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Base de données d'évaluation

Evaluation report

MOZ 1999/800: Social Mobilization and Communication Support for Immunization in Mozambique: A Joint Lessons Learned Study by UNICEF, WHO/AFRO, and USAID

Executive summary


From October 1 to October 15, 1999 a four-person team studied communication and social mobilization in support for polico eradicatin and routine immunization in Mozambique. This was the first of five national studies in Africa jointly planned and carried out by UNICEF, WHO/AFRO, and USAID (CHANGE and BASICS).

Purpose / Objective

The primary objective of these studies was, while intensive immunization activities were underway due to the approaching goal of global polio eradication, to capture experiences while they were still fresh and to exchange them among African countries and beyond. The focus was on good or innovative ideas that work, particularly in regard to a number of challenges that appear to frustrate most African EPI programs.


The study methodology comprised of document review, interviews and observations among key informants. The study team interviewed approximately 50 persons in Maputo and in the capitals of four rural districts in Sofala and Nampula provinces. These people ranged from mothers and fathers, to traditional birth attendants and healers, to teachers and religious leaders, to media people, to health staff and consultants.

Key Findings and Conclusions

Since 1992, the EPI has had to rely on mobile brigades based in district seats to provide minimal services in areas far from functioning facilities. Even today, only about half of public health facilities offer regular immunziation services. This is due to a lack of trained personnel, vaccine, spare parts, and equipment. In fact, only about half of health staff working in immunization have received specific training in the area.

Despite all of these problems, routine coverage levels officially have continued to rise. This may actually be the case due mainly to the activities of NGOs and mobile brigades. However, because of unreliable population statistics, program officials are in reality uncertain if routine coverage has been rising, holding steady, or even declining over the past two years.

From 1996 to 1999, Mozambique's EPI organized twice-annual National Immunization Days (NIDS) that became progressively more effective, culminating in the extremely successful NIDS this year. All of the best practices noted by the team are related to these immunization campaigns. Routine immunization services confront numerous basic challenges of organization and resources as well as lack of attention to demand creation. The effective and creative actions noted (and described in this report) are the following:

  • Making NIDS a non-partisan issue and source of national pride
  • Good planning at all levels
  • Effective advocacy from the Ministry of Health
  • Participation of local leaders
  • Effective use of local communication channels
  • Use of multiple media
  • Use of incentives
  • Role of public personalities
  • The march of children

Of special note is the manner in which the MOH and its partners made the NIDS a non-partisan issue, above politics, and a matter of national pride. Other key factors were the effective involvement of local leaders and the good planning and substantial funding that allowed the effective use of local creativity and resources.

The numerous program collaborators effectively employed local media such as plays, songs, dances, drums and megaphones to inform people and interest them in NIDS. Which of these channels to use was determined locally. Such channels, along with community meetings and house-to-house visits, were essential for reaching the large (but unkow) portion of the population who were not reached by electronic or print media.

The contrast between NIDS and routine EPI could not be starker. NIDS were supported by an extraordinarly political commitment, involvement of all sectors of society, community and local-leader participation, and an enormous amount of resources from the government, donors and the private sector. There was saturation coverage in mass media.

From several dozen interviews conducted by the study team, one of the most striking finding is the low level of basic understanding among mothers, fathers, and local leaders concerning immunization. These same people who so actively participated in NIDS cannot explain what a case of polio looks like. While people have the general concept that immunizations prevent disease, they do not know what disease. The most common answers from parents and leaders were malaria and cholera.


Despite the very effective, creative, and enthusiastic mobilization achieved for recent NIDS, communication activities in support of routine immunization and surveillance need significant strengthening. Many most wanted actions fall in two categories: (1) institutional strengthening; and (2) collecting and using reliable quantitative and qualitative information as the basis for solid communication planning and implementation.

Several of these needs were agreed to at a planning seminar of the EPI and its main partner organizations in March 1999. These included:

  • Better integration of RESP (the MOH's health education unit) and the EPI
  • Strengthening of RESP staff capabilities to support communication for routine immunization
  • A specific budget and funding for communication support for routine immunization and surveillance
  • A national plan for social mobilization/communication support for EPI and polio eradication

The partners have already taken some initial steps to implement these recommendations. Wth substantial support from UNICEF, for example, a draft five-year plan for EPI communicatons has been prepared.

Additional needs, identified by the study team and described in this report, include the following:

- Reliable coverage data
- Higher priority for routine immunization and surveillance
- Adapt effective ideas and build on momentum of NIDS
- Focus on basic health education in addition to mobilization
- In-depth research on knowledge, attitudes, and practices of mothers, health workers, and other groups
- Specific strategies for hard-to convince groups
- Improvements in the client orientation of immunization services.

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