IMMUNIZATIONbasics - Snap Shots Volume 9

The "public" in public health implies an important link between people and health systems. Community involvement is critical to the success of immunization. This issue of SnapShots describes some practical ways to build alliances between communities and health services to improve immunization coverage.

Why is this topic important?

Immunization currently prevents over two million child deaths each year. Strong immunization systems are increasingly important to sustain past immunization gains and ensure that new, more expensive vaccines, which have the potential to save several million more lives each year, are smoothly introduced. Community participation in immunization programs results in higher coverage and reduces the incidence of vaccine-preventable diseases. Informed and involved communities strengthen immunization programs by holding governments accountable to provide or increase support for immunization services. Communities can assist in planning, carrying out, and monitoring regular immunization and other primary health care services.

Recognizing the role of the community

Several international initiatives and strategies have already recognized the important role that communities play in improving both immunization programs and other primary health care services:

This high-profile attention has fueled interest in techniques for partnering with communities to improve not only immunization but also primary health care services, in general.

"Sharing responsibilities" instead of "increasing demand"

The purpose of community participation in immunization programs is often described as "increasing demand." This is misleading because it gives the impression that a lack of motivation or desire for immunization is the reason why children are not being vaccinated. Studies in many settings show that families are very willing to have their children vaccinated if:

The community component of RED

Since 2002, WHO and partners have supported the RED (Reaching Every District) approach to improving immunization coverage. Evaluations of RED in 2005 and 2007 in the Africa Region showed that districts implementing the approach were raising immunization coverage and that the approach could be used to integrate additional interventions. The 2007 evaluation also found that many health facilities were including community mobilization, meetings with community leaders and frequent interactions with community volunteers in their work plans and regular activities. The 2007 evaluation also confirmed that community volunteers were commonly involved in providing health education, assisting during outreach sessions and tracking immunization defaulters. Fewer than half of all community volunteers, however, were registering pregnant mothers and births, and volunteers were not sufficiently involved in planning immunization sessions and/or reporting diseases. The authors concluded that: "active involvement of community volunteers [is] key in increasing immunization demand, particularly for outreach in rural areas." (View a copy of the 2007 RED evaluation.)

Steps for involving communities in routine immunization

Health planners and managers should first assess the extent of community involvement in planning, providing, and monitoring their health services. Who are the community health leaders? What types of community-based organizations are already engaged in or could be engaged in health promotion? Are there community health or development volunteers playing a role in immunization and other primary health care services? Who are they? Where are they? Could their role be enhanced?

Although health staff may not be able to radically change service-delivery schedules, they should be willing to move toward immunization schedules that work for all involved. By consulting with community representatives in meetings, interviews, and group discussions, they will learn about community preferences and availability. By asking for community input over time, they will learn—from the clients' perspective—how well they are communicating key information, inviting and responding to questions, and treating families. If health workers give regular feedback to communities about coverage and disease outbreaks, community members will also be able to help in identifying underlying problems and defining practical solutions.

What can health workers, communities and USAID missions do?

Failing to partner with communities for immunization and other health activities is a missed opportunity. The new WHO Mid-Level Managers Module, Partnering with Communities (see page 1), suggests many practical ways to involve community leaders and community-based groups in immunization. We summarize some of these in the Quick Reference below and add some suggestions for USAID Missions and projects, as well.

Working with Communities to Strengthen Immunization

The Topic

Why is this topic important?

Recognizing the role of the community

"Sharing responsibilities" instead of "increasing demand"

The community component of RED

Steps for involving communities in routine immunization

What can health workers, communities and USAID missions do?

Quick Reference: Linking Communities and Health Facilities

What can communities do to help improve immunization and other PHC services?

Community members can assist with implementation by:

Community leaders and mobilizers can make important contributions to monitoring by:

What can mid-level managers do to encourage community participation in immunization?

What can USAID-funded projects and USAID missions do?