Interpersonal Communication for Immunization
Health providers have always been an important and trusted source of information for parents and caregivers in the Europe and Central Asia (ECA) region and beyond. The way they interact with families and the quality of their communication and engagement may have a positive or negative influence on caregivers’ decision to immunize their children. Research in ECA has shown that health workers do not always engage with caregivers in an open and supportive way, often using a patronizing and top-down approach in communication. As a result of time constraints and limited communication capacities, they often fail to understand the immunization-related concerns, fears and expectations of caregivers and fail to identify and address vaccine hesitancy. To help strengthen the communication and community engagement skills of front-line workers, the UNICEF Regional Office for Europe and Central Asia (ECARO) has developed this interactive and evidence-based training package to identify and address their own biases and misconceptions and to equip them with the essential knowledge, skills, and attitudes they need for positive and meaningful interpersonal communication. It consist of a Facilitator Guide, Participant Manual and a set of Presentations. Options Available options Facilitator guide Participant manual Presentation Download file (PDF, 5,62 MB) (PDF, 5,57 MB) (PDF, 11,88 MB) November 2019
Interpersonal Communication for Immunization. Presentation
Health providers have always been an important and trusted source of information for parents and caregivers in the Europe and Central Asia (ECA) region and beyond. The way they interact with families and the quality of their communication and engagement may have a positive or negative influence on caregivers’ decision to immunize their children. Download file (PDF, 11,88 MB) November 2018
Interpersonal Communication for Immunization. Participant manual
Good interpersonal communication can mean the difference between a child being fully immunized or not at all. This Interpersonal Communication for Immunization Participant manual seeks to help health workers value, acquire, and consistently use the knowledge, skills, and attitudes needed to communicate effectively with caregivers and communities about childhood immunization. Interpersonal communication for immunization capacity development is critical. Almost every study of health worker practices in the region finds that interpersonal communication for immunization overall is weak. Yet, at the same time, the vast majority of caregivers of young children cite health workers as their primary source of information about immunization. Health workers and health services must close this gap if nations and the world are to achieve universal immunization. Download file (PDF, 5,57 MB) November 2019
Interpersonal Communication for Immunization. Facilitator Guide
Health providers have always been an important and trusted source of information for parents and caregivers in the Europe and Central Asia (ECA) region and beyond. The way they interact with families and the quality of their communication and engagement may have a positive or negative influence on caregivers’ decision to immunize their children. Research in ECA has shown that health workers do not always engage with caregivers in an open and supportive way, often using a patronizing and top-down approach in communication. As a result of time constraints and limited communication capacities, they often fail to understand the immuni-zation-related concerns, fears and expectations of caregivers and fail to identify and address vaccine hesitancy. To help strengthen the communication and community engagement skills of front-line workers, the UNICEF Regional Office for Europe and Central Asia (ECARO) has developed this interactive and evidence-based training package to identify and address their own biases and misconceptions and to equip them with the essential knowledge, skills, and attitudes they need for positive and meaningful interpersonal communication. Download file (PDF, 5,62 MB) November 2019
Protecting children against measles in Romania
Parents living in Strehaia, a Roma community in South-West Romania, nod and smile in relief after watching a short video shown by their local physician on the benefits of immunizing their children. The physician answers questions from the parents before they gather their children and move to the next room where all of the children are vaccinated. The children range in age from young toddlers to 18 years old. The young ones hold their mothers’ hands tightly, but the older ones laugh and ask to watch the film again. The film is part of UNICEF Romania’s ongoing support to the Ministry of Health’s efforts to increase immunization coverage and prevent the spread of measles. Vaccination coverage in Romania has declined since 2000. In 2017, only 75 per cent of children had received two doses of Measles, Mumps and Rubella (MMR) vaccine – a coverage rate far below the recommended 95 per cent needed to protect all children. As a result of low immunization coverage, Romania has experienced a measles outbreak, with over 15,000 people affected since 2016. This includes 59 deaths, the majority being children. As part of ongoing efforts to increase immunization coverage, in July 2018 Romania’s Ministry of Health launched a door-to-door catch up campaign to vaccinate children who missed their vaccinations. In support, UNICEF developed a series of materials to provide parents with easy to understand, factual information about the benefits and process of children being immunized. These materials include the short film watched by families in Strehaia. The film is shown to parents and families in the most vulnerable communities in Romania - people living in hard to reach areas, those affected by poverty, and Roma communities. These communities often have children with the lowest rates of immunization. The film talks about the necessity and benefits of vaccination and, at the same time, addresses the most common vaccine-related questions from parents: Is it safe to vaccinate my child? What if she/he catches another disease? What if my child gets sick after the vaccination? Is the vaccine free of charge? A girl is vaccinated at a community center in Buhuși, in Eastern Romania as part of the UNICEF and WHO supported immunization catch-up campaign. A girl is vaccinated at a community center in Buhuși, in Eastern Romania as part of the UNICEF and WHO supported immunization catch-up campaign. “In the beginning parents did not want to vaccinate their children, but then they put their trust in us. We told them vaccines are good and we encouraged them to ask the doctor all the questions they have during the campaign. So they were able to have a clear picture on the benefit of vaccination,” said Gabriela Stan, a health mediator in the town of Buhuși, in Eastern Romania. Gabriela was part of the team that went door-to-door to inform parents from vulnerable communities about the benefits of vaccination. Although there have been positive developments in reaching vulnerable children with lifesaving MMR immunizations over the past few months in Romania, until the coverage rate reaches 95 per cent, children will remain at risk.
Protecting young children from vaccine-preventable diseases
Vaccination is one of the world’s safest and most cost-effective public health interventions. Yet growing distrust in science, coupled with misinformation, means that vaccination coverage rates are declining in some countries and communities, resulting in an upsurge of vaccine-preventable diseases. Research shows that those caring for children…
Tracking anti-vaccination sentiment in Eastern European social media networks
This UNICEF working paper aims to track and analyse online anti-vaccination sentiment in social media networks by examining conversations across social media in English, Russian, Romanian and Polish. The findings support the assumption that parents actively use social networks and blogs to inform their decisions on vaccinating their children. The…
Turning every “no” into a “yes” to protect children from the current measles outbreak in Romania
Over 19,000 people in Romania have been diagnosed with measles since 2016. To date, 64 people have died – 58 of them children. The outbreak is the result of a drop-in immunization coverage over the past two decades, with many parents fearful of vaccination, due to the spread of misinformation. For example, the proportion of children who have received a second dose of the measles vaccine – which is needed to adequately protect a child form the deadly disease - dropped from 97 per cent in 2000 to 76 per cent in 2016. It was only after UNICEF started re-engaging in the national measles programme that this drop was stopped, and the coverage is currently up 5 percent from 2016 for the second dose. UNICEF focused on improving immunization awareness of the general public via TV, radio and social media, as well as on redesigning the national electronic vaccination registry, on conducting catchup immunization campaigns in areas with extremely low coverage, and on improving behavior and communication skills of local health workers on immunization. Besides these actions, UNICEF supported teams of health and social workers in 45 communities in Bacău county, in eastern Romania. Their interventions focus on providing a minimum package of community-based health services, including access to vaccination, to save and improve children’s lives. Adina and Didina are two mothers who have been reached by these community-based teams, and whose children are now fully immunized against the disease. The initiative relies on the work of health professionals such as Gabi Stan and social workers like Magda Grigoriu to build trust with families. Delia and Mario are the first children to come home from school, followed by Alberto at 2 pm and Petrina at 3 pm. All four children do their homework at this small table with their mother Adina. Delia and Mario are the first children to come home from school, followed by Alberto at 2 pm and Petrina at 3 pm. All four children do their homework at this small table with their mother Adina.
Empowering refugee and migrant children to claim their right to health: Improving health literacy
“I have always had to behave ‘like a girl’ and I am not used to being asked for my opinion, but you ask me to say what I think during these workshops.” A 13-year-old girl from Syria describes the impact of empowerment workshops in Serbia Boy is drawing a picture. UNICEF-supported activities for children on the island of Lesvos, Greece The ‘RM Child-Health’ initiative has supported work across five European countries to improve health literacy among refugee and migrant children over the past year. As a result, they and their families have learned about key health issues, about the health services available to them, and how to demand health services as their right. Through its support for health literacy – the ability to find, understand and use information to take care of your own health – the initiative has helped to dismantle some key barriers to health services for refugee and migrant children and their families in Bosnia and Herzegovina, Bulgaria, Greece, Italy and Serbia. This 27-month, €4.3 million co-funded initiative, which was launched in January 2020 by the European Union Directorate-General for Health and Food Safety, works alongside young refugees and migrants to ensure that they have accurate health information in their own languages – information that reaches them via the channels they use and the people they trust. Importantly, the initiative makes them more aware of their right to health care in these European countries – welcome news for those who have fled from countries where good quality health care is either unaffordable or unavailable. With support from the initiative, UNICEF and its partners first worked with young refugees and migrants to identify gaps in the information available to them and in their own knowledge. This informed the health literacy packages that have been rolled out in all five countries over the past year, spanning a wide range of topics from immunization and nutrition to sexual and reproductive health (SRH) and gender-based violence (GBV). The packages themselves have been backed by detailed plans to ensure that their messages reach their audiences and gain real traction. Great care has been taken to ensure that information materials are culturally appropriate, gender sensitive and child-friendly, and that they are suitable for the ages and backgrounds of their audiences. Cultural mediators and interpreters have helped to overcome language and cultural barriers, while materials have been made available in, for example, Arabic, Farsi and Pashto. Activities have often been led by trusted professionals, such as nurses, physicians and psychologists who are already familiar with the needs of refugee and migrant children and their families. Materials have been shared through channels and locations that are well-used by refugees and migrants, including asylum offices, temporary reception centres, health centres, Mother and Baby Corners (MBCs), workshops and discussion sessions, during outreach activities and via social media. As a result, health literacy is now embedded into existing activities with refugee and migrant children and parents across all five countries, and is based firmly on their views and needs.
Mainstreaming what works: EU and UNICEF strengthen health capacity for refugee and migrant children
“Very often we have the feeling that this space functions as a container for the absorption of negative emotions of the people who visit us. People who come here often feel safe enough to share their fears, their frustrations and even their darker thoughts. We try to give them space to express their feelings and we always find ways to boost their morale.” A Coordinator from METAdrasi on the importance of the Mother and Child Space for refugee and migrant At the ADRA community centre for migrant mothers and babies, Belgrade, Serbia At the ADRA community centre for migrant mothers and babies, Belgrade, Serbia The ‘RM Child-Health’ initiative has worked with UNICEF and its partners over the past year to strengthen national health systems in five European countries so they can meet the needs of refugee and migrant children. The initiative recognizes that a strong health system delivers for every vulnerable child. It is also a system that looks beyond physical health care to address mental and emotional wellbeing and wider issues, such as gender-based violence. Strong health systems are vital to ease the bottlenecks that confront refugee and migrant families when they try to access health care. All too often, their attempts to claim their right to health services are hampered by language barriers, bureaucracy and discrimination. In Bulgaria, for example, where national immunization rates are already below the European average, refugee and migrant children are three times less likely to be vaccinated than other children. The challenges Refugee and migrant children often have complex health needs, which may go far beyond poor physical health. Migration has a negative impact, for example, on their mental health and psychosocial wellbeing. And that impact is intensified by poor living conditions, a lack of supportive social networks and social integration and, all too often, hostility from host communities. Many parents and caregivers, faced with barriers to health care and other basic services, as well as a lack of control over their own destiny, face real distress, and this can undermine their ability to meet the physical and emotional needs of their children at a critical point in their development. Gender-based violence (GBV) is another – and particularly harsh – challenge that affects many refugee and migrant children and young people. A chronic lack of child-friendly health information and durable solutions has heightened the risks of GBV, sexually transmitted diseases and early pregnancies, and the devastating consequences of all three for mental health. The response
A Mother and baby corner - a place of health and serenity
“Milos was born at a Reception centre, here in Serbia. We have been changing addresses ever since. We are currently staying at the Asylum centre in Belgrade. These are all difficult circumstances, where I, as a mother, don’t set the rules. And I find it very difficult.” Mother with a baby Sharife and her son Shahir Milos in the mother and baby corner in Belgrade, Serbia. That’s why Sharife is happy every time she visits the Mother and baby corner. The nearby Community centre, run by the humanitarian organization ADRA, houses just such a mother and baby corner, whose work is supported by UNICEF through the project ‘Strengthening Refugee and Migrant Children's Health Status in Southern and South-Eastern Europe’, co-funded by the Health Programme of the European Union (the ‘RM Child-Health’ initiative). Here, mothers can spend time in a safe space for women, change their babies’ clothes and nappies, access hygiene items for their children, breastfeed in privacy and put their children down for naps, as well as participate in workshops. And most importantly, because they are living in challenging circumstances, they can talk to a doctor about the nutrition, hygiene and early childhood development and immunization of their small child, but also about their own health and the health of older children. This is particularly crucial during the COVID-19 pandemic. Milos is learning through play in the Mother and baby corner. Milos is learning through play in the Mother and baby corner. The first piece of advice that mothers receive in the Mother and baby corner is always about breastfeeding – a source of food that is always available, hygienically safe and nutritious, and which boosts a child's immunity. “Breast milk provides all the nutrients a baby needs, but it also stimulates development [and] develops immunity. It helps the child to calm down, sleep better and be settled. This also helps me be calm,” explains Sharife with a smile on her face. Sharife is an experienced mother. Even so, she is very grateful for the advice she has received from the doctor at the Mother and baby corner. When Milos was six months old, she introduced solid food into his diet, while she continued to breastfeed. She recalls that Milos’s first solid food was rice cereal, and then later on vegetables, fruits and meat. The Mother and baby corner is a safe space where Milos and his mother can spend quality time together. The Mother and baby corner is a safe space where Milos and his mother can spend quality time together. “Milos likes best the carrot and apple puree I make for his snack,” explains Sharife. The needs of refugee and migrant women, according to social worker Andja Petrovic, have shaped the development of ADRA’s Community centre, where they would, as a rule of thumb, almost always come with their children. In order for women to be able to attend creative, recreational and educational workshops at the Women's centre, they needed a Child-friendly space for older children and a Mother and baby corner for women with infants. These spaces make it possible for mothers to participate in language classes, sports activities, creative workshops and, most importantly, in workshops about women's health and rights, while their children are taken care of and safe. In these challenging times, mothers really appreciate the chance to talk to a doctor about the health status of their children. “The most important thing is that all the advice from our doctor is in line with their economic circumstances and current living situation [in Reception centres],” explains Andja. “The advice is tailored to their life and I think they particularly like that, because they can see that their situation is acknowledged. Because when they go to a doctor [in other facilities], they get advice that they can’t follow because they don’t have the [living] conditions for that.” Dr Zivica Lukic explains that she talks to mothers mostly about nutrition, hygiene and how to respond to their babies’ needs. “We support mothers to establish and maintain breastfeeding, as it has not only economic benefits, but for mothers it also has emotional and physical ones. We know how healthy breastfeeding is for the child, but it is equally healthy for the mother, because it soothes and creates a strong bond between mother and child. When the baby is six months old, it’s necessary to introduce solid foods. I advise [the introduction of] vegetables that can be pureed well, such as potatoes and carrots, [as well as] rice.”