The communication strategy was developed in three stages:

• In the first stage, information on the local coverage of vaccination was made public, calling attention to those municipalities that were below the expected level and congratulating those that were exemplary in achieving their high coverage.
  
  

  This stage has been under development since the South American Week of Vaccination that was carried out in June. At the same time that the promotion of this event was being carried out, a plan was developed to make public to all the citizens the vaccination state of most of the 500 municipalities with the lowest coverage and to alert the population of the necessity to demand vaccination services.
  
  

  The South American Week of Vaccination was used as a connection between Vaccination Days or Crusades and the regular programme of vaccination. In this way, it was possible to keep people's attention on vaccines after the crusades, through local information.





• In the second stage, the campaign took advantage of the Vaccination Crusade called "The day to bring up to date itself" as a way to give a "push" for those municipalities that had low coverage levels.
  
  
  
  On August 30 the Vaccination Day "The day to bring up to date itself" (Día para ponerse al día) was carried out for the second time, as part of the government’s project to increase vaccination coverage before the end of the year. This Day was added to the strategy as an additional aid for the improvement of the coverage levels.
  
  
  
  For this Day the campaign was reinforced with radio spots, reminding all citizens about vaccines and to keep "puyando". Although the invitation for the crusades is generally exclusive to the intended population of child caregivers, on this occasion people were invited not only to attend to the vaccination session, but also to press others to attend and to encourage the authorities to take responsibility for the Day. Thus the success of the crusades publicly became a responsibility of the local authorities and not just of parents.





• In the third and last stage, an end of the year accounting was done to recognise the advances of the municipalities, congratulating the ones that improved and calling to attention those that lowered their levels or that simply did not manage to improve them.
  
  

  This stage was handled through mass communication media. The purposes were: to congratulate those who increased their coverage, to demonstrate that the "puyada" had really worked, and to invite the municipalities to do a final effort to complete vaccines of all the children before the year finished.

The strategy had three basic tenets to achieve the proposed objectives:

Regular programme versus Vaccination Days/Crusades

To improve the coverage, the Expanded Programme on Immunisation (EPI) usually ties itself Crusades or Days in which the vaccination is promoted, hoping to benefit from the already heightened awareness. Nevertheless, this has resulted in a pattern of demand for vaccines by the population that only occurs when there are huge promotions - the rest of the year the coverage declines until the next new crusade.


In order to address this situation, the "Puye" campaign developed a communication strategy designed not only for the Days or special dates of vaccination, but also for the regular programme. It was decided to take advantage of the communication facility to mobilise people and to motivate them to "puyar" all year by vaccinating their children. In this way the strategy aimed to overcome the chronic problem of increased coverage during the promotion days and the return to lower levels during the intermediate periods.

Vaccination as a part of the public agenda

Local and departmental governments had neglected the regular supply of vaccination, because this subject did not have real political importance for the administrations. For that reason this strategy aimed to make visible the state of vaccination in the country, municipality by municipality. It thus turned vaccination coverage into a politically important indicator of the situation of a municipality and of the management of it by the authorities.

Framed this way, the communication strategy had two desired effects: to the population it showed a risk situation that stimulated the demand of vaccines, but it also stimulated the citizen pressure that would generate actions that would facilitate the access to vaccines, such as home visits, special dates, extended schedules, etc. Vaccination was no longer seen as an extraordinary event but as a forum to make routine vaccination more accessible to people.
Local information about the state of vaccination, tied to the local responsibility to obtain better coverage, made vaccination into a political factor, an administrative challenge and an indicator of good or bad management. For the local authorities, the fact that the coverage of their municipality or department were known at the local level and also throughout the country, forced them to leave the anonymity of the national coverage and to do what was necessary to improve coverage in their jurisdictions, for not only the local citizens, but the whole country would be focusing its attention on this.

Dissemination of Significant Information

Whereas the data on national coverage has little meaning at the local level, the local information gets to "touch" people and to mobilise them to action. Therefore, the campaign was designed so that the numbers of vaccinated children and those without coverage were made public at the municipal rather than national level; it was also intended to adapt the messages to the regional language and expressions - guámbitos (children) in the department of Tolima.



As part of the media strategy posters were printed, distributed, and posted in 443 municipalities of all the country. For each municipality, the poster indicated if its assesment was good, fair or poor in vaccination, the number of children below one year that the municipality had, the number of children vaccinated in 2002 and the number of children still unvaccinated with the DPT and Polio vaccines. The poster also contained the message: "'Puye' in your municipality so that in this year all the children will have all the doses of all vaccines." By making public the information on vaccination coverage, the mayors were forced to look for mechanisms to improve coverage and this was reinforced by the constant pressure on the part of the inhabitants of the municipality to "puyando" in order to have children vaccinated.

Considering that the posters would only receive the appropriate attention if they were within reach of the population, the local authorities were not depended on to facilitate their distribution. This was not only because experience had demonstrated that these type of activities are often not taken very seriously, but also because the information that the posters contained questioned the management of the municipals authorities, so it was unlikely that they would be committed to circulating them.

A company was contracted to take posters to each city, and also to post them in all the public places where it was permitted. At the same time, the streets of each city or municipality were crossed by trucks with a "perifoneo" (town crier) that invited citizens to approach and read the posters to find out on the vaccine situation in their home municipalities.
Television spots were produced and broadcast through the 14 national, regional and local channels of public and private television, inviting the citizenship to demand free vaccination every day. These messages were broadcasted during five continuous months, obtaining coverage of more than 80% of the population in urban and rural zones throughout the country. The commercial spots were watched on average twice by 50% of the Colombians and three times by 43%. Spots were also produced for radio, and broadcast on eleven national and 48 regional radio networks, in addition to several mentions within radio programmes. Advisory notices were published in national and regional press, in addition to an editorial in the newspaper El Tiempo and several press releases.

The support of the press and the radio were important for they not only offered their space for national coverage, but also the strengthening of the campaign through regional media. In the case of the newspaper El Tiempo, the publications of "7 Days" in Tolima, Llanos, Boyacá and Cundinamarca were used; and in the case of RCN Radio and Caracol Radio, they offered a presence for the campaign in more than 11 radio stations of national coverage and 48 radio stations of focused regional coverage in the municipalities in which posters would be displayed.

The Minister of the Social Protection sent letters to mayors and parish priests expressing his support for the strategy and asking for their collaboration in the effort.

An educational book was delivered to the mayors with practical advice on how to handle the vaccines issue, and information on important factors in increasing the coverage, and the design of policies and projects of vaccination. A poster was also given to them that served as a "check list" of the ten key aspects that all mayors must review to be sure that the vaccination in their municipality was working as it should and in this way to become a "leading mayor" in vaccines.

The Church was also considered as an ally to help to promote the information and to demand that vaccination coverage be improved. For this, a letter from the Health Ministry was sent to priests from each municipality or city in which they were invited to support the campaign and to "puyar" health authorities so that they improved the vaccination coverage of their parishioners.

Immunisation and Vaccines, Children, Health.

The "Puye" campaign granted a different role to communication than usually provided within vaccination promotions. During Vaccination Days or crusades, communication generally is used as the final step of the process - to guarantee that people are informed on the vaccination event and that they attend it. In this strategy, communication was the central axis of the campaign, because it was used from the beginning, almost like the main motor of the vaccination strategy. To turn local information on vaccine coverage into a public issue served as an inspiration for citizen demand and the needed supply.

Through this experience it was demonstrated that making public the information on a usually forbidden subject to local communities, democratises the processes and programmes and makes them part of the local political agenda. In this way, vaccination coverage became a collective objective to achieve, under the permanent monitoring of the communities themselves.



National information on coverage is important data for the National Government, but it has little meaning for the citizens in their daily lives; by making it public at the local level, a person (the Mayor) was identified as having direct responsibly for the results.

As for mass media, the information was not always emitted through promotional spots or official advisories, but instead was introduced into the public debate in the form of news. This was considered by organisers of the campaign an important contribution of editorial support.