Table 2 Where health systems need to be strengthened in relation to communication for childhood vaccination
Health system issue | Key findings from the analysis | Implications for the strengthening of the health system to support vaccination communication |
|---|---|---|
Funding of vaccination communication interventions | • Least budgetary allocation to communication and social mobilization • Funds/incentives seldom available for routine immunization and some costs borne by health workers • Overdependence on donors • Problems and delays with disbursement of funds and materials at lower levels of the health system • Lack of funding for sustained communication programmes for routine immunization • Communication strategies intermittent (minimal between campaigns) | • Consider improving the funding allocation to communication activities, which should be continuous even after campaigns • Provide a regular source of funding for routine immunization communication activities in the recurrent budget of States and Local Government Areas as this may improve sustainability • Ensure that systems are available for the management and timely disbursement of funds within vaccination communication programmes, especially at the local level |
Equipment and transportation | • Lack of equipment (information, education and communication (IEC) materials, megaphones and vehicles) for adequate mobilization • Transportation difficulties | • State and local government Social Mobilization Committees and Health Promotion Departments should be strengthened to develop their own IEC materials |
Human resources for health | • Generally seen as inadequate • Inequities in distribution of human resources, with more resources in the urban than in rural Local Government Areas | • Consider redistribution of health workers, temporary staff from the pool of retirees or community volunteers who can serve as mobilizers • Consider providing incentives for health workers in rural settings |
Training | • Lack of human resources for supervision of frontline health care providers • Training deficiencies, with large numbers of communication personnel not sufficiently skilled • ‘Cascade’ training model results in dilution of training efforts | • Establish a system to monitor the appropriateness and quality of training activities at the local level • Training needs assessments should be conducted from time to time • Supervision of Local Government Area mobilizers by state social mobilisers should be strengthened • Frontline communicators in the various Local Government Areas should be provided with training guides or manuals which can be tailored to meet local needs |
Health provider attitudes | • Health providers, including vaccination teams, poorly motivated | • Ensure that vaccination teams are provided with incentives |
Attitudes of parents and caregivers towards vaccination | • Vaccine hesitancy and rejection in some religious groups may impede receipt of vaccination information | • Engagement of traditional and religious institutions and other community structures may be useful in countering refusal in some communities |
Political support | • Political support focused on campaigns only • Failure of State and Local Governments to take ownership of programmes • Health communication not seen as a priority by some policy makers • Lack of political commitment in some Local Government Areas | • Regular advocacy visits to political leaders • Improve accountability systems, particularly at the state and local government level, to prevent misappropriation of funds meant for the communication needs of the vaccination programme |
Community participation | • Lack of community participation | • Consider evidence–informed and locally appropriate interventions to involve communities in planning and implementation of communication intervention for both routine immunization and campaigns |