Quick Links #8: Incentives and demand for immunisation

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Below you'll find a brief list of just some of the polio communication resources related to incentives and demand from The Communication Initiative for Pakistan and Afghanistan.

Hi Everyone,

This Quick Links looks at the role that incentives play in increasing demand for immunisation. There is good evidence that well designed interventions with appropriate health related incentives have a positive impact on reducing chronically missed children. However, incentives by themselves have limited impact and need to be blended with other initiatives such as ensuring dependable supply and access, engaging community leaders, supportive media, educational tools, and high quality accountable delivery. Incentives also add cost and need to be focused on high risk communities.

I have included four articles this time (apologies for breaking my own rules but I think they’re worth taking a closer look at if you have time). The first looks at the impact of several blended interventions in northern Nigeria which had a positive impact on immunising children in non-compliant communities. The second compares immunisation camps with and without pluses and determines that pluses increase uptake of immunisation services. The third is a meta-analysis of demand side interventions in low and middle-income countries that finds educational or knowledge based interventions were most effective at increasing demand but that incentives also have a positive effect. The fourth ‘bonus paper’ looks at an intervention in Nigeria which combined incentives with direct observation of vaccination in very high risk non-compliant communities which helped reduce numbers of chronically missed children.

Demand Creation for Polio Vaccine in Persistently Poor-Performing Communities of Northern Nigeria: 2013–2014

This paper describes and evaluates the impact of a range of blended demand creation interventions in persistently poor-performing high-risk communities in northern Nigeria from September 2013–November 2014. The interventions included health related pluses targeted at mothers and caregivers and older siblings, road shows and dramatic theatre, a Qur’anic teacher package, improved engagement of influencers to nomadic groups and those in security compromised areas, health camps, and use of state level media through multiple channels. The paper finds that this blend of demand creation interventions played a critical role in improving the quality of polio SIAs in communities noncompliant with uptake of polio vaccines and contributed to a reduction in polio transmission.

Improving immunisation coverage in rural India: clustered randomised controlled evaluation of immunisation campaigns with and without incentives

This evaluation in rural Rajasthan, India was based on two interventions one focused on immunisation camps designed to improve reliability of immunisation services and the other immunisation camps with the addition of a plus of lentils provided to caregivers who came to the camps and immunised their children. It found that improving reliability of services improved immunisation rates, but the effect was modest due to low level barriers for care givers bringing their children to vaccination sites. Small incentives play a role in overcoming such barriers, have large positive impacts on the uptake of immunisation services in resource poor areas, and are more cost effective than purely improving supply.

Strategies to increase the demand for childhood vaccination in low- and middle-income countries: a systematic review and meta-analysis

Demand-side interventions lead to an increase in child vaccination coverage in diverse low- and middle-income settings and among communities with lagging health and social indicators. Immunization programmes have often focused on strengthening vaccine supply. Our results show that policymakers who seek to increase access to vaccines through the routine immunization system should also consider demand-side strategies. Educational or knowledge translation interventions were more effective on average than interventions based on incentives; however, both strategies were effective.

Targeting the last polio sanctuaries with Directly Observed Oral Polio Vaccination (DOPV) in northern Nigeria, (2014–2016)

This intervention focused on densely populated settlements with reported high rates of noncompliance, suspicious vaccination coverage, concealment of non-compliant cases, and fraudulent house and finger- marking during the previous SIA round. It combined vaccinating children under the direct supervision of an independent supervisor to ensure compliance with attractive incentives (pluses) such as soap and nutritional items. The pluses were used to encourage parents to willingly submit their children for vaccination or directly attract children to the vaccination teams or post. The paper found that the use of DOPV coupled with other interventions rapidly reduced the number of chronically missed children in the most high-risk LGAs leading to improvement in population immunity.

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Cheers

Chris

A note on Quick Links:

Quick Links is a small experiment from The Communication Initiative that might help those working for polio eradication in Pakistan and Afghanistan identify useful knowledge on issues the programme is facing. It is designed to be brief and not add too much to anyone's inbox. Each email focuses on an area of particular importance to the Pakistan and Afghanistan programmes and presents brief descriptions of three resources that may be of interest or use to those of you working in the country. The mailing list, by design, is quite small though anyone who's interested can send a request to cmorry@comminit.com and they'll be added to the list. We also welcome suggestions and requests for specific topics to be covered and/or resources to be identified.