Evidence: Community Engagement in Liberia: Routine Immunization Post-Ebola

Participating organisations in the Global Alliance for Social and Behaviour Change - Building Informed and Engaged Societies were asked to identify, in their opinion, the 5 most compelling research and evaluation studies that demonstrate the direct impact of this field of work on a major development issue. This was one of the nominees. For the full compiled list, please click here. For the compilation of the key impact data across all research evidence identified, please click here.

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Title of paper, article, book (chapter), publication?:

Community Engagement in Liberia: Routine Immunization Post-Ebola

Name(s) of author(s)?:

Juliet Bedford, Ketan Chitnis, Nance Webber, Phil Dixon, Ken Limwame, Rania Elessawi & Rafael Obregon

Who published this paper, article, book (chapter) or other publication?:

Journal of Health Communication, 22:sup1, 81-90, DOI: 10.1080/10810730.2016.1253122

What are the best extracts that highlight the evidence for the impact of a communication for development, social change, behaviour change, public engagement, or informed citizen strategy on a development issue and priority?:

A national integrated polio, measles, and deworming campaign was implemented across Liberia May 8–14, 2015. The community engagement and social mobilization component of the campaign was based on structures that had been invested in during the Ebola response. This article provides an overview of the community engagement and social mobilization activities that were conducted and reports the key findings of a rapid qualitative assessment conducted immediately after the campaign that focused on community perceptions of routine immunization in the post-Ebola context. Focus group discussions and interviews were conducted across four counties in Liberia (Montserrado, Nimba, Bong, and Margibi). Thematic analysis identified the barriers preventing and drivers leading to the utilization of routine immunization. Community members also made recommendations and forwarded community-based solutions to encourage engagement with future health interventions, including uptake in vaccination campaigns. These should be incorporated in the development and implementation of future interventions and programs.

To which development issue does this evidence and impact data relate?:

Disease outbreak response; Routine immunization

To which strategic approach(es) does the evidence and impact data relate?:

Community engagement

What research methodology (ies) was/were used to produce this evidence and impact data?:

Rapid Qualitative Assessment
Following the immunization campaign, a rapid qualitative assessment was conducted in four counties (Montserrado, Nimba, Bong, and Margibi). The aim of the assessment was three-fold: to determine the barriers to and drivers for routine immunization; to determine the barriers to and drivers of routine immunization uptake during the campaign; and to identify and document examples of positive community engagement during and after the Ebola outbreak in terms of community self-mobilization, leadership, and innovation.

Data Collection
Data collection was conducted in four counties over 8 days: Montserrado (May 15–16), Nimba (May 18–19), Bong (May 20–21), and Margibi (May 22–23). The rapid assessment was conducted in line with prevailing ethical principles to protect the rights and welfare of all participants. Permission to undertake the research was granted by the County Health Teams and was supported by the UNICEF Country Office. In each county, three communities were visited. The communities were selected by the local CMCs and DMCs and included one community in which immunization uptake had been positive and coverage was high, one community in which there had been resistance to immunization and coverage was lower, and one community that had demonstrated innovation and self-leadership during the Ebola outbreak. At each site, a focus group discussion was conducted with community members, primarily caregivers (mothers, fathers, and grandmothers) and community leaders. The discussion was structured by a topic guide, but the direction and content of each focus group was determined by the participants and focused on issues they prioritized, although all components of the framework were covered to ensure thematic comparison across communities. All focus group discussions were conducted by the primary investigator (JB), supported by a CMC and/or DMC, who translated between English, Liberian English, and local languages as necessary. A number of focus groups were observed by County Health Team representative(s). All participants gave their consent by signing or putting their thumbprint on a standard UNICEF consent form and were provided with refreshments (a soft drink and biscuits) after the discussion. The consent forms were deposited with the UNICEF Liberia country office at the conclusion of the study. At one site in Monrovia (20th Street), mothers who had not taken their children for immunization were interviewed individually rather than in a group discussion. In Nimba county, communities that had good vaccine uptake and poor vaccine uptake were visited, but because the former also demonstrated positive leadership during the Ebola outbreak, the research team used the additional time to visit a community clinic to engage with health staff who had been providing immunization services during the campaign. An additional interview was conducted with the doctor and officer-in-charge (OIC) of the Bahn Health Centre that serves the Bahn Refugee Camp in Nimba (hosting refugees from Côte D'Ivoire).

What is the URL to access this paper, article, book (chapter) or other publication?:

https://www.tandfonline.com/doi/full/10.1080/10810730.2016.1253122?src=recsys

Why was this research evidence found to be useful?:

It provides evidence of the key role that community engagement plays in the recovery phase of a major disease outbreak, and the need to listen to and facilitate community-led solutions in a context of high vulnerability and mistrust of health services.