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Table 2 Where health systems need to be strengthened in relation to communication for childhood vaccination

From: Factors affecting the implementation of childhood vaccination communication strategies in Nigeria: a qualitative study

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