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Immunization

Mobilizing communities

next Sylvia Luciani, Former Senior Advisor, UNICEF Programme Communication

Q: How has UNICEF been mobilizing communities to support immunization efforts?

Luciani: For the last few years, one of the areas we have really been focusing on is polio eradication. We are now very close to our goal – there are only a few countries left where the wild poliovirus is still circulating. The challenge is to keep up the momentum and to maintain the interest of governments, health personnel and donors. When you eradicate a disease, the last areas are usually the most difficult. Often in these countries, conflict or difficult geographical terrain make it tricky to reach the population through conventional means. Thus, we think of creative ways to reach people in war-torn countries, people living in the remote areas, nomadic peoples, or groups living in areas where there are negative rumours about polio immunization, such as a link between immunization and family planning.

Q: How does UNICEF help governments immunize amidst conflict or wars?

Luciani: We have overcome many constraints by assisting governments to conduct what we call Days of Tranquility. Days of Tranquility are when we convince all the parties involved to cease hostilities in order to allow children access to health care. We have found out that it is very, very important to have relationships with religious groups and non-governmental organizations (NGOs) operating in the area because they are very often successful in making contact with the parties involved. Afghanistan is a very good example. Last year, National Immunization Days were successful because Days of Tranquility were initiated with various parties involved in the conflict. Southern Sudan and Somalia are other examples where this has worked.

Q: How does UNICEF collaborate with partners to persuade reluctant populations to immunize?

Luciani:  In the past few months we have made energetic efforts to reach the most un-reached groups in India, specifically in Uttar Pradesh and Bihar. In order to do this, we used both mass media and a network of motivators. Sometimes the only way to immunize a community is to have one-on-one dialogues with key decision makers. For instance, in one very tiny village in India, the leader of the community absolutely refused to allow the children to be vaccinated for polio, despite the fact that he himself was disabled by polio. Little by little, one of the local motivators managed to win his support by helping him reflect on what had happened to him and how important it was to protect the children within his family and his community.

Q: How does UNICEF help to reach nomadic populations?

Luciani: Often if the children don’t come to the vaccinators, the team must travel to them.  In certain areas in West Africa, families with children move constantly, making immunization a formidable task.  In the case of the area of Mali and Niger, vaccinators travelled to salt mines in the desert where nomadic groups would go to allow their animals to feed on mineral salt. This annual congregation of cattle and camel owners is also a very important socializing event for that region in Africa. In addition to the regular socializing, there was also the provision of fundamental health services for children.

Q: How can rumors undermine an immunization effort?

Luciani:  There are several rumors typically associated with immunization. One is a supposed link between vaccination and family planning (that the vaccination is actually a form of birth control). Another is that immunizing children could give them HIV/AIDS. Of course, these rumours are totally unfounded. Yet, when they spread, immunization efforts can be severely affected. Over the last few years we have learned how to dispel these rumours by making sure that populations have the accurate, transparent information.

We work with the ministries of health, local governments, the media, NGOs and all of our partners in order to reassure the population that vaccines are safe and a benefit for children. We are also careful to keep in close contact with media channels. It is possible for the media to misunderstand technical information. This is how rumours can really fly. We have also learned that we must go to the source of the rumour – without creating a fuss – to dispel fears or correct misinformation.

Q: Who are the key decision makers in these communities?
 
Luciani: Religious leaders and traditional healers are two very important groups in many of these countries. It is incredible how much can be done with the participation of religious leaders of all faiths. Most religious groups have been incredibly supportive of immunization efforts, informing the people through masses, sermons or prayers. They are very influential within their constituencies and they are often able to convince marginalized groups of the population who are more difficult to reach via the regular health system.

Traditional healers have also been very supportive of immunization efforts. It is important to inform these groups fully because they are often the first people parents consult if they have concerns about immunization. One good example was in Malawi, several years ago, where traditional healers were trained and used during the immunization campaign against polio. It was a great success because the traditional healers felt that their leadership roles were recognized and they agreed to inform the people about the importance of being immunized.

Q: What is the role of the UNICEF-trained health workers in motivating populations?

Luciani:  Health workers and vaccinators are really on the frontlines of the immunization effort. In many cases, they are the parent or care-giver’s main source of information on immunization. We noticed that vaccinators were losing this opportunity to convey critical information and to encourage mothers to return for further immunizations. Very often during National Immunization Days, health workers and vaccinators are overwhelmed with hundreds of people waiting to be served. Under pressure, health workers and vaccinators often move quickly from one child to the next.

We are encouraging a child-friendly approach: Smile at the mother, encourage her in her role as a caring parent. Just saying simple things can make a difference. Not only will the mother come back for the next immunization, she will go back and tell her relatives, friends and neighbours. Secondly, it is important that the care-givers know what the vaccine is going to do for their child: Tell them what disease the vaccine is preventing and tell them when to come back for the next immunization.

Q: What are some of other ways UNICEF enlists the aid of community members?

Luciani: One great eye-opener for us occurred in an immunization campaign against measles and rubella in Kyrgyzstan. This campaign was unusual because the government was trying to immunize a population up to 24 years of age. It is easier to get parents to bring in their small children for immunization than to convince adolescents and young adults to participate. Furthermore, once we arrived in Kyrgyzstan, we discovered that a large population of children was living in the streets.

How were we going to reach these children who didn’t sleep in any fixed place and had hardly any access to health care services? We decided to engage the children who lived in the streets in our planning workshop. For the first time, these children felt like valuable members of society and were able to provide some input. They told us where other homeless children slept and offered themselves as peer educators. This reinforced our belief that when you involve people you are trying to reach in your planning, you really get valuable insights for giving the programme the best chance of success.