The Development of an Expanded Program on Immunization (EPI) demand creation strategy and EPI demand creation products using Human Centred Design Methodology and Tools.

Background/Objectives:

UNICEF Zimbabwe supported Ministry of Health and Child Care (MoHCC) in a project to translate market and KAP/B-social norms research insights into actionable activities to improve vaccination uptake in hesitant and objecting populations. The goal was to develop EPI demand creation strategy and products using key findings from EPI-KAP study and human centred design (HCD). The HCD provided for understanding the factors influencing immunization coverage, identified problems and issues that stand in the way of EPI demand growth and equitable coverage and brought diverse perspectives together to facilitate ways to promote and create demand for immunization.

Description Of Intervention And/or Methods/Design:

A five-day workshop was held to train personnel from UNICEF, MoHCC and partners on how to apply the HCD approach to identify the human factors that enable or impede vaccination and activate this research with and within communities. Participants built preliminary personas based on their years of experience working with the target communities. They painted a picture of the contextual story of each actor, their strengths, inuences, and barriers to vaccination. Fieldwork was done in 4 communities within Manicaland province: Marange, Zvipiripiri, Mavhiza and Mutare. Data collection was done through semi-structured group dialogues, focus group discussions and key informant interviews. Data collection tools used were a focus group discussion guide, a key informant interview guide and design cards. Caregivers of children aged below 2 years, health workers, religious and traditional leaders and vaccine objectors were the respondents. These groups served as a representative sample of the country.

Results/Lessons Learned:

An HCD evidence-based strategy couched on an understanding of the needs, barriers and motivators of key audiences in order to design targeted and integrated communication EPI demand creation products was developed for Zimbabwe. Using HCD, Twenty four (24) design researchers were trained. Fifty eight (58) caregivers, 23 health workers, 17 household heads, 29 leaders and 4 media representatives were interviewed during field work. Findings indicate that husbands and church leadership are important influencers in vaccination. Village health workers encourage vaccination despite their personal beliefs. Vaccine objectors were not against vaccination but did not vaccinate their children due to church doctrine. Media reported that they would be better able to serve the public and more equipped to translate immunisation information into compelling stories if they had greater knowledge on immunization, and a direct relationship with the MoHCC.

Discussion/Implications For The Field:

Negative attitudes of health staff instead of accepting the Apostolic community contribute to vaccine hesitancy. Other reasons include vaccination stock-outs, lack of information on adverse effects, social pressures and lack of anonymity when seeking health services. Motivation levels of VHWs were low and this might affect their work. Connecting the dots between HCD - C4D in designing solutions with vaccine objectors is key in increasing acceptability of vaccination. MoHCC needs to provide an option for communities to receive some health services secretly. Working relations between the media and the MoHCC would greatly facilitate the sharing of immunisation information with communities.

Abstract submitted by: 

Titus Moetsabi - UNICEF

Priscilla Kusena  - UNICEF

Cynthia Ncube - Population Services Zimbabwe