Bate Papo Vacina! (Let's Get Vaccinated!)

Caregivers and health workers know best what barriers to vaccination they face and how to address them. To build truly people-centred health systems, community involvement is key. Thus, this study amplified the voices of caregivers and health workers and uncovered new insights by using principles of community-based participatory research (CBPR) and human-centred design (HCD) to fully engage community members and health workers in generating new knowledge and solutions, thereby increasing ownership. Study objectives included:

• Identifying and describing the primary drivers of why some children under two are not completing their full immunisation schedule, including both pre-COVID-19 and during pandemic conditions;
• Identifying community-driven solutions to improve full immunisation of all children below two years; and
• Assessing the extent to which using CBPR and HCD principles engaged participating health workers in active listening about the barriers caregivers face when vaccinating their children.

Through every step of the study, VillageReach is working to amplify the voices of end users - those administering and receiving the vaccines - starting at the beginning by hiring and training four local caregivers with children under the age of two as co-researchers on the study. Having been empowered with new research skills, they actively involved other caregivers (with whom they have shared experiences as mothers) and the health workers they interviewed in reflecting on findings, making decisions, and co-creating solutions. This strategy was designed to ensure a diverse research team that involved individuals who fully understand the context of the community and are thus able to explore more nuanced aspects of immunisation-related behaviours. (Knowing the local language, habits, and customs helps build trust with study participants and community leaders.) In addition, this approach contributes to reducing the unequal power balance between researchers and participants that occurs in traditional qualitative studies in an effort to create an environment in which caregivers feel comfortable discussing potentially sensitive topics.

Specifically, the study had three phases:

1. Photovoice and semi-structured interviews (September-November 2020): Caregiver researchers recruited and enrolled 32 other caregivers with children who were fully vaccinated (n=10) or partially vaccinated (n=22). These caregivers were provided with a camera and were asked to take and describe photos that reflect their experience vaccinating their young children. Following the photovoice activities, caregiver researchers interviewed the caregiver participants about their vaccination experiences, using the photos to guide deeper discussion.
2. Live messaging and semi-structured interviews (January-February 2021): Caregiver researchers interviewed health workers (n=12) and collected their ongoing observations via SMS (text messaging) over the course of a month of providing vaccinations. At the end of the month, they debriefed the SMS observations and conducted a semi-structured interview guided by the World Health Organization (WHO) Increasing Vaccination Model.
3. HCD workshops (April-May 2021): Organisers facilitated two HCD workshops with 19 participants each, including caregivers, health workers, community leaders, and Expanded Programme on Immunization (EPI) and district health staff. The participants reviewed the barriers that the study revealed, identified key problem statements, and generated their own potential solutions to be shared with all participants and the government (June-July 2021). The HCD workshops were followed by brainstorming, co-creation, and prioritisation of potential solutions with government and potential partners, coupled with a review of effectiveness studies linked to similar solutions (August-September 2021).

There is ongoing continued exploration of and advocacy for identified solutions in an effort to expand the global knowledge base of new strategies to increase equity in immunisation.

Immunisation and Vaccines

According to VillageReach: "Particularly as COVID-19 disrupts routine immunization, understanding how to improve full vaccination coverage is more critical than ever. Researchers have identified many barriers to vaccination in sub-Saharan Africa - like the distance some caregivers have to travel to bring their child to a health facility. However, despite years of effort and research, global coverage still has not increased above the levels where it plateaued about 10 years ago."