A community comprises many parts—community leaders, community health workers, caregivers, and more. To truly address the needs and concerns of the hardest-to-reach people and communities, their voices must be heard.
The Bate-Papo Vacina! Project (Let’s Talk About Vaccines) did just that, bringing radical collaboration to the Gile and Namarroi districts of Zambezia Province, Mozambique, to address barriers to full vaccination coverage for children under two. The project employed a collaborative approach involving caregivers, health workers, community health workers, district and Provincial health authorities in the co-creation and design of the intervention.
The project, a five-year initiative funded by Wellcome Trust, has been successful, exceeding targets and showing promise for long-term sustainability and expansion. An end-line evaluation report and docu-video of the project have since been released, showcasing Bate-Papo’s achievements.
Following the release of the docu-video, I caught up with Gaspar Come, Project Manager of the Bate-Papo project, to learn more about Bate-Papo’s success and future.
Gaspar Come and Felizarda Cristina Saize discussing on the Bate-Papo flyer at Mudine Health Center in Namarroi District, Mozambique. (Photo Credit: Januario Bila)
Q: One of the project’s key achievements was enhanced community engagement. How has this played out in Bate-Papo’s implementation, from all parties involved?
The use of a human-centered approach for developing this intervention was essential in having everyone engaged. They got involved in identifying the barriers and coming together to think of solutions to address those barriers altogether as a group, involving provincial and District health authorities, the health facilities and workers, the community leaders and the caregivers themselves. They were part of developing the intervention and because of that, everyone clearly understood what their role was in the intervention.
We recognized that resources were not and will never be enough to execute mobile brigades across all the health facilities, and what we came up with was the idea of prioritizing where there are more kids requiring vaccination and addressing the distance issue to the communities.
The prioritization is not only done by the health workers, but the community needs are voiced by the the community leaders, community health workers and RED-REC (1) focal points.
Q: When community leaders are involved in the process of immunization and address barriers between the community and the health facility, how did this contribute to immunization rates?
A: Community leaders were involved in the study phase where we were trying to identify barriers in accessing immunization. They share their views and some of the challenges they saw from the caregivers – what they thought would impact the caregivers’ ability to access immunization for their kids. In the intervention, they attend monthly collaborative meetings at the health facilities where immunization activities are planned, and mobile brigades are prioritized to reach communities with the greatest need for immunization services.
In the implementation, we involved some community leaders, especially when we looked at the Gile District. That was the difference between the two districts. In Gile, we involved community leaders, but in Namarroi we involved RED-REC focal points. Community leaders were involved in helping to promote immunization education sessions in their communities around the importance of vaccination.
Because they are community leaders, they’re well respected and well-known in the communities. Their contribution is valued because it helps involve other community leaders in supporting the program, in raising awareness around the importance of vaccination in communities and in helping caregivers attend the mobile brigade.
Q: Before implementing Bate-Papo, it was said that there was not a link between the community and the health facility. How can we, as VillageReach and partners, ensure that this link continues and is maintained, that community needs and preferences continue to be integrated, even as the project continues to expand and is scaled up?
A: One way through which can do that is by sharing how successful this collaboration is for the benefit of communities and helping reach the health facilities’ objectives, which is immunizing all the children of the communities. We’re also trying to involve other partners as we implement the intervention because VillageReach is not the only partner working on immunization. We try to involve them and share our practice.
Even the provincial health authorities themselves recognize the impact that [Bate-Papo] has created or is creating. The government has sat down with partners and said, “Let’s hear from VillageReach working with the communities.”
While we are partners today, one day, we might leave. The government must be aware of what best works at the community level. It’s that they also want to work with us, they want to learn, but at the same time they find this useful.
Q: The co-created interventions demonstrate that collaboration is key between multiple groups – government, communities and their leaders, community health workers. What was instrumental in ensuring that everyone’s voice was heard and taken into account when designing these interventions?
Ilda Cossa and Alberta Penissela talk waiting to be assisted at Mudine Health Center Namarroi District, Mozambique. (Photo Credit: Januario Bila)
A: We try to balance having representatives from all these groups so that we don’t hear much from one side, but we hear from everyone equally.
What we did was strategically create an open space through our co-designing workshop, allowing everyone to contribute, especially emphasizing how relevant and how important it would be hearing from community health workers, caregivers and community leaders.
The intervention itself is a reflection of most of their contribution, even the educational material we designed together with the group. Their opinions and perspectives are reflected in what they thought would be most useful because we really wanted to design an intervention that appealed most to people that are affected, which are caregivers and community health workers. This was not easy work, but we agreed that everything Bate-Papo does must resonate most with communities.
Q: For VillageReach, what would you want to see with Bate-Papo moving forward? What is needed for Bate-Papo to scale up and become sustainable?
One of the challenges we have is securing funding to expand the intervention across the whole province. Right now, we’re implementing in five districts, but Zambezia has 22 districts and five are not even 50%.
We will be expanding now in the next few two to three months to three more districts, that will add up to eight in total that we will be implementing it in for the next two years. But that’s still not even 50% yet. It’s eight out of 22. That’s one thing we can do as VillageReach, secure the availability of funding, but above all keep having good partnerships with the health authorities, from the provincial to the ministry level.
Also, integrating other interventions would help Bate-Papo reach more people. For example, through Bate-Papo, what we do is create demand and raise awareness around the importance of vaccination. But at the same time, we promote equity in immunization service delivery. We have other interventions across VillageReach that would complement [Bate-Papo] and would make vaccines available at health facilities where and when they need it.
Thank you for this interview! I look forward to seeing the future of Bate-Papo. Take care and goodbye!
Read the full end-line report for the Bate-Papo project here.
Check out the Bate-Papo trailer below. You can watch the full docu-video on Youtube.
(1) 1 RED-REC is a strategy implemented by the World Health Organization and UNICEF which stands for reach, every child, reach every district.