‘We All Work Together to Vaccinate the Child’: A Formative Evaluation of a Community-Engagement Strategy Aimed at Closing the Immunization Gap in North-West Ethiopia

Abstract

The role of community engagement (CE) in improving demand for immunization merits investigation. The International Rescue Committee developed a CE strategy to implement a vaccine defaulter-tracing tool and a color-coded health calendar aimed at increasing uptake of immunization services in north-west Ethiopia (‘The Fifth Child Project’). We report findings from a formative evaluation of this project. In May/June 2016 we conducted 18 participant observations of project activities, 46 semi-structured interviews and 6 focus groups with caregivers, health workers, community members/leaders. Audio-recordings and fieldnotes were transcribed, anonymized, translated and analyzed thematically using inductive and deductive coding. Additional data was collected in November 2016 to verify findings. The project was suitably integrated within the health extension program and established a practical system for defaulter-tracing. The calendar facilitated personalized interactions between health workers and caregivers and was a catalyst for health discussions within homes. At the community level, a regulation exercise of sanctions was observed, which served as a deterrent against vaccine default. Pre-existing community accountability mechanisms supported the CE, although varying levels of engagement between leaders and health workers were observed. The benefits of shared responsibility for immunization were evident; however, more transparency was required about community self-regulatory measures to ensure health-related discussions remain positive.

Community engagement strategy for increased uptake of routine immunization and select perinatal services in north-west Ethiopia: A descriptive analysis

“…Nearly 54% of all eligible infants in both woredas defaulted at least once during the project period. Involvement of caregivers in mining activities and associated travels were reported to the study team as one of the key causes for default [ 13 ]. Nonetheless, most defaulters (84%) were identified and subsequently caught up with vaccinations they had missed, exceeding the 70% target.…”

“…We conducted an evaluation, consisting of quantitative and qualitative methods, to assess FCP contribution in improving utilization of immunization and related perinatal services in BGRS. This paper describes the intervention and reports quantitative findings; qualitative methods and findings are presented in a complementary paper [ 13 ].…”

What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

“…Interventions that promote joint decision making may be successful. An intervention supported by the IRC in Ethiopia assessed the impacts of the use of a color-coded health calendar to increase uptake of immunisation services and found that the calendar promoted health discussions within households (34). DHS data also indicate that women in BGRS have lower rates of FP use than women in almost every other region in the country (35).…”

Vaccination: Is There a Place for Penalties for Non-compliance?

“…Significant emphasis is placed on promoting shared individual, community and governmental responsibility for immunization against vaccine preventable diseases in the Global Vaccine Action Plan (30). Projects that seek to engender shared responsibility for vaccination can however result in unexpected by-products, as was the case in a community engagement immunization project in north-west Ethiopia (31). Active engagement of health development army members and kebele (smallest administrative unit in Ethiopia) leaders in promoting immunization resulted in action that was not planned by the project implementers.…”

“…This community action is interesting in that it is decided at a more local level rather than imposed by higher levels of the health ministry or government. To what extent it was completely democratic is up for question, but the research findings suggested that the sanctions were endorsed by a variety of community members and suggested by members of the health development army who work closely with mothers in neighbouring households (31). Hence, although this community self-regulating exercise did give rise to questions about the coercion and individual rights, it encroached less on civil liberties in that the sanctions were agreed in keeping with pre-existing community accountability mechanisms, which involve community members and representatives.…”