Nationwide communication campaign on immunization
“Timely immunization is your child’s bodyguard” - This is the main slogan of the behaviour change communication campaign launched in Georgia in February 2007. The campaign is carried out by the Ministry of Labour, Health and Social Affairs in collaboration with the Ministry of Education and Science and with the support of UNICEF. The campaign, will last until the end of the year. The main objective of the campaign is to improve immunization coverage to children below one year of age and to reduce the spread of vaccine-preventable diseases. The campaign calls mothers and other caregivers to ensure the timely immunization of their children at two, three and four months of age. Process A COMBI Training Workshop was conducted February 20-24, 2006 for a group of experts, participants from various Public Health Centers, NGOs, MOH Departments, Medical University faculty, the National Center for Disease Control, etc. The workshop culminated in development of the draft COMBI plan on immunization which further was finalized as a result of various meetings and discussions. The training was facilitated by Dr. Everold Hosein, Communication Advisor of the World Health Organization. Working group was set up consisting of representatives of the Ministry of Health and National Center for Disease Control. Project officer was hired by UNICEF to monitor and oversee the implementation of the final plan. MOU was signed between UNICEF and the Ministry of Health. Baseline Study The purpose was to conduct in-depth research of the immunization behaviour among health professionals and caregivers in order to develop a comprehensive understanding of the current communication/behavioural gaps. According to the Baseline Survey on immunization, level of awareness of parents on vaccination is low and timely vaccination for Hepatitis B, Diphtheria/Pertussis/Tetanus and Poliomyelitis at two, three and four months stands at about 17 per cent. The main reason for vaccination delay is the widely-held perception of the risk to babies of post-vaccination complications.
(a) To have 90% of all mothers who have given birth in the past 12 months take their infant child to the nearest health facility promptly and on schedule at 2 months, 3 months, and 4 months for the appropriate vaccinations against diphtheria, pertussis, tetanus, polio, and hepatitis B, leading to an increase of total coverage of these vaccines from approximately 84% for most of these vaccines to the level of 90%, requiring about 3000 more mothers than usual bringing in their children for these vaccinations, and raising the level of timely vaccination from an estimated current level of 84 % at 12 months to 90% on schedule for each of those specific months. Rationale It would not be advisable in a single public communication campaign to attempt to address all the behavioural outcomes expected under the general heading of immunisation, given the various vaccines and their scheduling. The public would simply be overwhelmed and confused. One needs to limit the behavioural focus if behavioural impact is desired. UNICEF/Georgia in discussion with its partners decided to focus on a critical set of vaccines which are best taken with fewer side effects if taken promptly and on schedule at 2 months (DPT 1, OPV 1, Hep B 2), 3 months (DPT 2 and OPV 2), and 4 months (DPT 3, OPV 3, Hep B 3). While all vaccines are important, the medical view at UNICEF/Georgia was that focusing on getting the 2-3-4 month set of vaccines to 90% and above will make a tremendous difference to the protection of children’s health in Georgia. The first set of vaccines (BCG and Hep B 1) are given at the maternity house where babies are delivered and the vaccines are administered within hours, with a coverage of rate of near 100% in 2005. But once the baby is taken home, we see a drop in coverage with the vaccine sets at 2 month, 3 months, 4 months. Effective focus on these first set of vaccines in the first year of life set the basis for engaging parents in timely immunization for other vaccines on the schedule. In COMBI practice one is advised not to attempt communicating more than three behaviours at a time because people can usually remember only three items at a time: Give them a list of four, they’ll recall only three. The behavioural objective of focusing on the 2-3-4 schedule of vaccines fits neatly this recommendation of limiting oneself to three behaviours at a time. The 2-3-4 schedule is descriptive of three separate but similar behaviours at each of those time periods. Strategy Focuses on ultimate results of mothers taking their newborn promptly and on schedule at two, three and four months of age to the nearest health facility.
Administrative Mobilization - Memorandum from the Ministry of Health addressed to the regional health departments, district self-governance, regional public Health centers; Interpersonal Communication/Personal Selling Within the framework of the campaign medical workers have been mobilized at central, regional and rayon levels. During the forthcoming months family nurses throughout the country have carried out home visits to inform mothers and other caregivers about the benefits of immunization and to advocate for timely vaccination. During the first round of the campaign, 50 nurses from across the whole country were awarded with special gifts, plastic cards with a value of GEL 100 (60 $US), from the TBC Bank. These are the nurses who have achieved high immunization coverage in their regions/districts. There will be another round of evaluation of the campaign in November which will recognize an additional 50 nurses who will also receive awards from the TBC Bank. This is the first attempt to involve Georgian business companies in immunization programmes. School Promotion The campaign also targeted school children to educate them about the importance of timely vaccination and to have them serve as “personal sellers” of the message in their homes. Immunization lessons were arranged in all schools across the country in April and children received school calendars including information on immunization. Public relations/Advertisement Within the media campaign four advertising segments, each lasting three to four weeks, have been broadcast on radio and television in March, April, July and October. Talk-shows on immunization have been launched on national and regional TVs and radio; video-audio releases have been produced, media feature articles in major newspapers have been released and a 12 minute film on immunization has been aired on two national and on all the regional TVs. Informative booklets, posters, banners with campaign messages have also been produced and displayed in health facilities. Point of Service Promotion The campaign banners and posters were posted at each health facility, whether private or state or rayon-linked, where parents bring their children for regular checking, and for immunization. The materials were placed at the entrance of the polyclinics and different strategic locations. Business Partnership for Immunization The Local TBC Bank awarded successful nurses. Procter and Gamble Company donated 15,000 boxes of disposable Pampers wipes for mothers who take their children for immunization.
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