This 39-page document focuses on the role that religious leaders can play, and have played, in immunisation initiatives around the world. Following an introductory section, which is excerpted below, the document examines detailed strategies for "forging alliances" supportive of increased trust in immunisation. A section on "building trust" stresses that "In responding to resistance [on the part of religious leaders], the first reaction is to
develop messages to counter the resistance and disseminate them immediately. Experience shows that more measured approach is often more effective." Case studies from Sierra Leone, Angola, and India illustrate this point.

"Why Religious Groups?"

By approaching religious groups with an informed
respect for their views, communication and health
officers can often gain the trust needed to garner their
support.

Whether immunizing children house-to-house or providing services at fixed sites, the support of the community is essential in achieving broad coverage. One way of eliciting such support is to gain the trust and confidence of religious leaders, who often wield tremendous authority at the grass roots. Religious leaders not only have the power to shape public opinion, they can also mobilize their constituencies
and improve the links between communities and health services. By approaching religious groups with an informed respect for their views, communication
and health officers can often gain the trust needed to garner their support.

However, even with strong alliances, vocal minorities have sometimes used religious arguments to dissuade parents from immunizing their children. Such resistance may be tied to a political agenda or based on a misunderstanding of the facts. Whatever the case, UNICEF, among other agencies, is often a key player in developing an appropriate response. Allies among religious organizations can be crucial collaborators in reacting in an appropriate and effective way.

The guidelines presented in this workbook were created for communication and programme officers and their immunization partners seeking to develop and maintain strong working relationships with religious leaders and groups. They also suggest what actions might be taken when a religious leader or group organizes resistance to immunization. While the guidelines provide an overall framework, they do not offer specific health messages based on religious texts. Such messages should be generated at the local level by religious groups themselves, since interpretation of doctrine can be influenced by culture and social conditions and may vary among religious sects. In fact, the very process of debate and arriving at a common position on immunization is what can ensure long-term involvement on the part of religious groups.

The guidelines also suggest ways to reinforce a group’s own organizational structure so that leaders and their followers stay actively engaged in supporting
immunization and other health programmes.

Three case studies illustrate how alliances were built in Sierra Leone, Angola and India to overcome resistance against routine immunization and polio eradication. The studies are intended to illustrate processes that have worked, rather than
models to follow when working with religious groups.

Why religious leaders?

Because they:

• Wield considerable social and political influence
• Have an established network of people and an organizational and physical infrastructure that reaches from national to district and community levels
• Are a source of credible information for their followers
• Provide motivation to act for the wider social good
• Can sanction certain behaviours or actions
• Can become allies in dispelling rumours and reducing resistance
• Are often willing to act on their own with minimum support

What can a strong working relationship with religious groups achieve?

It can:

• Instil local ‘ownership’ to ensure that every child is vaccinated
• Build local capacity to organize, reach consensus on and resolve social problems
• Create long-term support for essential health services for children

What are the guiding principles for building alliances with religious groups?

• Be proactive. Don’t wait for a crisis before approaching them for support
• Do your homework. Know the group's stance on child health
• Start small, and approach leaders of different religious groups and sects separately, respecting leadership hierarchy
• Take care to show respect for the beliefs and values of those with whom you are working
• Be a facilitator for dialogue
• Don't quote doctrine. Stick to the facts and issues on which there is broad agreement, such as the importance of child health
• Don't consolidate multiple religious groups until they request joint activities
• Don't appear to align with any group. Try to include as many groups as possible, but let each work according to its own views
• Plan for sustainability