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Jun 16, 2023   |   Blog Post

Co-Creating with Under-Reached Communities to Improve Routine Immunization Outcomes in Mozambique

Caregivers at a mobile brigade in Gilé. (Photo Credit: Arsenio Manhice)

By Arsénio Manhice

Advocacy and Communications Manager

What would it look like if communities were involved in designing and implementing the health care solutions they need to thrive? Bate-Papo Vacina! (Let’s Talk About Vaccines) aims to find out.

We know that developing top-down solutions is not enough. When communities are involved in developing solutions to local problems, they are bought into them, leading to better outcomes for everyone.

That is why we’ve been piloting a community co-created solution – Bate-Papo Vacina! (Let’s Talk About Vaccines) – across Mozambique’s ZambĂ©zia province.

To increase demand for routine childhood immunization services and reduce drop-out rates for children under two, VillageReach’s Bate-Papo Vacina! engages with caregivers of fully- and partially-vaccinated children to capture and elevate their voices and develop a solution to address their expressed concerns.

Background

From February 2020 to February 2022, VillageReach, funded by the Wellcome Trust, worked collaboratively with the Zambézia Provincial Health Department to understand the barriers that prevent complete vaccination in children under two.

This approach, known as Bate-Papo Vacina!, utilized a participatory, community-based approach and sought the voices and experiences of the caregivers of these children, as well as community health workers (locally known as agentes polivalentes elementares (APEs)) and community leaders from Gilé and Namarroi, to co-create a solution that addresses the challenges caregivers face to fully vaccinate their children.

Since September 2022, VillageReach has begun to pilot this co-created solution in 11 health facilities in the Gilé and Namarroi districts, dropout rates in the hardest-to-reach communities with the greatest needs.

“Our expectation is that caregivers can have access to equitable mobile brigades (MB) and that all the children from the hardest-to-reach communities have access to vaccines they need to thrive,” said Gaspar Comé, Project Coordinator at VillageReach.

Core Components of the Bate-Papo Solution

Three components make up the Bate-Papo solution:

  1. Immunization Education

Final mockup of cards designed by Stanford’s Digital Medic.

VillageReach and Provincial Health authorities partnered with Stanford’s Digital Medic to create pictorial cards which health care workers (HCWs) and APEs disseminate, delivering three key messages: (1) the routine immunization schedule, (2) vaccine side effects and how to treat them and (3) how to involve other family members in the immunization process.

HCWs and APEs hand out the cards during individual and group education sessions. VillageReach also uses large poster versions of the cards at the health facilities during group education sessions. These cards also link caregivers to the AlĂ´Vida hotline for more information.

APEs and HCWs are trained to deliver key messages and provide an interactive and communicative immunization experience for these sessions. This includes explaining the procedure to them, what to expect, and listening and responding to caregiver concerns.

  1. Mobile Brigade Prioritization

APEs and community leaders meet monthly to review community data with their health facilities. Based on this data, a mobile brigade (MB) would prioritize communities that are furthest from the health facility and have the highest number of dropouts.

  1. Collaborative Immunization Activity Planning

Monthly meetings between the district health authority, HCWs, APEs, and community leaders are used to develop immunization plans, share information on immunization challenges and review monthly immunization data.

APEs also play a more active role in planning and executing mobile brigades – such as deciding where in the community the MB will take place, alerting caregivers and community influencers of the upcoming MB, and providing immunization education during MBs.

Early Successes

The active involvement of caregivers, community leaders, and health workers in improving immunization access has led to many early successes. In the 9 months of implementation, the solution has contributed to fully immunizing 6,989 children, representing 84% of the target for the year.

In a preliminary evaluation conducted by the University of Western Cape (UWC), the Bate-Papo solution was seen by informants as a new vision and a collaborative way of identifying drivers of under-two routine immunization dropouts and generating community-driven solutions to address under-two immunization access and uptake.

“It’s a project that came to change something and I can already feel that change. The most impressive thing about this study is that it [got]…people from the community… to describe the problems and then propose the solutions, “said one health care worker on their experience with Bate-Papo.

What makes Bate-Papo stand out is its extensive, diverse reach and its co-creation at each stage of the process, in which caregiver and HCW voices were amplified as part of a transdisciplinary study team. The team consisted of caregivers, provincial health officials, and VillageReach staff at the provincial, national, regional and global levels.

Caregivers were researchers, acting as the driving force behind the photovoice and SMS exchange data collection process with caregivers and HCWs.

Bate-Papo’s co-designed nature has demonstrated an increased need for solutions tailored to clients’ needs and aspirations. It has also improved communication between service providers, community leaders and caregivers around service provision and caregiver barriers to under- two routine immunization access and uptake, and information on forthcoming vaccination outreach activities.

Our commitment to co-creating solutions with communities has led to a strong sense of ownership and community empowerment across Gilé and Namarroi. We look forward to showcasing this work with caregivers, HCWs and communities in the coming months as we find new pathways to primary health care for everyone.

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