If you can identify specific barriers to immunization, you will need to decide which of these might be targeted in order to look for a solution. Which of these barriers might it be possible to remove? How might this help to increase immunization coverage and decrease dropout rates? Why are so many children not brought for immunization? Table 9.1 lists some commonly reported reasons.

Reason why child not fully immunized	Caregivers giving this as the main reason (%)
Unaware of need for immunization	22.8
Unaware of need to return for next dose	12.8
Vaccine not available	12.5
Mother too busy	6.3
Vaccinator absent	6.1
Place and time of immunization unknown	6.0
Immunization site too far away	5.7
Family problems and/or mother ill	5.3
Fear of adverse effects following immunization	4.0
Time of session not convenient	2.6

Stop reading for a moment and think about which of the reasons in Table 9.1 are the most likely reasons for children not being brought for immunization in your catchment area.

These are the issues that you should concentrate your communication efforts on, and that should form the basis of your communication objectives.

Which of the reasons listed in Table 9.1 do you think could be best addressed by improved communication? How might you hope to address these barriers to an effective immunization service?

Show answer

Many of the reasons given in the table could be addressed by improved communication, but in particular you might have suggested:

Unaware of the need for immunization: You could arrange a community meeting to explain the advantages of immunization, and the seriousness of the diseases it protects against.
Unaware of the need to return for the next dose: You could ensure that all those bringing their children for immunization are clearly told when they should return and why.
Place and time of immunization unknown: You can make sure there are notices clearly visible at your Health Post and in the kebele office announcing when and where immunization is available. You can also make every effort to remind people of these dates and places whenever you visit families, and ask your volunteers to tell everyone they visit.
Fear of adverse effects: Whenever you are telling people about the advantages of immunization and the seriousness of the diseases it protects against, you could also explain that there may be mild side-effects, but that these are very rarely serious.

Setting objectives

You will recall from Study Session 8 that objectives always have to be specific and the outcomes must be measurable. A well-constructed objective identifies what will be done in order to achieve it, who will do it and where, what resources will be used, and the timescale in which the target should be achieved. You will also need to work out what resources are available in the community that can be used for the communication activities that you may wish to organise.

Having set your communication objectives, you next need to decide what activities would be the most appropriate to help you to achieve them. You should address the following questions:

Strategies and activities

There are a number of possible strategies or activities you can use to get your message across to the community. These might include a community conversation (Figure 9.3 and see Section 9.3.4 later in this study session) or a community mobilisation or advocacy programme. The work plan for conducting these activities should be realistic. You will need to think about what it is that you want to do, when you hope to do it, how many people you will need to help you and who these people might be.

Assessment, monitoring and evaluation

You will also need to find ways to check whether your strategy or activity is working. For example, you might have held a meeting or conducted a community conversation to explain the advantages of immunization, and the seriousness of the diseases it protects against. You hope that this might increase immunization coverage by encouraging caregivers to bring their children to the Health Post for immunization.

How could you evaluate whether your message was understood and whether it has made a difference to people’s behaviour?

Show answer

There are many possible ways you might try to evaluate the effectiveness of your activities. Here are some suggestions (you might have thought of others):

You could record how many people attended the meeting or community conversation, and who they were. You could then monitor how many of these people have shown a change in behaviour. You could see if these people brought their children for immunization, or brought them more regularly than before.
If someone who is not known to you brings their children for immunization for the first time, you could ask how they knew the immunization was available. This might help you to establish whether those who were present at the meeting or community conversation spread the message to others.

If you look back at Figure 9.1, you will see that it is a circle. This is because the results of your monitoring and evaluation help you to determine which strategies and activities are making progress towards achieving your objectives. This information should be fed back into your next communication analysis, so communication improves when you find out about people’s attitudes and behaviour next time.