Adolfo David, a district Expanded Program on Immunization (EPI) officer in the Gilé district of Mozambique, saw a lack of immunization information as a barrier for caregivers seeking life-saving vaccines for their children. Because they needed information about the importance of vaccines and how to mitigate side effects, caregivers were sometimes hesitant to vaccinate their children, leading to immunization drop-outs and higher rates of preventable disease across his district.
But through the Bate-Papo Vacina! (Let’s Talk About Vaccines!) project, immunization education is easier than ever for caregivers to access, shifting perceptions, social norms and increasing awareness about the importance of immunization and trust in health services.
The Key Role of Communities
Improving immunization information, informing social norms about who within the family can support getting a child immunized and improving the consistency and reach of mobile outreach services has led to an uptake in under-age-two vaccinations across the community, health facility and district levels in the Mozambique provinces of Gilé and Namorroi, with Bate-Papo contributing to fully immunizing 6,989 children, 84% of the target numbers for the whole year within the first 9 months of its implementation.
“Implementing Bate-Papo is improving immunization services delivered compared to other facilities that Bate-Papo does not cover,” said Adolfo. Immunization rates are increasing, mobile brigades are more attended and education for immunization is a reality. Click To Tweet
Adolfo attributes this accomplishment to communication with and the involvement of community groups, including caregivers of fully- and partially-vaccinated children, community health workers (locally known as Agentes Polivalentes Elementares (APEs)) and community leaders, from the inception of the project through to the implementation of tailored solutions.
“The way of communicating and approaching caregivers in the communities is better at the [Bate-Papo] implementing facilities than other facilities; there are strong results when community leaders and APEs are involved in the process,” he said.
“VillageReach is expanding the reach of immunization information,” agreed Januário Mafabisse, District EPI Officer in Namarroi District.
This is done through pictorial cards created by VillageReach and provincial health authorities in partnership with Stanford’s Digital Medic. Health care workers (HCWs) and APEs disseminate these cards to caregivers and mothers, 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.
These pictorial cards are handed out 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 AlôVida hotline for more information.
“The cards provided by VillageReach facilitate interaction with mothers in the community,” added Januário.
Targeting Communities with the Greatest Needs Through Equitable Mobile Brigades
Since the implementation of the Bate-Papo project, EPI district managers and health workers have noted an increase in knowledge and awareness about the importance of vaccination in the implementing communities. They attribute this to the involvement of community stakeholders in educational sessions and the use of co-created educational materials.
These educational sessions and materials prepared the ground for the unprecedented success of the EPI-coordinated mobile brigades.
“Mobile brigades attendance is a positive since the implementation of Bate-Papo compared to other years,” said Januário. “Mothers go to the mobile brigades aware of the importance of vaccines.”
The success of this immunization drive is especially significant because the latest round of mobile brigades focused on communities that are the furthest away from a health facility and are home to the most children who still need to complete their vaccination series. This is of particular importance, as mothers who participated in the research phase of the project noted that long and often unsafe travel to the health facility and lack of inconsistent mobile brigades was a consistent barrier to fully vaccinating their children.
By involving community focal points, health care workers (HCWs), APEs and elected community leads, in planning monthly mobile brigade and immunization activities, mobilization has succeeded and vaccine uptake has been more widely accepted in previously hard-to-reach areas.
“As district EPI officer, I see that the resources we have for mobile brigades are being used in a very equitable way now that we are implementing the Bate-Papo solution. Mobile brigades are helping us target those communities with the greatest needs,” Januário continued.
A Brighter Future for Hard-to-Reach Communities in Gilé and Namorroi
Like Adolfo, Januário believes that the Bate-Papo program has empowered caregivers, elevating their voices and experiences: “With Bate-Papo, mothers found an easy way to voice themselves and speak about their difficulties in accessing immunization services.”
Mutual learning through collaboration is a core principle of Bate-Papo Vaccina!. District EPI officers like Adolfo and Januário have discovered that increasing access to immunization information and services can help to boost immunization rates. They have gained a better understanding of the obstacles caregivers face in accessing immunization services for their children, and this knowledge has allowed them to successfully collaborate with caregivers to develop services that address these obstacles.
“We see [Bate-Papo’s] impact in ensuring that more children from the most remote communities are getting vaccinated,” Januário remarked.
To learn more about how the Bate-Papo community-centered solution makes a difference in people’s lives, you can read this series’ first and second blog posts. We hope you’ve enjoyed reading this deep dive into the role of Let’s Talk About Vaccines! in reducing immunization drop-outs across Gilé and Namorroi.
About Bate-Papo Vacina
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.
Since September 2022, VillageReach has begun to pilot this co-created solution in 11 health facilities in the Gilé and Namarroi districts, aiming to increase the demand for immunization services and reduce dropout rates in the hardest-to-reach communities with the greatest needs.