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
Going for a vaccination with my cousin Emina
“Don’t worry, it doesn’t hurt, it just stings a little. It’s easier if you look the other way,” says Emina to Irma as they fix each other’s hair. This is an important day for Irma Fafulić, who has already prepared a clothing combination to wear and asks us to wait for her while she changes in another room. Both girls soon return to the living room of Irma’s humble home, dressed up and with their hair done to their liking, but now they are faced with another dilemma: they are not sure if their protective facemasks will match the rest of their outfits so they deliberate on which one to wear to the vaccination point. The atmosphere in the living room of the Fafulić family in the village of Varda near Kakanj is almost festive: they are visited by Edin Sejdić, mediator from the Kakanj-based Roma Support Centre “Romalen”. Six-year-old Emina and her mother Fatima Dedić from Visoko are currently visiting the Fafulić family, so the girls have been inseparable for days. “I call her sister even though we’re actually cousins, and I’m a little older than Emina,” says Irma with a smile full of crooked milk teeth and explains that she has completed her second grade online due to the COVID-19 situation. Now, she says, she is deservedly enjoying her school holidays after a very challenging period when she had to compete with other relatives for access to a single shared mobile device so that she could attend her online classes. When asked what she liked most about school this year, she retorts right off the bat: “My teacher Dženita!” The rest of the Fafulić-Dedić household listens attentively to Edin, whom they have known for a long time, and who has stopped by today to escort their Irma to the local health centre for a vaccination. Statistics show that only four percent of Roma children in BiH are vaccinated Roma girl UNICEF/ Majda Balić Raising awareness about the importance and effectiveness of immunization in Roma communities is one of the regular activities implemented by the Kakanj-based Roma Support Centre “Romalen” Edin is kind of a link between the health-care system and the residents of this small community, and as a true man of the people, he explains the advantages of immunization, dispelling misconceptions and rebutting arguments of even the most fervent opponents of vaccination in the audience. He is one of the 16 mediators trained to do outreach work and help Roma communities with vaccination procedures in four cantons with sizeable Roma population (Zenica-Doboj, Sarajevo, Central Bosnia and Tuzla). Raising awareness of the importance and effectiveness of immunization in Roma communities is one of the regular activities implemented by the Kakanj-based Roma Support Centre “Romalen” under the project Immunization for Every Child in Bosnia and Herzegovina (BiH), in cooperation with UNICEF BiH. Edin is a link between the health-care system and the residents of this small community. Edin is a link between the health-care system and the residents of this small community. He admits that doing outreach work is not always easy, adding that people often confuse going to the doctor for an injection for receiving vaccines, and that there are still those who remain unconvinced of the benefits of immunization. But Edin has a way with people, patiently walking them through the entire process, emphasizing benefits and dispelling fears. By the end of the project, as many as almost 1500 families in the four cantons will have been informed about the benefits and effectiveness of immunization, as well as vaccination procedures and options. Mediators like Edin also provide assistance by escorting the youngest members of the community to vaccination points. “Thanks to this project, you can also retroactively receive the vaccines you missed,” says Edin, adding that many Roma are not at all aware of what needs to be done, or when. Mediators are therefore an invaluable asset to the community as they motivate, inform and mobilize people, and prepare the ground for the child’s immunization. Each mediator has a vaccination schedule for every child, and reminds parents when it is time to go to a health facility. Mediators are carefully selected from among their communities, they are persons of trust, and are usually involved in supporting the community through other projects – so they are familiar to the people they interact with and have already gained trust of the local residents. The same is true of the Fafulić family, who are now ready to have their Irma vaccinated after receiving relevant information from Edin. Mujo Fafulić Mujo Fafulić, president of the Kakanj-based Roma Support Centre “Romalen” “Roma mediators have a vital role to play in Roma communities. Statistics show that only four percent of Roma children in BiH are vaccinated. This project aims to raise this immunization rate, even using statistics on the mortality of unvaccinated children as one of the arguments,” explains Mujo Fafulić, president of the Kakanj-based Roma Support Centre “Romalen”, the organization implementing the project. “These are one-on-one conversations, with mediators visiting communities to check on the spot what the vaccination rates are and whether children are vaccinated at all, as well as which vaccines they have received, while also motivating parents to have their children immunized if they have not done so before. "By the time they reach adulthood, children should complete the vaccination cycle, and mediators are doing outreach work to explain the benefits of on-schedule immunization, as well as the adverse consequences of failing to do so." Mujo Fafulić Emina has already received the vaccines scheduled for her age, and she confidently shares her last words of advice with her cousin Irma before they leave, so that there are two parallel conversations going on in the living room – adults talk about the benefits of immunization and health care, and the little girls, holding hands, have their own conversation about what the needle looks like and where on the hand the nurse will give Irma a jab. Rubbing their hands with disinfectant, with their facemasks on, the girls extend their hands to the mediator, ready to go – Emina, being more experienced, will escort Irma to help her go through this whole experience as painlessly as possible. Irma’s parents Jasmina and Nermin are staying at home and waving to the girls from the window. Holding hands, with their fingers intertwined in a clasp that shows care and love, the children set out together on their trip to the health centre. The trip they are taking is one that is recommended to everyone as it promises better health and protection against diseases that are still lurking about and are far from being eradicated. Dr. Rownak Khan, UNICEF Representative in BIH confirms that by saying: “Vaccination is the best protection from communicable diseases. Unfortunately, Bosnia and Herzegovina’s low immunization rates, 68% full immunization and only 4% among Roma children, mean that children in this country are at high risk of getting vaccine preventable diseases resulting in outbreaks, particularly measles outbreaks. Currently, UNICEF is working with two Roma NGOs, Kali Sara and Romalen, to raise awareness on the importance of vaccination in Roma communities, by connecting with health institutions, Public Health Institutes and ministries with Roma communities through Roma health mediators to reach the most vulnerable children. This will also reduce equity gaps and will protect all children in BiH from vaccine-preventable diseases.” All children, regardless of the country or circumstances in which they live, have the right to develop and thrive. As a key component of the human right to health, immunization saves millions of lives and protects children against vaccine-preventable diseases. Immunization saves two to three million lives each year. Vaccines now protect more children than ever before, but nearly one in five infants miss out on the basic vaccines they need to stay alive and healthy. Low immunization levels among poor and marginalized children compromise gains made in all other areas of maternal and child health. This material is produced within the initiative Increase awareness on the importance of vaccination with special focus on Roma communities - Immunization for every child! UNICEF Country Office in Bosnia and Herzegovina’s programme on immunization, funded by the Centers for Disease Control and Prevention (CDC) through UNICEF Headquarters. We would also like to thank UNICEF Europe and Central Asia Regional Office for their support.
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…
Frontline social workers provide vital support to improve health
Yura has been a social worker for many years. “When I started working in social services, I was mainly interested in family therapy,” she says . “In time, I found out that supporting communities to become resilient and self-reliant is an extremely rewarding experience.” A year ago, she joined the Council of Refugee Women in Bulgaria (CRWB) – a civil society organization created in 2003 to support the integration of refugees and migrants. “Guiding through people from refugee and migrant backgrounds on health-related procedures in their host country is a way to empower them to find solutions to health issues,” explains Yura. And this is particularly vital for those fleeing from armed conflicts and humanitarian crises. As they search for safety and better life opportunities, both adults and children go through many traumatic experiences as a result of often prolonged stays in refugee camps, limited access to health care, and the dangers they face as they travel through volatile areas. By the time they finally reach a safe destination, they are often in very bad physical and psychological shape. “In Bulgaria, refugee children arrive with their parents or – in some cases – unaccompanied. Psychological problems, infectious diseases, medically unobserved pregnancies and, in particular, a lack of immunization, are common problems that have a negative impact on their health and wellbeing.” Radostina Belcheva, Project Coordinator and Deputy-Chair of CRWB The CRWB partners with UNICEF Bulgaria to provide general health checks and referrals, as well as life-saving vaccines in line with children’s immunization schedules, and equips parents with information on health risks, entitlements and how to access medical services. “As part of the ‘Strengthening Refugee and Migrant Children’s Health Status in Southern and South-Eastern Europe’ (RM Child-Health) project co-funded by the European Union’s Health Programme, we work with our partners to ensure that children can follow immunization plans and that their vaccination status is updated in their immunization documents. These are crucial steps in ensuring good health . ” Diana Yovcheva, Programme Officer with UNICEF Bulgaria Working directly with refugees, Yura consults families that want to access health services. “Some cases are easier than others”, she says, recalling a consultation with Ahmed*, a 45-year-old father of six children, who fled Syria in 2020 and received humanitarian status in Bulgaria. A chef by profession, Ahmed settled quite well in the host country, found a job in a restaurant and, after some time, managed to reunite with his wife, his four sons and two daughters. “Ahmed was referred to the CRWB by friends and he came in for a consultation on the immunization process with his youngest baby girl, Yasmina, only one year old” explains Yura. During their meeting, the social worker provided information about the health system in Bulgaria, the role of a general practitioner, and how people with refugee status can access medical services including vaccinations for their children. Although Ahmed’s baby girl had been vaccinated before her arrival in Bulgaria and had an immunization passport, the father urgently needed to update her vaccination status to synchronize her vaccinations with the recommendations of the national immunization calendar. “I contacted the Regional Health Inspectorate and helped Ahmed to provide the necessary documents and find a translator, as the documents were in Turkish”, says Yura. Subsequently, she helped Ahmed schedule an appointment with a medical doctor and Yasmina received her next vaccine. Parents often lack the necessary vaccination documents. According to Yura, “Sometimes children have not had any vaccinations, or they have been vaccinated in their country of origin, but their immunization cards have been lost or destroyed.” Such cases require additional consultations, research and coordination, as well as testing for antibodies and immune responses when it is not clear whether the child has been vaccinated. “By empowering parents to familiarize themselves with the immunization plans and procedures we help them become proactive in following up on their children’s health." Yura, Social worker To address the COVID-19 restrictions and keep active communication with refugees and migrants, the CRWB and UNICEF developed leaflets in Bulgarian, Arabic and Farsi with details about the health system in Bulgaria and the importance of vaccinations, and regularly provide health-related information via social media. “The role of communication in immunization is essential. Our frontline staff interact on a daily basis with beneficiaries, but we have also used other means [such as a Facebook group dedicated to health-related topics] to keep the information flow going, particularly during the COVID-19 pandemic . ” Radostina Belcheva, Project Coordinator and Deputy-Chair of CRWB Logo - Strengthening Refugee and Migrant Children’s Health Status in Southern and South Eastern Europe This story is part of 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). The content of this story represents the views of the author only and is her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the European Health and Digital Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains .
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.