Lessons Learned from Community Dialogues in Zamfara State

This 11-page report is an effort to provide guidance and define a clearer focus for community dialogues organised to eradicate polio and boost immunisation activities in Zamfara State, based in the North Western Zone of Nigeria. As explained here, in April 2006, Save Mothers and Children (SMAC) began conducting a series of (55) community dialogues in 25 settlements of 12 high-risk local government areas (LGAs) in the state. These dialogues are part of the strategy associated with Immunization Plus Days (IPDs), which involves informing and educating caregivers about the importance of child immunisation, as well as encouraging them to access services during immunisation campaigns and promptly report Acute Flaccid Paralysis (AFP) cases and other diseases. The forum provided by dialogues is, as explained here, designed to enable local leaders, influential persons, and the people to interact, raise questions, and receive answers about - and to be involved in planning and action related to - immunization. Dialogues use existing local structures, such as the grassroots mobilisation promoted by SMAC to promote communication between the immunisation programme and caregivers.

Following additional background and a disease profile (e.g., from January-December 2005, there were 221 AFP cases in the 12 LGAs, of which 65 turned out to be wild polio virus cases from 12 LGAs; by December 29 2006, there were 49 WPV cases from 226 AFP cases in 12 LGAs), author Nosa Owens-Ibie details the methodology developed for the community dialogues. Logistical specifics are offered, some of which highlight the communication strategies that shaped the process. For example,

1. Activities commenced with a courtesy call to the traditional ruler. Following such a courtesy call in Shinkafi LGA, "mobilization of the community ahead of the dialogue led to a carnival-like reception for the SMAC team by LGA officials on the outskirts of the town. This attracted considerable interest in the meeting....As a result of this community dialogue, key community leaders...declared their support for the oral polio vaccine (OPV)...."
2. The active role of the district head in the dialogues was meant to provide a source of assurance of some level of community ownership. These leaders also answered questions.
3. The presence of polio victims was an approach used by organisers to demonstrate in a very visual way the dangers of poliomyelitis. Paralysed children often sat with the dignitaries.
4. The dialogues opened and closed with prayers by an Imam; a number of Qu'ranic verses were also cited. (A poster was used to explain vaccine-preventable diseases and why it is important to be vaccinated.) At the end of some of the dialogues, such as the one held in Rawayya, Bungudu LGA during the November 2006 IPDs themselves, key influential leaders like the Imam and a leading educationalist who had been consistently non-compliant led teams to vaccinate their children.

Indicators used to assess the impact of this process - e.g., those related to issues/concerns such as religious convictions and attitudes of health workers- are detailed in the report in graphic (tables/charts) as well as narrative form. Here are a few highlights:

• Awareness - A 12-item questionnaire measuring awareness developed by the State Team and administered before and after the dialogues to 5 men and 5 women; in addition, 60 men and 40 women were randomly interviewed in 6 LGAs. Based on this process, the author of this report indicates that levels of awareness on all the indicators were generally higher after the dialogues, although not all of them knew either the date of the next IPDs nor the antigens to be given nor the ideal age of the children and women to be vaccinated. Radio was the main source of information for those who heard about the round before implementation, followed by information coming from traditional rulers (mentioned only by 5 respondents). Those who had doubts about immunisation reportedly had such doubts cleared by the end of the sessions.
• Coverage - The State Team examined coverage in the settlements where dialogues were conducted (in preparation for the November 2006), and compared this with the coverage in those same settlements during the September 2006 IPDs, using end process monitoring data. This process revealed that 11 out of 19 settlements recorded higher coverage in the November round after the dialogues. Three settlements actually vaccinated fewer children in the November round, in spite of the dialogues. The author says that "Considering these aspects, there was no consistent outcome in terms of impact of the meetings though evidence tends to show that the dialogues positively impacted coverage figures."
• Participation - Most of the dialogues had higher attendance figures than the 50 originally proposed per male or female session, with children having a relatively strong presence. The session for men attracted more participants across LGAs. In general, more traditional and religious leaders than LGA officials took part in the meetings.
• Reporting - Eight suspected AFP cases were reported during the dialogues.

A list of lessons learned, and recommendations gleaned, from this process follows. Here is a synopsis of the author's key communication-centred points in these 2 sections of the report:

• It is important for State/LGA Teams to develop indicators before dialogues are conducted.
• All available local information channels should be used to mobilise various categories of stakeholders in order to ensure their participation in the dialogues - with due consideration of which stakeholders are key in particular communities. In general, the involvement of traditional rulers was found to be a good entry point in organising community dialogues and is key to the participation of a cross-section of the community.
• "Since dialogues are useful in the ventilation of critical views and grievances crucial to immunization outcomes, they should be organized in a way that allows sufficient time for people to express their views." Organisers found that a maximum of 2 hours is a realistic time frame for each dialogue, and that dialogues conducted after the Friday mosque Jumaat service foster a higher level of attendance/participation, especially when the service is used to announce and invite people to the forum.
• While pre-implementation dialogues are vital build-ups for creating awareness of upcoming campaigns or to promote routine immunisation and disease surveillance, dialogues during immunisation campaigns themselves were found to be crucial in assuring higher-level community compliance. Organisers found that community dialogues should be better structured to address specific problems and specific groups of stakeholders in urban areas for greater effectiveness after a situation analysis. Such dialogues should be organised along with other approaches in order to impact awareness of and access to immunisation services.
• The technical capacity of non-governmental organisations (NGOs) in the organisation, management, and documentation of community dialogues and other programme activities should be strengthened, to make them less dependent on donors or partner agencies, and as a way of ultimately promoting community ownership.
• Dialogues could be used to identify potential polio and immunisation advocates who could subsequently be approached to play specific roles in furtherance of the objectives of the programme.

To request a copy of this paper, please contact the author (see below).