In the quiet village of Mudine, Mozambique, Jolita, a 27-year-old mother of two, knows the challenges of raising healthy children all too well. When her 2½-year-old son, Alceu, needed his vaccinations, she struggled to keep track of his schedule without a health card. That changed in 2022 when a community health worker, known as an Agente Polivalentes Elementares (APEs) in Mozambique, visited her village, bringing essential resources and hope for a healthier future.
A Simple but Powerful Change
Initially, Jolita found it difficult to stay on top of Alceu’s vaccination schedule because the local health center had run out of vaccination cards. However, when community health workers distributed new cards and taught caregivers how to use them, Jolita realized how important it was to have a clear record. This small but significant tool was the key to ensuring her child stayed up to date on vital immunizations.
Understanding the Challenge
“Let’s Talk About Vaccines!”—locally known as Bate Papo— was created to improve childhood vaccination rates and strengthen trust in immunization services. The program’s interventions were developed through community-based participatory research (CBPR) and human-centered design (HCD) workshops in Zambezia Province, specifically in the districts of Gile and Namarroi. In these collaborative workshops, community members, caregivers and health workers worked together to identify local barriers to immunization and co-create effective, low-cost solutions.
VillageReach hired and trained caregiver researchers from participating communities during the project’s first research phase. Guided by behavioral and social drivers of vaccination and immunization journey frameworks, they uncovered four main reasons why children under two years old often miss their vaccinations:
- Concerns about side effects, especially if the child was already behind schedule.
- Lack of social support and the perception that vaccination is solely the “mother’s” responsibility.
- Uneven social dynamics between caregivers and health care workers.
- Eroded trust in the health system due to repeated negative experiences in accessing vaccines and other services.
Mothers with their kids at Mudine Namarroi District Mozambique. Photo credit Januario Bila
These findings set the stage for the second phase: a co-design workshop in which community leaders, caregivers, government officials and health workers shaped the interventions to address these challenges.
Bate Papo in Action
From those workshops, four key components were introduced as part of the Bate-Papo Vacina! pilot program:
1. Immunization Education
VillageReach, Stanford Digital Medic, community health workers (Agentes Polivalentes de Elementares—APEs), caregivers and local leaders collaborated to design pictorial cards with clear messages about routine immunization. These resources emphasized the importance of vaccines, the necessary visits for children in their first 18 months, understanding common side effects and the role everyone—not just mothers—plays in a child’s vaccination journey.
2. Mobile Brigade Prioritization
Using a simple paper-based tool, health facilities and community focal points reviewed data on children in need of vaccinations and their locations. This helped them efficiently plan mobile brigades—outreach health teams that travel to remote communities—to ensure that no child misses out on the immunizations they need.
3. Collaborative Immunization Planning
Monthly meetings at health facilities brought together APEs, health care workers and community focal points. These gatherings offered a dedicated space to plan upcoming mobile brigades, discuss community mobilization strategies and ensure caregivers were informed and prepared for immunization days.
4. Supportive Supervision
In response to feedback from APEs and health care workers, the district Expanded Programme on Immunization (EPI) team began providing bi-monthly supportive supervision visits. These visits offered hands-on assistance and guidance to local health workers, ensuring swift resolution of any challenges with the interventions.
Training, Monitoring and Stakeholder Engagement
To effectively launch these interventions, VillageReach organized trainings for 118 participants, including APEs, community leaders, health care workers and district EPI managers. Attendees learned empathetic communication techniques to address vaccine hesitancy and received a refresher on the government’s Reach Every District, Reach Every Community (RED/REC) strategy.
Throughout the pilot, routine monitoring and evaluation tracked crucial data such as the deployment and prioritization of mobile brigades, the number of education sessions delivered with the new materials, and vaccine coverage rates. Additionally, WhatsApp channels provided real-time coordination between community health workers and health officials, ensuring that progress updates and challenges could be shared quickly and collaboratively.
The Impact: A Mother’s Perspective
For Jolita, the Bate Papo program underscored the importance of routine immunizations and empowered her as an advocate within her community. When she received a vaccination card during one of the Bate Papo sessions, she immediately understood how crucial it was to keep her son on schedule. Now, she takes Alceu for his immunizations and encourages friends and neighbors to do the same.
Jolita’s story is not unique. Across Gile and Namarroi, the Bate Papo approach—grounded in community-driven solutions—has ensured that children receive life-saving vaccines. By engaging caregivers, health workers, and community leaders at every phase, the program has fostered trust, alleviated concerns about side effects, and created a culture where everyone feels responsible for a child’s health.
Through collective action and shared responsibility, Bate Papo continues to empower communities across Mozambique, building a healthier future—one vaccination at a time.