Using evidence on community engagement to increase routine immunisation in Nigeria
Nigeria is amongst the 10 countries with the largest number of children who have not completed their recommended immunisations. Whilst routine immunisations have increased, the coverage of later vaccines continues to be low. To encourage caregivers not to miss due dates for immunisation, 3ie supported a pilot of community-based distribution of vaccine indicator and reminder (VIR) bands by Direct Consulting and Logistics Limited, Health Strategy and Delivery Foundation, and Precision Development Research and Advocacy. These low-cost, durable, wearable ankle bands for infants have a built-in reminder system that gives caregivers visual cues for immunisation due dates.
3ie also supported the implementers and an independent researcher from Johns Hopkins University’s International Vaccine Access Center to conduct formative evaluation to assess the feasibility, acceptability and relevance of the VIR bands.
The authors reported that although vaccination knowledge and intention to vaccinate were high and there were no stated socio-cultural impediments to vaccine uptake, motivation to vaccinate was still low. At endline, only 9 per cent of enrolled children had received their third dose of pentavalent vaccine by 18 weeks. The most commonly cited reasons for under-vaccination largely pertained to caregiver complacency.
A major setback to the VIR band intervention was the high failure rate of the time-strip indicator, which led to delays in vaccinating many enrolled children. In addition, the limited availability of VIR bands due to import restrictions might have reduced immunisation uptake amongst caregivers who perceived it as an incentive. These issues limited the study team’s ability to accurately measure the effectiveness of VIR bands.
Although the bands did not work as expected, evaluation findings indicated that engaging community leaders (traditional and religious leaders) and traditional birth attendants improved the acceptability of interventions to improve routine immunisation uptake in the community.
'We have always known that religious leaders are an important stakeholder and people trust them. The VIR band study solidified the evidence, highlighting the role of community leaders in improving acceptability of health interventions.'
Type of impact: Inform discussions of policies and programmes
When subsequent phases of the evaluated programme or policy draw from the findings of the evaluation or review, and/or the study team participates in informing the design of a subsequent phase.
This is one of 3ie’s seven types of evidence use. Impact types are based on what we find in the monitoring data for an evaluation or review. Due to the nature of evidence-informed decision-making and action, 3ie looks for verifiable contributions that our evidence makes, not attribution.
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Kebbi state’s Accelerated Action for Impact Strategy and its inputs to the national Community Engagement Strategy were informed by the research team’s discussions of study findings with the state’s Primary Health Care Development Agency. A government official who was part of the study advisory group said the finding that involving community leaders promoted acceptability of health interventions was timely and reaffirmed lessons from other states. The agency plans to involve community leaders, such as village heads, in referring infants to health facilities and tracking defaulters. The agency will also use traditional birth attendants to promote health education on routine immunisation amongst mothers.
As part of the Community Engagement Strategy, traditional birth attendants will be amongst the community volunteers who will inform Mai Ungwas (village heads) of every newborn so they can list the child in their register. Kebbi state has also established a Juma’at Mosque Committee to involve religious leaders (imams and pastors) in raising awareness on routine immunisation during their weekly sermons.
International Initiative for Impact Evaluation (3ie), 2020. Using evidence on community engagement to increase routine immunisation in Nigeria [online summary], Evidence Impact Summaries. New Delhi: 3ie.
Evidence impact summaries aim to demonstrate and encourage the use of evidence to inform programming and policymaking. These reflect the information available to 3ie at the time of posting. Since several factors influence policymaking, the summaries highlight contributions of evidence rather than endorsing a policy or decision or claiming that it can be attributed solely to evidence. If you have any suggestions or updates to improve this summary, please write to firstname.lastname@example.org