National Immunisation Campaign: Measles, Polio and Vitamin A

A communication and social mobilisation strategy and operational plan were developed, including a national advocacy component as well as grassroots activities. The idea was to involve people from all walks of society in the campaign, drawing the attention of stakeholders and citizens to the importance of vaccines for the healthy development of all children. In this regard, everyone - parents, family members, teachers, health workers, neighbours, community leaders, religious groups, political leaders and opposition parties, authorities, donors and journalists - was invited to take part in the movement to ensure that no Mozambican child would be left behind. Activities were designed to raise public awareness of the campaign and to build the feeling that everyone should participate.

The involvement of prominent, easily recognisable personnel - including famous political figures and athletes - was one strategy used both in the launch phase of this campaign, and throughout the process. On April 7 (International World Health Day, as well as the National Women's Day) 2005 in Maputo City, His Excellency the President of Mozambique, Mr. Armando Guebuza announced the campaign and shared its theme: "An Immunized Child a Healthy Child". During the event, President Guebuza declared the campaign a national priority. Provincial Governors were also encouraged and challenged to launch activities on the same day; according to organisers, both national and provincial launches were well attended by the population and well covered by the mass media. After the official launch a series of advocacy tools and strategies were developed and implemented, which also involved public figures and famous personalities. The Prime-Minister, the First Lady, UNICEF and WHO Representatives, former Minister of Education and children's champion Graça Machel, United Football Club Manager and Coach Carlos Queiroz, football coach Chiquinho Conde, the singer Stewart, and the athlete Lurdes Mutola were invited to take part in the campaign by urging everyone to get all children immunised. For example, Mr. Queiroz visited Maputo and Nampula and met with the Minister of Health to demonstrate his support for the cause. The media covered the visit and a press conference was held after the meeting.

Mass media was a key strategy for increasing awareness of the process and importance of vaccination and mobilising parents and others to take action. Nine television spots were produced and disseminated through public and private and community TV stations in order explain the need to immunise children, and to detail the dates and locations of the vaccine offerings. In these spots, authorities and recognisable personalities talk face-to-face with the population, inviting them to go to the vaccination sites. Radio spots were also broadcast through public, private, and community stations. Public debates and interviews were also aired, with the participation of MoH, UNICEF, and WHO staff members. During the process, joint press releases were disseminated to share information about the launch, as well as about campaign support from the private sector, civil society organisations, the government, and others. Two advertising announcements were published at least twice in the main national newspaper "Notícias".

Community mobilisation was another key strategy, in light of the fact that in Mozambique only 46.4% of the population is literate, and that two-thirds of women and more than half of men have no access to mass media (for additional background/statistics, please see "Key Points", below). Traditional communication means and strategies were used in an effort to make sure that all Mozambicans would be aware of the campaign (e.g., specific dates and sites). The following activities were developed in all 11 provinces:

• A series of community meetings was held, involving local authorities such as traditional healers, community chiefs, religious leaders, and health and education workers.
• A theatre role play on the measles and polio vaccination was written and produced by a youth group (Aro Juvenil), under the supervision of the MoH. They presented it in some communities and trained other community theatre groups at district level to perform it. The role play was also recorded on video; 144 copies of the tapes (1 per district) were disseminated and broadcast through the mobile units and community TV stations.
• Community awareness activities were undertaken using 174 megaphones and 30 multimedia mobile unit vehicles to reach out to the most remote areas; messages were aired in Portuguese and local languages. The mobile units and community TV stations broadcast spots and the theatre role play (described above). Besides the involvement of the Health Provincial Directorates, the Social Communication Institute also supported this activity through their mobile units and trained staff.
• In an effort to promote public debate, community radio spots were broadcast both in Portuguese and local languages; health and local authorities and the population were invited to participate in those programmes.
• To encourage the participation of children and promote health through football and other sports activities, children's sports festivals were organised in every provincial capital, involving at least 200 youth players. In addition to prominent athlete support and the involvement of non-government organisations (NGOs) such as Right to Play, the Governors and other authorities were involved in the event. During the medals/cups, balls, and school material distribution to the winner teams (male and female), participating political figures talked about the importance of the immunisation campaign and reminded the audience about the dates and sites. Local and national media (particularly TVM and Radio Mozambique) covered those festivals.
• Political leaders from different parties, at community level, were involved during the preparatory phase and during the campaign itself. Activists from the various parties wore the campaign T-shirt and carried the cup while travelling to villages and calling on the population through household-to-household mobilisation.
• Religious groups talked about the campaign during services, and also promoted house-to-house awareness activities. Tthe Church of Jesus Christ and the Saints of the Last Days involved 800 activists in the Provinces of Sofala, Maputo Province and City.
• National and international NGOs drew on their communication approaches (e.g., megaphone messaging and house-to-house mobilisation) and committees to channel campaign messages to populations with whom they usually work.

In order to support the activities listed above, information, education and communication (IEC) materials were produced. These included posters picturing children receiving vaccines (50,000); information leaflets (57,200); brochures for teachers, health workers, and the media (19,110); banners (200); vaccination post signs (2,464); athlete Lurdes Mutola's vaccination cards stating the date for the polio second round for the under-5-year-olds (9,000,000); T-shirts (49,132); and cups (40,976). All materials were distributed directly to the districts.

Immunisation and Vaccines.

Measles is still one of the major causes of child mortality among other preventable killer diseases in Mozambique. More than 90,000 cases have been identified since 1998; more than 50% of the latest cases occurred in children above the age of 2. In order to fortify the immune system of all children under 5 years of age and protect them against acute respiratory diseases and other infections, Mozambique decided to administer Vitamin A during this campaign as well.

Due to logistics and personnel constraints, it was decided that the campaign would be carried out per region (Northern, Central and Southern Regions), starting on August 1 and finishing on October 14. One month after the first round, a second round of polio vaccine would be given to the children under 5 years old. Approximately 5,000 vaccinators and 33,000 mobilisers/activists were involved in this process.

According to Inquérito aos Agrregados Familiares (IAF, 2003), radio broadcasting reaches more people in Mozambique than the print media, even though more than 55% of households do not own a radio. Usually not more than one radio or television station can be accessed outside Maputo Province. Mass media channels are apparently on the increase, especially newspapers in the main city centres and community radio stations in rural areas. However, interpersonal communication, drama, and music are among the most effective and important forms of development communication in Mozambique.

UNICEF shares the following preliminary/process evaluation findings and lessons learned:

Mozambique has a strong oral culture; therefore the interpersonal communication means (community theatre and meetings) and the radio, megaphone and mobile unit activities seemed to have worked very well, especially at district and village levels. Those messages were transmitted in Portuguese and 16 local languages which facilitated the communication. The involvement of community, political leaders and local authorities made a difference at community level. It's fundamental to prepare the villages for the campaign, explaining its objectives and goals to their leaders, since they represent important campaign allies at grass roots level. The churches and NGOs played an important role at community level and their activists were central in taking messages to remote areas and to persuade some of the difficult to convince groups....A social mobilization group should be well coordinated at central level so as to react immediately against emergency situations which may occur in regard to the mobilisation process. As the dates got closer, doubling and/or increasing the messages (using megaphones) guaranteed increased mobilizations. Visual material was useful as a tool, but if it had been only used as a strategy, it would have compromised the campaign. The design, production and distribution of all IEC materials should be ready at least one month before the social mobilization activities start and should be done and disseminated at once to save money (better logistic planning).