John Snow, Inc. (JSI)
In this presentation, Lora Shimp, Senior Immunization Technical Officer and Technical Lead at John Snow, Inc. (JSI), provides examples of the use of social and behavioural research and data in immunisation. She begins by asking, What works in immunisation and polio eradication? She points to advocacy and policies, planning and mapping, media management and partners, and population-based tracking at individual, household, and community levels.
Data she shares indicate that, when one looks at regional full immunisation rates by socio-economic status (SES), it is clear that the groups with highest SES are better vaccinated than the lowest SES group in each region. The 1 in 5 children who miss out on immunisation are generally the most vulnerable, and failure to be immunised can be used as a marker for other key interventions in addition to immunisation. Shimp suggests that immunisation programmes can help the equity agenda by providing data on the children who are missing out. Those who miss out on immunisation are likely to be missing out other key interventions. And since immunisation reaches nearly every child, attendance at a session can be used to check for other key interventions, including on the family practices that can increase a child's chance of healthy life.
Looking at data out of India (reasons for under- and un-immunised children in two largest states), it is clear that lack of proper and adequate information and communication at the community level is a major factor. Turning to reasons for not completing immunisation and reasons for non-immunisation as revealed by an immunisation coverage assessment survey of Deoghar/Jamtara, Jharkhand, February 2010, Shimp outlines a communication indicators in supportive supervision checklist. This features indicators such as:
- Auxiliary nurse midwife (ANM) is giving 4 key messages on immunisation to parent/care taker of child
- Presence of Anganwadi (nutrition extender) worker in immunisation session
- Presence of accredited social health activist (ASHA)/link worker/mobiliser in immunisation session
- Information, education, and communication (IEC)/behaviour change communication (BCC) materials displayed at site
- Supervisory visits by district/block level medical officer to ANM's sub-centre area in last 3 calendar months
Using Nigeria as an example, Shimp presents the 5 components of the reaching every district (RED) approach, including linking communities and services. There has been progress in resolving persistent non-compliance with a tailored package of interventions; often, it is traditional leaders who play a role.
Email from Lora Shimp to The Communication Initiative on February 8 2018.