USING COMMUNICATIONS TO ACCELERATE IMMUNIZATION COVERAGE
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USING COMMUNICATIONS TO ACCELERATE
IMMUNIZATION COVERAGE - extracted text
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A Guide to Systematic Needs Analysis and Effective Planning
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UNICEE. MlD-NOR HI INDIA OF I ICE, NEW DEI HL MAY, 19M8
USING COMMUNICATIONS TO ACCELERATE
IMMUNIZATION COVERAGE
4*
A Guide to Systematic Needs Analysis and
Effective Planning
UNICEF, MID-NORTH INDIA OFFICE, NEW DELHI, MAY, 1988
CONTENTS
INTRODUCTION.......................................................................................1
THE PROGRAMME PROBLEM ............................................................2
FACTORS CONTRIBUTING TO THE PROBLEM
OF LOW COVERAGE.............................................................................. 3
ACTIONS NEEDED TO ADDRESS THE FACTORS
CONTRIBUTING TO LOW COVERAGE............................................. 5
PLANNING FOR IMPROVING COMMUNICATIONS...................... 8
INTRODUCTION
This is a guideline for UIP Communications planning in Mid-North India
States.
It is for use by the district UIP coordinator and district media staff.
This is prepared, based on analysis of 28 coverage evaluations,numerous
field trip reports and observations of immunization sessions.
This analysis clearly reveals that demand creation or lack of knowledge is
NOT the only factor affecting low coverage. Other managerial/
administrative support actions must simultaneously be carried out with
planned communications efforts to remove identified knowledge gaps.
Therefore it is important to use this guideline as a tool in the district
planning exercise so that communications planning is an integrated part of
programme planning.
If the district planning exercise has already been conducted or initiated,
you can still use these guidelines to incorporate the necessary actions into
the district plan to make it comprehensive.
1
THE PROGRAMME PROBLEM
Only 9-57% infants fully immunized.
•
Only 6-84% pregnant women fully immunized. Punjab and
Himachal have better TT Coverage. On an average only 30-40
percent of women are being reached with even one dose.
Access to immunization services is 41-91%, gauged by first contact with
infant for DPT/polio immunization. This high contact is most often not
maximized by imparting the necessary education and giving concurrent
immunization when applicable, so as to reduce the total number of visits
required to complete the child’s immunization.
•
Access of pregnant women to immunization services is only 14-71%, guaged
by first contact with pregnant women for TT first dose administration.
BCG coverage averages 20-60 percent. This low average
brings down percentage of fully immunized infants.
•
Drop-out rates for DPT and Polio are 16-46%. High drop-out continues due
to Jack of information about date and time of next dose, incorrect
information about contra-indications and inadequate follow up by health
staff.
•
Drop-out rates for TT arc 4-45 percent resulting in only 30-40 percent fully
protected pregnant women.
4-55% infants still not reached. On an average this is 20-30
percent.
Measles coverage 4-30%. This has low priority at service
delivery and community level.
Identify the programme needs in your district by carrying out a similar exercise with the actual programme
statistics from your district.
2
FACTORS CONTRIBUTING TO THE PROBLEM OF LOW COVERAGE
Reasons for Failure reported in coverage
evaluations
•
Unaware of need, (including unaware of number
of doses)
•
Vaccinator absent.
•
Place and time of vaccination not known.
•
Vaccine not available.
•
Fear of side reactions.
•
Child ill/mother too busy.
Low BCG Administration
•
All workers not trained to give injection.
•
Vaccine wastage fear of workers.
•
Contact with child not maximized - BCG administered on
separate day and vial not opened IF enough children not
present.
•
Health staff not aware that vaccine can be administered
concurrently with other vaccines as long as child is 9
months old.
•
Community not convinced about importance of immunizing
against measles.
•
Community not aware that complications accompanying
measles can be dangerous to life.
•
Community not aware that measles can be prevented.
Low Measles vaccine administration
Low TT administration to pregnant women
x
•
•
3
All Medical Officers and health staff not convinced about
inclusion of measles vaccine.
,
Measles vaccine not available everywhere.
•
Pregnant women/community
consequences or its prevention.
unaware
of
disease,
•
Pregnant womcn/community not aware of number of doses
and when they should get immunized.
•
Workers do not maximise contact with child by giving
concurrent immunization.
•
Health workers have little contact with pregnant women
during antenatal period.
•
Health workers do not educate about side reactions.
•
Workers often refuse immunization for fear of vaccine
wastage.
•
Workers often have wrong information about maximum
interval between doses and often refuse/restart the series-if
gap is more than four weeks.
•
Worker not present to administer vaccination.
•
Vaccine not available.
•
Community is not aware of what constitutes complete
immunization.
•
Community is not aware that incomplete immunization does
not offer complete protection.
•
Community
has
contra-indications.
•
Community has fear of side reactions.
Health workers do not follow up cases after administration
of first dose.
•
Community often does not know where and when to go for
next dose of immunization.
Workers often refuse to immunize some children due to
incorrect knowledge about contra-indications.
•
People prioritize other work in relation to immunization
because they do not fully understand the dangers of
non-immunization.
•
Health workers do not utilize dais for keeping contact with
pregnant women and monitoring antenatal care.
•
Low staffing of female health workers.
20-30 Percent population not reached
•
Low staffing, difficult terrain and inadequate mobility
contributes to this.
•
Resources of other dcpartments/agencies not pooled for
educational efforts.
•
Total population not covered with educational inputs
•
Resources not pooled for logistics management.
High Drop-out Rates
•
inaccurate
information
about
4
ACTIONS NEEDED TO ADDRESS THE FACTORS CONTRIBUTING TO
LOW COVERAGE
The main objective of this exercise is to identify the necessary actions
required to address all the major factors contributing to low coverage.
This exercise indicates that if we are to achieve the objectives of the
Universal Immunization Programme there is need for simultaneous
action at managerial, administrative support and training levels in
addition to improvement in planning of communications to remove
the gaps in information amongst community members.
ACTION NEEDED
FACTORS
Reasons for Failure reported in coverage evaluations
Vaccinator absent
Better planning and management of logistics and manpower use.
Vaccine not available
Better supervision and monitoring.
Place and time of vaccination not known
Unaware of need (including unaware of number of doses)
Fear of side reactions
—
Communication and motivation of parents and community
members.
Child ill/mothcr too busy
Low BCG Administration
All workers not trained to give injection
Workers’ fear of vaccine wastage
Contact with child not maximized - BCG administered on
seperate day and vial not opened IF enough children not present
Sharing of administrative instructions on vaccine wastage at
field-level and explanation in training.
Adjustments in immunisation days to maximise contact with the
child.
Better supervision and monitoring.
5
FACTORS
ACTION
Low Measles vaccine administration
All Medical Officers and health staff not convinced about
inclusion of measles vaccine.
Stressing importance of measles vaccine in Dist.planning
workshops and training programmes.
Measles vaccine not available everywhere
Health staff not aware that vaccine can be administered
concurrently with oilier vaccines as long as child is 9 months old
Include in training of paramedics.
Community not convinced about importance of immunizing
against measles.
Community not aware that complications accompanying measles
can be dangerous to life.
Education of community.
Community not aware that measles can be prevented.
Low TT administration to pregnant women
Pregnant women/community unaware of disease, its
consequences and prevention.
Educating, motivating the community members
Pregnant women/community not aware of number of doses and
when they should get immunized.
Health workers have little contact with pregnant women during
antenatal period.
Health workers do not utilize dais for keeping contact with
pregnant women and monitoring antenatal care.
Educating, motivating Dais as an important influence group.
Planning manpower use for adequate antenatal care.
Low staffing of female health workers.
6
FACTORS
ACTION
High Drop-out Rates
Health workers do not educate about side reactions.
Health workers do not follow up cases after administration of first dose.
Including these aspects in the training of
paramedical staff.
Workers often refuse to immunize some children due to incorrect knowledge
about contra-indications.
Sharing all administrative instructions with
workers.
Workers do not maximise contact with child by giving concurrent immunization.
Planning at block level for following up cases
with problems.
Workers often refuse immunization for fear of vaccine wastage.
Supervision and monitoring.
Workers often have wrong information about maximum interval between doses
and often refuse/restart the series if gap is more than four weeks.
Worker not present to administer vaccination.
Better planning and management of logistics and
manpower use.
Vaccine not available.
Community is not aware of what constitutes complete immunization
Community is not aware that incomplete immunization does not offer complete
protection.
Community has inaccurate information about contra-indications.
Educating, motivating parents and
community members and influence groups.
Community has fear of side reactions.
Community often does not know where and when to go for next dose of
immunization.
People prioritize other work in relation to immunization because they do not
fully understand the dangers of non-immunization.
20-30 Percent population not reached
Low staffing, difficult terrain and inadequate mobility contributes to this.
Resources of other dcpartmcnts/agencics not pooled for educational efforts.
Total population not covered with educational inputs
Resources not pooled for logistics management.
7
Planning for logistics and manpower use for
adequate coverage.
Planning for educating the community (linked
to above) and also using other resources
outside the health sector.
Who are the target groups?..................................................... 9
PLANNING
FOR
What are their communication needs?...................................9
Who is responsible for communications planning and
implementation?....................................................................... 11
What support can we take from the collector?...................... 11
IMPROVING
Steps in implementation.......................................................... 12
COMMUNICATIONS
Maximising the impact of the communication efforts and
optimum use of available media resources
some tips..... 13
Some resources at district level............................................... 14
Ii
&
WHO ARE THE TARGET GROUPS FOR COMMUNICATIONS INPUTS
•
Medical Officers/coinmunicators at district and block level, MEIOs(DEMOs), BEEs, Trainers.
•
Health Staff and other workers such as Anganwadi Workers
•
Community —
(i) Parents and young couples
(ii) Influence groups -Village Health Committees
Sarpanch & Panchayat members
Dais, VHGs
Mahila Mandals, women’s groups
School Teachers
MLAs
WHAT ARE THEIR COMMUNICATION NEEDS
MEDICALOFFICERS/COMMUNICATORS/TRAINERS
•
•
•
9
Communications planning must be integrated with service delivery
planning at block level and communications conduction should be
integrated with every step in immunization service delivery.
Planning for communications should not be restricted to
involvement of health staff alone.
Involvement of Block
Development Officer, Block Women & Child Development
Extension Officers in ICDS blocks, Block Education Officers etc,
should be sought
Importance of measles immunization. Complete immunization
includes measles vaccine.
Using paediatricians as major allies for measles immunization.
Importance of educating people about complications accompanying
measles and preventive action.
Responsibility of educating staff about latest regulations about
vaccine wastage.
Responsibility of educating staff about correct information about
contra-indications.
To maximize contact with child. Multiple immunization such as
BCG, DPT, polio and measles can be carried out. Neither their
safety, nor their efficacy is compromised.
remaining doses should be given as if the prolonged interval has
not taken place. But all scheduled doses should be completed by
12 months of age.
Responsibility of educating staff about completing the remaining
doses of immunization even if there is a larger interval in some
cases. Interrupted immunizations need not be restarted i.e the
Importance of ensuring follow up between immunization sessions
for treating case of reactions.
HEALTH STAFF AND OTHER WORKERS (ANGANWADI WORKERS)
Information about latest regulations on vaccine wastage.
Importance of following up cases.
Information about concurrent immunization and importance of
maximizing each contact with target child and mother.
Importance of educating parents about what is complete
immunization.
Information/guidance to complete doses of prescribed
immunization even in those cases where interval is more than the
prescribed amount.
•
Educating parents/community of dangers of non-immunization and
motivating them to protect their children.
•
Ensuring educational efforts reach all people
Correct information about contra-indications and importance of
imparling this to mother.
•
Getting the help of Dais, VHGs, School Teachers, Panchayat
leaders, Health Committees etc.
Importance of measles immunization and educating community
about complications accompanying and need for prevention.
•
Importance of using local examples of acceptors to motivate others.
Importance of educating community about reactions which child
might get and action necessary.
COMMUNITY
Parents
Importance of immunization - disease prevention - dangers of nonimmunization.
•
Information about where and when services are available.
•
Importance of measles immunization - prevention.
•
Importance of TT for pregnant women.
*
Importance of convincing other parents to get their children
immunized.
•
Who can answer their questions/doubts about immunization.
Motivation for immunizing and protecting child (emotional appeal)
What is complete immunization - complete protection (time factor
to be explained).
Correct information about contra-indications.
Knowledge of side reactions which might occur and what is to be
done.
10
Influence Groups!
Importance of immunization-disease
immunization, complete immunization.
prevention-dangers
of
reduction of morbidity occurs.
non•
Role and responsibility for motivating for immunization.
Convince them that they use their channels of communications for
motivating and for community organization/assistance to actually
get children immunized.
Convince them that credibility will increase if absence of disease and
WHO IS RESPONSIBLE FOR COMMUNICATIONS PLANNING AND
IMPLEMENTATION ?
The administrative unit for planning and implementation is the district.
•
The main responsibility of planning and implementation lies with the
District UIP Coordinator and District media staff under the overall
guidance of the Chief Medical Officer.
•
Active participation and support of the Collector is required for mobilising
resources of other government departments, service organisations,
industrial houses, banks and official media channels.
•
Cooperation of district departments heads in sending out appeals to
the block-level/field functionaries.
WHAT SUPPORT CAN WE TAKE FROM THE COLLECTOR ?
Help in activating the District Media Coordination Committee for using all
possible channels for communication for educating about immunization
Requesting active participation of field functionaries of departments in the
task of educating the community.
Special appeals to Panchayat leaders and teachers to help motivate people
to have all children immunized.
Help in mobilizing resources outside the government sector, such
as through banks, industrial/business houses, voluntary groups and
service organisations.
Help in activating all important media like radio/newspapers etc.
for community education through special appeals and the Media
Coordination Committee Meetings.
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STEPS IN IMPLEMENTATION
(i) Integrate planning for UIP communications with District
Planning Workshops.
•
•
Review local coverage evaluations/programmc statistics in
order to specifically analyse communications needs (on the
same basis as in these guidelines).
If District Planning Workshops have already taken place, a
special meeting may be called.
(ii) Based on the guideline and information obtained from
the local analysis, integrate and build in all aspects of
communications needs of medical officers and paramedical
staff and identified actions needed into the district plan for
UIP planning/orientation/training at various levels.
(iii) Now address the planning for communications needs
of the community members - both parents as well as
influence groups.
•
For each main target group, identify the communication
channels that will be used to deliver the messages based on
needs identified.
•
Identify local agencies or institutions that can participate in
the communication activities. These could be:
industrial/business houses, Banks, Groups like Rotary/Lions
etc., Voluntary agencies, service organisations
•
Identify the persons/institulion/agency responsible for
carrying out the communications activities at various levels.
•
Identify/prcpare the communications materials to be used
by the responsible persons/agencies for all communications
channels identified.
•
Try out materials produced on a sample of persons who
represent the major target audiences identified and finalize
the materials.
•
Make a check-list of activities to be carried out with the
time-frames spelt out.
•
Specify
the
responsibilities.
•
Direct this into a management and time plan for full
coverage of the district with educational activities. This
should include special efforts in problem areas or low
coverage areas.
resources/finances
available
and
(iv) After the district planning meeting or special UIP
planning meeting, call a joint meeting of the various
department heads, members of the District Media
Coordination Committee to seek cooperation, share plans
and discuss actual roles to be played. The meeting should
be chaired by the Collector. The roles or expectations from
different department functionaries should be worked out by
UIP Coordinator and Media staff before this meeting and
agreed upon in the meeting. This meeting will launch the
UIP communication plan of action in the district.
(v) Implement activities according to the schedule prepared.
Monitor the implementation to detect problems or
unexpected obstacles. If these occur, make changes
accordingly.
12
MAXIMIZING THE IMPACT OF THE COMMUNICATION EFFORTS
AND MAKING OPTIMUM USE OF MEDIA RESOURCES
AVAILABLE....SOME TIPS
•
Ensure that all media channels reinforce the same major elements
of communications needs identified through analysis of coverage
evaluations and field experience.
•
If there is a radio station in the district, send out together with an
appeal from the Collector the following materials to the concerned
producers/station director:
one audio tape on radio jingles on immunization;
•
In places where there are TV transmitters - inform people to look
out for the health spots - specifying the timing.
•
Send out appeals by the Collector to sarpanches, school teachers
highlighting their role as local influence group in the community
and giving suggestions as to how they can help the programme to
help save the lives of mothers and children.
•
Send out cinema slides on immunization to the cinema houses
together with an appeal from Collector/Commissioner for regular
screening.
•
Assistance that can be requested from local agencies and groups:
- to finance/sponser media and publicity activity such as radio
programmes, cinema slides, film shows, newspaper advertisements,
hoardings, handbills, banners etc.
one copy of ‘Immunize your Children’ immunization folder;
one copy of folder - Immunization - A Simple Way to Protect
Mothers and Children
days of regular immunization at government hospitals and health
centres.
•
•
13
Regional language newspapers in the district to be sent collectors
appeal and all information material as radio stations (except the
audio cassette).
Field publicity officers should also be provided with this
information and materials and asked to educate and motivate
persons in the course of their routine touring in the villages.
- through their welfare/health officers, to educate all workers
about immunization and ensure that in families of their
workers/staff, all children and pregnant women are fully immunized.
- to adopt areas for undertaking/supporting intensive education
activities and providing services. These could be in far-flung areas
or poorly staffed areas.
SOME RESOURCES AVAILABLE AT DISTRICT LEVEL FOR
COMMUNICATION ACTIVITIES
1 Activities for which support from UNICEF Zone and State Offices can be given in each UIP district:
Publicity Activities
Rs. 15,000/district
Area specific communications materials development
such as pamphlets, banners, newspaper advertisements etc.
Workshops and meetings at state and
Rs .7,000/meeting/district
district level for orientation of opinion
leaders and influencers.
Printing of state government reports,
Rs.5000/activity
preparation of audio-visuals of state government
Soft ware support to NGOs supporting state/district
immunization programmes
Rs.l0,000/district
Inter-sectoral coordination meetings and
Rs.lO,OOO/district
workshops on convergence - ICDS, MOHFW,
NGOs, Urban Development, etc.
The following page contains a few ideas on use of these funds. They are not meant to be prescriptive but
provided to start the thought process. Local needs and requirements should guide the actual expenditure of funds
to fulfill the specific needs identified.
14
Publicity Activities
Printing of reports, preparation of audio-visuals
Funds under this head for each district should be used to meet the
community education needs identified earlier. Depending on local
situation and specific requirements, the following activities/items
can be supported:
• Printing of hand bills for targetted distribution to parents,
influence groups.
•
Preparation of few banners (local agencies such as banks or
NGOs might be willing to finance these and possibility
should be explored).
•
Newspaper advertisements in regional language newspapers
announcing dates and other important information.
•
Hiring of TVs, VCRs for screening immunization film to
community.
•
Drum-beaters or mike announcements for audio-publicity,
especially in weekly market days or just prior to
immunization day. (Consider possibility of providing a
fixed amount to each SHC for this also).
•
Financing other local systems for public announcements in
key places at key times.
•
Financing local folk/drama parties for immunization related
shows - especially in problem/resistant areas.
•
Printing of Collectors appeals to Panchayat members,
school teachers etc to help in programme.
Based on local needs, this sum could be linked up for use in
publicity activities i.e. the printing and production of materials
aspect.
Workshops and Meetings
Funds under this head may be used for
• Reorientation of paramedical staff at PHC level based on
needs identified.
•
Block level or below orientations for influence groups based
on needs identified and groups identified. (Not necessarily
restricted to MLAs) should be done to cover the entire
block, specially focussing on "low coverage" areas of block.
Soft-ware support to NGOs supporting
state/district immunization programme
Depending on local requirements, this sum could be used for
orientation of local NGOs, private practitioners or associations of
medical officers or paying contingency expenses for actual
assistance in conducting immunization (in the last event, an area
should be allocated for complete coverage) based on GOT
guidelines.
Inter-Sectoral Coordination Meetings
Instead of just conducting coordination meetings at district or block
level, these funds could be used for orienting AWWs, school
teachers etc in how they can actually affect the "coordination" to
help the programme.
11. In addition, the District Health and Family Welfare Media wing may have finances available for
educational activites. Possibility of using these should also be explored.
111. Local banks, commercial houses or voluntary agencies may be willing to finance some educational
efforts as well as cooperate in the educational activities.
15
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