Social Mobilisation for Immunisation

BCH Africa's immunisation-related activities are based on the conviction that - while strengthening and extending health service delivery (e.g., vaccination) is important - this approach cannot be sustainable in terms of increasing demand and use without promoting and supporting capacity building, empowerment, social mobilisation, and ownership. This 2-year experience, conducted in Deido and Cite des Palmiers, consisted in processes to build capacity and to assign responsibility for immunisation activities in the framework of community structures; the idea is that immunisation would become a "social stake" calling for the support and involvement of everyone. To that end, immunisation activities were co-managed by the district health officials and community representatives; community-based sensitisation and community monitoring of immunisation coverage were carried out by community representation structures under the supervision of district health teams.

Specific communication-related activities included:

• Carrying out advocacy with health authorities to garner their commitment to and support for community mobilisation;
• Assisting officials of the involved districts in setting up or reactivating dialogue structures and local social mobilisation committees;
• Conceiving and producing education and training materials for local community capacity building;
• Strengthening the knowledge and skills of dialogue structure members and local social mobilisation committees related to immunisation, advocacy and social mobilisation, immunisation coordination, and community monitoring techniques;
• Assisting with training of community relays; and
• Supervising and coaching social mobilisation committees.

In addition to these interpersonal actions, BCH Africa drew on research as a key means of assessing knowledge, attitudes, and practices (KAP) related to immunisation and vaccination. The strategy here involved seeking information from community members themselves in order to identify the educational needs of the population, toward informing future initiatives. Carried out in collaboration with Littoral Provincial Health Delegation in Cameroon, the State Registered Nurses School of Douala, and the health districts teams' (including local social mobilisation committees), BCH Africa carried out a KAP survey in 2004 on immunisation in 6 of Cameroon's health districts. In the course of the survey, students of the State Registered Nurses School of Douala initiated dialogue structure members in the distribution of vitamin A capsules at the level of the local community to children aged 12 to 59 months and women in the post-partum period.

Immunisation & Vaccines.

According to BCH Africa, more than 8 million children in sub-saharan Africa are still unreached by routine immunisation.

The KAP study revealed the following main results:

• only 26.41% of parents know diseases that are prevented by immunisations;
• only 14.99% of parents know at what age a child must have received all of his or her vaccinations;
• only 33.04% know how many times a child should be given vaccinations to be considered completely vaccinated; and
• most parents (75.55%) are convinced that vaccination is the best means to protect their children, yet many (41.66%) are afraid of post-vaccination reactions.

BCH Africa also found that the quality of the vaccination service delivery hinders the massive and regular participation of parents in immunisation activities. Issues identified include poor time management characterised by a long waiting period in immunisation posts (65.42%) and existence of illegal practices of bribery for vaccination (73.89%).

The organisation intends to consolidate and expand the evidence gleaned through the KAP survey in the 6 initial districts by conducting a further survey in 2007. BCH Africa is also ready to collaborate with other African countries in any initiative aimed at promoting ownership of immunisation by communities, as well as national and international partners; the idea is that extending the field of this study to other provinces of the country could make it possible for Cameroon to have the national behavioural data necessary to elaborate Expanded Programme on Immunisation (EPI) communication plans.