to routine immunisation by 2002-03

Policy for safe injection practice and introduce ADS

Five-Year Plan (in harmony with nation's 10th plan)

Target 1: Routine Coverage

2002/03: 25 districts will have 80% coverage.

2003/04: 50 districts will have 80% coverage.

2004/05: All 75 districts will have 80% coverage.

2005/06: 50 districts will have 90% coverage.

2006/07: All 75 districts will have 90% coverage.

Target 2: Polio eradication

2002/03: Zero case of Wild polio virus

2003/04: Stop wild virus transmission

2004/05: Certify eradication

Target 3: MNT elimination

2002/03: 80% TT coverage among WCBA in 20 districts.

2003/04: 80% coverage among WCBA in 35 districts.

2004/05: 80% coverage among WCBA in 50 districts.

2005/06: 80% coverage among WCBA in 65 districts.

2006/07: 80% coverage among WCBA in all 75 districts.

Target 4: Measles, mortality & morbidity

2002/03: Development of a national Strategy and an Action plan.

2003/04: 90% measles coverage & case Management training for HWs in 15 hight-risk districts.

2004/05: 90% measles coverage & case Management training for HWs in 20 high-risk districts.

2005/06: 90% measles coverage & case Management training for HWs in 20 districts.

2006/07: 90% coverage & case Management training for HWs in 20 districts.

Target 5: DPTHep-B introduction

2002/03: Introduce in 15 districts.

2003/04: Introduce in 25 districts, making a total of 40.

2004/05: Introduce in 35 districts making a total of 75.

2005/06: Continue

2006/07: Continue

Communication campaign 2002 - 03

More than just producing posters & nudging journalists to write stories!

Communication plan to promote new behavioural norm around goals:

• 25 districts to attain 90% coverage
• 15 districts to attain 80% coverage
• Zero case of wild polio virus
• 80% TT coverage among WCBA in 20 districts
• Development of a national Strategy and an Action plan
• Introduce Hepatitis B vaccines in 15 districts

Transitioning from polio to full immunisation…

Communication goals:

1. Promote full immunisation (including OPV)
2. Reduce drop-outs
3. Expand MNT to adolescent girls
4. Improve images of health workers
5. Sustain zero-case result for polio

Barriers

Lack of awareness of full dosage

No interaction between mothers and HWs

Confusion between OPV & routine, expectation of home visits

Fear of adverse effects following immunisation

Poor card retention, no record of date, time & place

National communication has been downscaled

Campaign design

Primary target: Parents

• Mass media
• FMs and IPC: Western mountains, Far-Western Hills, and Western and Central Terai regions

Secondary target: Health providers and Female Community Health Volunteers (FCHVs)

How to reach them?

National media – renew and sustain public awareness of routine immunisation

FM and regional outreach through spots in Urdu, Tamang, Tharu, Bhojburi, Awadi and Maitali languages

IPC – reaching parents through health providers

A parallel campaign to improve Health Worker's image

Using parallel campaign to reach parents

Create a new image of health workers

Improve HW's knowledge and skills (life skills)

• Integrating communication & life skills in on-going HW training and new orientations (on HepB & ADS)

Give recognition to their role in community health

Campaign theme:

• “When do I see you again?”
• “We offer a full range of vaccines plus safe syringes!”

HWs to be reached through TOT and district IPC

Series of Focused Group Discussions or Rapid Assessment to understand attitude of ethnic minority towards routine immunisation (many already know what is Polio!)

Internal barriers:

• Tedious operations procedure in preparing bid for contractors to undertake FGDs
• Rapid assessment with simple questionnaire may speed up process, but respondents aren't entirely representative of all ethnic groups

Actions from May – December 2002

Commission FGDs to provide baseline for designing radio & TV spots targeting parents

SSA to bring a consultant on board to assist with campaign management

Map out broadcast schedule

Develop print materials, including gender-sensitive icon, to promote visual identification of full immunisation (full vaccination for girl children is lower than boys – 64% and 68%, respectively)

Introduce life skills to on-going training of health workers and refresher training of FCHVs

Introduce life skills to TOT for health workers in new HepB vaccination and use of ADS

Develop and distribute fact sheets and Frequently Asked Questions for HWs to address common myths (eg. a child cannot be vaccinated during a fever), resistance and rumours

General campaign targeting parents

“Market” routine immunisation through radio, TV and print advertising

Ensure MOH supports the campaign for 2 – 5 years with on-going monitoring and update of spot messages

Theme: “Full immunisation insures your child's health”

An opportunity presenting itself

General campaign launched on 10 June 2002 through “Traffic Safety Week”

Full immunisation icon with three messages are developed

14,000 full immunisation stickers pasted in all taxi, buses, safra tempos and tuk-tuk plying along Kathmandu Valley

6,000 arm-bands for traffic police carry full immunisation messages

The icon... for now

The messages:

• “I have fully vaccinated my child, haven't you?”
• “Full immunisation before your child reaches 1-year-old”
• “Full immunisation covers a range of health protection: BCG, DPT, OPV and measles – altogether 8 doses. Visit your nearest health facility today!”

Hereafter...

• Pretest icon further and adapt it for rural parents
• Develop and disseminate a series of print materials targeting at both urban and rural parents
• Launch radio and TV social advertising to renew public awareness of routine EPI
• Develop message to engage public in detecting wild polio paralysis and report to a hotline
• Develop messages targeting adolescent girls for MNT in 20 districts
• Develop messages targeting parents in 15 districts for HepB vaccination (to go hand in hand with parallel campaign to improve health workers' image)