Lessons learnt from implementing community engagement interventions in mobile hard-to-reach (HTR) projects in Nigeria, 2014–2015

Abstract

BackgroundThe year 2014 was a turning point for polio eradication in Nigeria. Confronted with the challenges of increased numbers of polio cases detected in rural, hard-to-reach (HTR), and security-compromised areas of northern Nigeria, the Nigeria polio program introduced the HTR project in four northern states to provide immunization and maternal and child health services in these communities. The project was set up to improve population immunity, increase oral polio vaccine (OPV) and other immunization uptake, and to support Nigeria’s efforts to interrupt polio transmission by 2015. Furthermore, the project also aimed to create demand for these services which were often unavailable in the HTR areas. To this end, the program developed a community engagement (CE) strategy to create awareness about the services being provided by the project. The term HTR is operationally defined as geographically difficult terrain, with any of the following criteria: having inter-ward/inter-Local Government Area/interstate borders, scattered households, nomadic population, or waterlogged/riverine area, with no easy to access to healthcare facilities and insecurity.MethodsWe evaluated the outcome of CE activities in Kano, Bauchi, Borno, and Yobe states to examine the methods and processes that helped to increase OPV and third pentavalent (penta3) immunization coverage in areas of implementation. We also assessed the number of community engagers who mobilized caregivers to vaccination posts and the service satisfaction for the performance of the community engagers.ResultsPenta3 coverage was at 22% in the first quarter of project implementation and increased to 62% by the fourth quarter of project implementation. OPV coverage also increased from 54% in the first quarter to 76% in the last quarter of the 1-year project implementation.ConclusionsThe systematic implementation of a CE strategy that focused on planning and working with community structures and community engagers in immunization activities assisted in increasing OPV and penta3 immunization coverage.

Contributions of Volunteer Community Mobilizers to Polio Eradication in Nigeria: The Experiences of Non-governmental and Civil Society Organizations

“…The lessons learned and the strategies used by VCMs should serve a resource for future programming to address broader health goals. 28,29 This article, along with others documenting the contributions of CGPP-supported VCMs in Nigeria, 24,25 shows that involving respected, trusted local women in health implementation can be highly effective, particularly when they are supported by other community influencers such as traditional rulers, religious leaders, community leaders, women leaders, and other opinion leaders. Providing referrals and information to address pressing needs of families outside of polio helped increase uptake and acceptance of the program and created trust.…”

“…The scope of their performance and the extent of their impact have been previously reported. 24,25 Our article adds to the literature by documenting the specific contributions and key strategies used by the CGPP VCMs.…”

Malaria eradication within a generation: ambitious, achievable, and necessary

“…[86][87][88] Lessons from polio indicate that an ongoing, iterative community engagement strategy that utilizes existing community structures, including community health workers, can increase demand for health services and improve participation, even among mobile and hard to reach populations. 89,90…”

How can rural community-engaged health services planning affect sustainable health care system changes? - A process description and qualitative analysis of data from the Rural Coordination Centre of British Columbia’s Rural Site Visits Project

“…Relationship building between stakeholders is also seen as more effective than attempting to provide a myriad of health care services (12, 13), especially as each rural community is unique and “one size fits all” approaches are largely ineffective (6, 14). While there have been efforts by health service policy makers to align their actions with rural communities’ expressed priorities (15, 16), the processes used for community engagement have received less attention (17) and descriptions seldom include adequate documentation of the processes involved (17, 18).…”

“…The community engagement literature does not show examples of rural health projects initiated and led by physicians, even though physicians have been key partners in other research on rural community-engaged health services planning (15). Much of the research on community engagement in rural health service planning has had a specific focus, for example in improving immunization programs in Nigeria (17) or chronic disease care in the Torres Strait Islands (13). There are some examples of research focused on community participation for broader primary care reform, for example, in the Northern Health Authority region of BC (15) and the Remote Service Futures (RSF) Project in Scotland (10, 12, 16).…”