This practical guide on training facilitators to communicate about immunisation emerged from a collaborative in-service training session, held in January 2005 in Addis Ababa, Ethiopia. That training was part of an initiative developed by the Southern Nations, Nationalities, and Peoples' Region (SNNPR), Oromiya and Amhara Regional Health Bureaus, Essential Services for Health in Ethiopia (ESHE) project, which was implemented by John Snow, Inc. in collaboration with Abt Associates Inc., the Academy for Educational Development, and Initiatives, Inc. Financial support for this guide was provided by the United States Agency for International Development (USAID).
The resource begins with a section on how to plan and organise a training programme, including a topic on how training can be evaluated. A course syllabus is included. Next, 6 sections are outlined focused on communication around the Expanded Program of Immunization (EPI) target diseases, vaccines, and their administration. For each session, specific modules are outlined - with lesson plans, learning aids, excercises, and handouts. For example, instructions are given to the facilitator as to how to spark conversation about two role plays - meant to illustrate how the ways in which effective communication on the part of the caregiver can impact on immunisation coverage:
"Adapt your two role plays from the following stories:
Role play #1 HW [health worker]: Baby Yonas! (Shouts towards the row of seated women)...Baby Yonas!!
Almaz: Yes Nurse? (she stands up and moves towards the procedure table with her baby)
HW: Don't you listen? Why do you come here then? Show me your card!
Almaz: (becomes uncertain of what to do and stands in front of the procedure table)
HW: Just sit down! Don't waste my time; I have many children for immunization today.
Almaz: (sits down and gets her baby ready for injection)
HW: (writes on the card and then gives the baby an injection without any regard for the baby or the mother; he writes on papers on his desk, ignoring the mother)
Almaz: Please...I do not know the injection you gave my child and if I am to bring her back for another immunization.
HW: Look, are you stupid? Bring that your card. Everything is in this card. You have to be reading this card properly and make it your Bible or Qur'an. You see I have already marked the injection I gave your baby on the card.
HW: (continues): The card also contains the immunization schedule as follows (head down he reads the information from the card as rapidly as possible):
At birth........................BCG [Bacillus Calmette-Guérin, which is a vaccine against tuberculosis] & OPV [oral polio vaccine] 0
At 6 weeks..................DPT [diphtheria, pertussis (whooping cough), and tetanus]1 & OPV1
At 10 weeks.................DPT2 & OPV2
At 14 weeks.................DPT3 & OPV3
At 9 months.................Measles
Almaz: Please Nurse...
HW: Madam! No questions. You are wasting my precious time. I have told you that I am always very busy in this clinic. Who’s next? Baby Alemu!
Role play #2 HW: Baby Yonas, please, come this way.
Almaz: Yes Nurse (she stands up and moves towards the procedures table with her baby)
HW: Please sit down. How are you and how is your baby today? May I see your card?
Almaz: Fine sister! (Sits down and gets her baby ready for vaccination). I do not have a card. Today is my first day.
HW: Don’t worry. I will give you a card. (Health worker takes the card out and records all the necessary information and directs Wro. Almaz to get her child ready for vaccination). Wro. Almaz can I confirm that your child's name is Dele, and he is 4 weeks old.
Almaz: Yes, Nurse. Thank you.
HW: I am going to give your child a vaccine on his left upper arm and some drops into his mouth. The vaccine in the upper arm protects your child against tuberculosis, which give children a chronic cough. The drops prevent polio, that disease which can make children lame. The small injection does not cause much pain. It may give a small lump that will last only a few weeks. You should keep the injection site dry and do not dress it (HW gives the injection on the left upper arm of the child). The drops do not cause any problems.
Almaz: Thank you Nurse. I am so happy you are not angry with me.
HW: Wro. Almaz, why would be angry with you?
Almaz: Ah! You know the other mothers told me that because I did not bring my child immediately after birth, the nurses were going to shout at me. Thank you very much.
HW: Records the vaccine given and tells Wro. Almaz the date, place and time of the next vaccinations. The HW also explains that to be fully immunized the child needs to complete several visits before the child’s first birthday. Your next visit will on this same day, Monday, in four weeks time. Do you have any questions or anything, which you would like me to explain further?
Almaz: Yes, Nurse. What should I do if I miss my child's immunization appointment?
HW: Wro. Almaz, I know it is not always easy to keep all the appointments, but you should try as much as possible to keep the immunization appointments. Immunizations are very important for protecting your children against dangerous childhood diseases. But if you fail to keep an appointment, just come on the next immunization day even if the child is sick. We give immunizations every Monday in this clinic.
Almaz: Thank you Nurse, (smiling). I will make sure I do not miss any immunization appointment.
HW: Bye-bye Wro. Almaz, see you in 4 weeks time."
Annex 1 includes immunisation coverage and drop-out indicators.
Email from Mike Favin to The Communication Initiative on February 23 2015.