strengthening routine immunization in nigeria through

NPHCDA – National Primary Health Care Development Agency

Strengthening Routine Immunization in Nigeria through Community Engagement Strategy


Outline

Why Community Engagement?A

Community Engagement Framework B

Role of Key Community Engagement Players C

D Challenges

E Tools – Line list

F Progress so far – Sources of information


Rationale and objectives of community engagement framework

• Building on experiences from polio eradication, NPHCDA developed a community engagement

framework that seeks to engage and sustain community participation and responsiveness to

immunization and other PHC services through existing traditional and religious structures

• Community engagement therefore strives to leverage on influence and authority of these community

gatekeepers by working collaboratively with communities to enhance ownership of health programs.

The strategy hinges on religious and traditional leaders because:

o They are valued and trusted by the people and therefore highly influential

o They are very critical to the growth and development of the people and communities

o They play the role of counselors on both day to day and spiritual matters

o They are trusted sources of information and community gatekeepers


Rationale and objectives of community engagement framework

• Community engagement strategy aims to address demand-side issues that

hinders immunization of Children before their first birthday

• The CE strategy shall be implemented as a civic responsibility of all

stakeholders.

• No financial incentives will be provided to traditional leaders to increase

ownership and sustainability, Non-monetary incentives will be provided to

recognize good performing traditional leaders

5**Facility to be equipped with SDDs or other passive storage devices1. Community Engagement Focal Person

2. CB-HMIS register includes line list of <1, DOB, and status of immunization; CHIPS: Community Health Influencers, Promoters and Services

Village Head

Imam/Pastor

TBA

Barber

Family/husbands

Community Head

Weekly

Community volunteers

District Head

NPoPC

▪ Vital birth registration

DHIS

Newborn line list/CB-HMIS

register2

LGA M&E

Emir

CHIPS, VCMs,

CBOs

Patent Medicine

Vendor

Others e.g. Head of

Market, Women

Leader

Child Health

Card

Monthly

reconciliation

meeting

Monthly

Summary register

Health Facility**

▪ Conduct daily sessions

▪ Vaccine availability**

▪ Optimal number of staff

▪ Registration by settlement

< 3 days

▪ # of children born

▪ # of children referred

▪ # immunized per ward to be obtained from DHIS2

and triangulated by data teamCEFP1

(CHIPS)Weekly

WDC

Reporting system Referral system Reports Work together Feedback

Framework for identification, registration, tracking, and linkages of newborns, defaulters, and left-outs to

health facilities

6

HRM, The Clan Head

NPoPC

LGA M&E DHIS

▪ # of children born

▪ # of children referred

▪ # immunized per ward to be obtained from DHIS2

and triangulated by data team

Monthly

Vital birth

registration

d

Bayelsa’s community engagement framework outlines key roles in order to improve follow up of all newborns

for timely vaccination

SOURCE: NPHCDA, Bayelsa SPHCDA

d Reporting system Referral system Reports Work Update Feedback

Framework for identification, registration and tracking of newborns and referrals to health facilities in Bayelsa state

Pastor

TBA

House to House Mobilizer

Heads of Youth Groups

Maritime Union

Patent Medicine Vendor

Heads of Women Groups

Community Volunteers

<3 days

Compound Chief /

Community Appointee /

House to House

MobilizersAmayanabo /

Amananawei

CEFP1

(CHIPS)

Health facilityxx

▪ Conducts daily RI session

▪ Registration by settlement

▪ Child health cards for all children vaccinated

Monthly HMIS

forms

Weekly

Summary registerNew born register/Line-

list2

Weekly reconciliation

meetings

WDC

xxFacility to be equipped with SDD fridges or other passive storage devices

1. Community Engagement Focal Persons

2. CB-HMIS register includes line-list of <1, DOB and status of immunization; CHIPS: Community Health Influencers, Promoters and Services

DHIS RI data shared with HRM

Clan Heads Health Council each

month


Stakeholders of community engagement at all levels


At the community level, all stakeholders will participate in ensuring all children are fully immunized

Relatives, Women,

Youth groups, and

trade unions

CHIPS and CBOs

Patent medicine

vendors

Town announcers

Barbers

TBAs

Imams/Pastors

Community Head

RI service provider

Ward CE focal person

PartnersOther

community members


Emirate council on

health/advisory

committee on health

District head

Village head

Ward head

State CEFP/SERICC

LGA

CEFP/LERICC/RIFP

Ward CEFP/WDC

RI service provider

Leadership, governance, monitoring of implementation and provision of

feedback will take place at different levels

▪ Emirates and Chiefs Council

Committee on Health meeting

▪ SERICC

▪ State CEWG meeting

▪ LERICC

▪ LGA monthly performance review

▪ Ward monthly performance

review

▪ Monthly reconciliation meeting

using line-list and child

immunization register

Traditional system Health system Fora for engagement

Le

ad

ers

hip

an

d G

ove

rna

nc

e

Existing fora can be leveraged for conduct of LGA and Ward performance review meetings

Feedback channel Reporting channel


Community Head roles and responsibilities

Community

Head

▪ Write down the name of all eligible children in the settlement and maintain an updated line-list

▪ Pass immunization messages during naming ceremonies in your community

▪ Work with TBAs, barbers, Imams to identify, track and mobilize eligible children back to health facility

for vaccination

▪ Work with health facility RI service provider to plan RI sessions and refer parents to HF for vaccination

▪ Send out town announcers to inform the community of fixed and outreach sessions

▪ Attend ward performance review meetings

▪ Reconcile line list with health facility child register together with RI service provider at reconciliation

meeting

▪ With support from HF, track defaulters and left outs to the HF for vaccination

▪ Report linked visits to the HF to the village head

▪ Report to the village head, all unsatisfactory behavior of health workers to caregivers or to their duties

at the health facilities

▪ Seek assistance if unable to read and write


District Head and Village Head roles and responsibilities

Village Head

▪ Supervise activities of the Community Head including their training and involvement in mobilizing children for immunization

▪ Work with Ward CEFP to plan and review progress on linked visits Community Head

▪ Review number of linked visits by Community Head and take appropriate actions based on the data

▪ Provide update on progress and challenges faced during community engagement to the District Head

▪ Report unsatisfactory behavior of the HWs, Community Head and caregivers to the District head

▪ Actively participate in LGA CEWG and monthly RI review meetings

▪ Provide update on progress and challenges faced during community engagement to the ECCOH

▪ Supervise all activities of the village heads (both training and implementation)

▪ Address all unsatisfactory behaviors of the village heads and HWs and flag up to the ECCOH

▪ Work with LGA CEFP to plan, monitor and ensure the implementation of strategy

▪ Ensure RI messaging during Friday prayers

District Head

12|

TBA, Traditional Barbers and Town Announcers will play key roles in the

mobilization and referral for immunization

▪ Sensitize mothers on the importance of immunization

▪ Report all newborns to Community Head for line listing and referral for vaccination

▪ Refer all newborns to health facility for vaccination

▪ Work with Community Head to track newborns never vaccinated and defaulters

Responsibilities

Traditional Birth

Attendants

(TBAs)

▪ Sensitize fathers on the importance of immunization

▪ Report all newborns to Community Head for line listing and referral for vaccination

▪ Refer all newborns to health facility for vaccination

▪ Work with Community Head to track newborns never vaccinated and defaulters

Traditional

Barbers

Town

announcers

▪ Mobilize caregivers to health facilities or outreach/mobile

session points for immunization

13|

Imams and Pastors will play key roles in the mobilization and referral for immunization

Responsibilities

▪ Conduct sermon on the importance of child health as a

responsibility to parents including immunization during naming

ceremony of all newborns and child dedication. Right of child to:

‒ Exclusive breastfeeding and good nutrition

‒ Good health including immunization

‒ Good education

‒ Good up bringing

▪ Conduct sermon on the importance of child health as a

responsibility to parents including immunization during Friday

Mosque prayers/Church services

▪ Conduct sermon on right of mother to good nutrition and health to

enable her breastfeed baby and importance of exclusive

breastfeeding

Imams/Pastors

14|

HF community engagement focal person (CEFP) roles and responsibilities

Every month…

RI service provider

▪ Maintain updated child register (by name and settlements)

▪ Attend monthly ward reconciliation meetings

▪ Reconcile Community head’s line list with child register to identify

defaulters and left-outs

▪ Provide on-the-job mentoring on filling the line list register for

Community head’s

▪ Sensitize all Imams on the importance of RI

▪ Inform Ward CEFPs of Community head not attending reconciliation

meetings

15|

Ward community engagement focal person (CEFP) roles and responsibilities

Every month…

Ward CEFP

▪ Work with Community heads to update line list of under-ones in the ward

▪ Schedule and submit reconciliation meeting calendar to the LGA CEFP

▪ Hold and attend monthly ward reconciliation meeting (including Village Heads)

▪ Reconcile Community heads’ line list with health facility registers during monthly meeting

▪ Conduct all ward-level activities at health facility central to all the Community heads in the ward

▪ Share phone number with Community heads and Health facility RI service provider

▪ Combine, update and submit Community heads’ line list and contact information to LGA CEFP

▪ Work with Community heads to track defaulters and provide solutions to community engagement

problems within the ward

▪ Discuss and submit reports on progress and challenges faced during community engagement to the

LGA CEFP and Village Head

▪ Train, mentor and supervise health facility staff in ward on name-based community engagement

process

16|

LGA community engagement focal person (CEFP) roles and responsibilities

Every month…

LGA CEFP

▪ Schedule and submit reconciliation meeting calendar to the state CEFP

▪ Hold and attend LGA CEWG meeting (including District Heads) two times

▪ Work with the Traditional leaders (e.g District Heads, Village Heads e.t.c.) to track

defaulters and provide solutions to community engagement problems within the ward

▪ Combine, update and submit Community heads’ line list and contact information to

State CEFP

▪ Update LGA Dir PHC on community engagement issues and progress

▪ Discuss and submit reports on progress and challenges faced during community

engagement to the LGA Director PHC, State CEFP and District Head

▪ Train, mentor and supervise Ward CEFPs on name-based community engagement

process

17|

State community engagement focal person (CEFP) roles and responsibilities

Every month…

State CEFP▪Schedule, hold and attend State CEWG meeting two times

▪Ensure timely submission of monthly CE data by LGA CEFPs and analyze

for decision making

▪Discuss and submit reports on progress and challenges faced during

community engagement implementation to the State CEWG, STLC,

S/ECCOH and STFI

▪Train, mentor and supervise LGA and Ward CEFPs on name-based

community engagement process

18|

State Health Educator roles and responsibilities

Every month…

State Health

Educator

▪Supports State CEFP to monitor implementation of community

engagement strategy:

o Attend State CEWG, STLC, S/ECCOH and STFI as scheduled to

discuss progress and challenges faced during community engagement

implementation

o Participate in advocacy visits to traditional and religious leaders and

other stakeholders

o Train, mentor and supervise LGA and Ward CEFPs on name-based

community engagement process during routine RISS visits


Where community engagement is being implemented, some challenges still hamper effective implementation of CE activities

Inability to write

Line-listing

Some Community Heads are not able to read or write

in English or Arabic and do not have scribes

Conflicting activities

of RI Service Provider

Health facility worker unavailable for reconciliation

meeting due to conflicting activities

Advocacy/

Orientation

Absence of line listSome Community Heads do not have exercise books

for line listing of new-borns and under 1s

Funds constraintAbsence of funds for orientation and training of

stakeholders in the traditional and health institutions

IssuesCategory Details Recommendation

Utilise community resource persons to

support line listing

Poor quality of

training

Request for stipends

Not aware of meeting

venue and time

Reconciliation

Community Heads cannot develop line-lists as they

were not adequately mentored by the health workers

Some Community Heads request for stipends to carry

out CE activities

Community Heads not aware of the venue and time

of reconciliation meeting

Continuous on the job mentoring and

refresher trainings in small clusters

Explore non-monetary incentives for recognition

and motivation of traditional leaders

Orient on CE strategy and develop schedules

for meeting with Community Heads

Develop reconciliation meeting schedules for

all community Heads factoring other activities

Provision of line list registers by SHCDAs of

exercise books by Traditional leaders

Leverage on existing activities and partner

resources

Poor identification

and tracking

Weak coordination

Defaulter tracking Some health workers are unable to identify defaulters/

unimmunized children and document those referred

Community Heads do not know community resource

persons attached to support tracking of defaulters

Provide OTJ mentoring for HWs on defaulter

tracking

Identify, link and orient Community Heads and

community resource persons

20

Template for line list of newborns by the Community Heads

* Can be ruled into an exercise book. Detailed Community Based Health Management Register will be provided subsequently

Day Month Year 1 2 3 4 5

TOTAL

Referred Health

facility

Immunization visits

National Primary Health Care Development Agency (NPHCDA)Community Routine Immunization Register

State………………………………... LGA………………………………... Village…………………………… Ward…………………………….. Year…………………………..

S/NDate of

Reporting

Name of

parent

Phone

numberName of child Address

Date of Birth


There is a need to ensure that community leaders are a better source of

information to address some of the demand side issues

Q1 2018 Q2 2018 Q3 2018 Q4 2018 Q1 2019

Proportion of caregivers who obtained information on RI services from community leaders(percent)


In summary, implementation of the CE strategy is hinged on 3 main pillars and some key enablers

▪ Community Heads members

record names of children

under the age of one year

including newborns in his

settlement

Line listing

1 2 3

▪ The CEFP works with both

the HW1 and the Mai’

unguwa at an agreed time

and venue to compare Mai’

unguwa’s line-list and the

facility child immunization

register

▪ HW1 identifies defaulters and

generates a list

Reconciliation meetings

▪ Mai’ unguwa with support

from community members

and CBOs (TBAs, Barbers,

Imams, etc) refers identified

children to RI session site for

immunization

Tracking defaulters and left-outs

1. Strong coordination by CEWG including CEFPs

2. Supportive supervision by state, LGA and ward community engagement focal persons and provision of tools and job aids

3. Performance appraisal mechanism through conduct of state, LGA and ward level review meetings and recognition/reward of best performing TLs

Key enablers


For a successful roll-out and implementation of Community Engagement, a number of activities need to be conducted

02Advocacy to First Class Traditional Leaders, State Council of Traditional leaders, Emirate/Sultanate

Council Committee on Health, Ministries of LG and Chieftaincy affairs, women affairs, religious affairs e.t.c

01Interview and appointment of State, LGA and Ward community engagement focal persons

03 Training of traditional leaders, community volunteers, CEFPs and RI service providers

05 Supervision of CE activities at health facilities and settlements

04 Provision of CE tools (Manuals, SOPs and community based line list register for Mai Unguwas)

06 Monitoring, evaluation and revision of strategies


Practical implementation of community engagement activities

Health worker, caregiver and mai unguwa displaying the

child immunization register, child health card and community

child line-list

Dan Amar ward, Bauchi LGA, Bauchi

Health worker and mai unguwa reconciling the community

child line-list with the health facility child immunization

register

Madorawa/Takatuku ward, Bodinga LGA, Sokoto


Thank you

strengthening routine immunization in nigeria through

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