A midline evaluation from the University of Western Cape and the University of Cape Town has found that a community-led approach to immunization piloted by VillageReach in rural Mozambique is promising to improve key immunization outcomes. The Let’s Talk About Vaccines program, also known as Bate-Papo Vacina, uses participatory research and human-centered design to improve demand and access to routine immunization for children under two in the most hard-to-reach areas.
The study found that the Bate-Papo Vacina project resulted in:
- A 22% increase in the average number of total vaccines delivered monthly in the intervention sites.
- A rise of 56% in the average number of fully vaccinated children per month in the intervention sites
- Increased role and scope of community health workers (CHWs), who are now equipped with knowledge and support tools to collaborate closely with health workers and community actors in providing immunization education and supporting routine immunization mobile brigades.
- Elevated community trust in the essential program on immunization (EPI) and medical services, leading to improved social norms regarding caregivers seeking health services instead of alternative treatments for children.
- Increased family involvement in routine immunization, with more family members taking children for vaccination services, thus reducing the burden on mothers.
- Increased attendance at mobile brigades, with health care workers reporting higher attendance due to CHWs and other community actors’ support in planning and notifying community members in advance.
*Note: differences between control and intervention sites were not statistically significant.
However, compared to the control sites the 22% and 56% increase was not statistically sufficient to confirm the effectiveness of the intervention. The midline evaluation study also found that persistent systemic challenges need to be addressed to create sustainable, transformational change to improve routine immunization outcomes, including:
- Resource constraints at the district and health facility levels impede the ability to conduct all mobile brigades as planned.
- Environmental impacts such as seasonal weather patterns and natural disasters impact consistent access to mobile brigades for particularly hard-to-reach communities.
- Recognition and incentives for CHWs to continue to meaningfully collaborate closely with health workers and community actors in providing immunization education and supporting routine immunization mobile brigades.
“Of course, it [awareness on immunization] got better…This is felt through the massive adherence at our vaccination posts, which demonstrates that our services have improved….” – Health Care Worker involved in the Bate-papo Vacina Project.
The evaluation researchers recommend the following:
- Supporting and strengthening the capacity of local structures.
- Continually sharing developments to foster dedication to immunization reach and acceptance.
- Transfer insights and solutions to other child and EPI priorities, like nutrition.
- Exploring additional VillageReach strategies to overcome barriers, such as transportation initiatives to support an equitable supply chain.
- Using available evidence to advocate for system changes and address resource constraints.
- Engaging other partners in sustainability planning, including developing a joint funding strategy.
Overall, the Bate-Papo Vacina pilot project is a promising example of how a community-led approach may improve immunization outcomes in rural areas. More research is needed to confirm the long-term effectiveness of the approach, but it has the potential to make a significant contribution to improving immunization coverage and protecting children from preventable diseases in rural Mozambique and beyond.