CTI

Community Theatre For Immunisation

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Background

Although several supply-side factors are frequently enumerated as contributing factors to low coverage in Nigeria, weak demand for Immunisation and poor community linkage for Immunisation are significant demand-side constraints. Despite demonstrable evidence of vaccine availability, implementation of fixed and outreach sessions, and numerous Immunization campaigns, low demand for Immunisation services are a key contributor to the numbers of un-immunised children in the country. Even as community involvement helps address both supply and demand-side factors, it can be especially critical to generating demand for Immunisation services.

Our Intervention: Community Theatre using a Human Centered Design

We commenced an engagement of caregivers and communities on Vaccine-Preventable Diseases & Immunisation, using community theatre that showcases real stories. The content for the theatre was developed with the communities, using a human-centered design. Our proposed idea is intended to empower caregivers to seek and fully utilise immunisation services, by engaging caregivers and communities on Vaccine-Preventable Diseases, Immunisation and Social Determinants of Health, using community theatre that showcases real stories.

Communities were and continue to be engaged to take the lead in identifying some of the demand side challenges and barriers to demanding immunisation, such as Adverse Events Following Immunisation, awareness on the routine immunisation schedule, awareness on availability of sessions and knowledge about Vaccine Preventable Diseases. These topics then form the foundational issues around which the content of the drama and theatre performances are co-created with the communities. Additionally, drama series are co-created on income level and educational level of caregivers, and how these drive interactions with immunisation services.

Our Intervention engaged with Government stakeholders of two States and three Local Government areas Our intervention engaged with Government stakeholders of two States and three Local Government Areas (LGAs), to introduce the project to them. Initial engagements included key informant interviews of decision-makers and mid-level managers of the immunisation and primary health care programmes in these locales. The results of these interviews complemented desk reviews of existing national and state immunisation programme reports, to help provide local context of the immunisation programme and highlight both the demand-side challenges and current approaches to solving the problems. Focus activities at this level were the planning and review meetings, held at both State and LGA levels, working in sub-groups with these key stakeholders.

The community theatre here is being used to stimulate social change by showcasing to the audience key aspects of immunisation, with the participants identifying issues of concern and discussing through the possible solutions, whilst enhancing tolerance for different perspectives on the same problem. The plays are performed in public places like Markets, in traditional meeting spaces in a community dialogue setting, in schools and in religious houses, inviting a wide array of audiences to watch including caregivers. The plays are also recorded, for potential airing in local theatres & on television.

This idea is different because it incorporates a human-centered design, in the development of the community theatre. It also designed to have a cast of community members with real experiences and supported by theatre professionals, as opposed to professional actors playing roles. The intervention builds on existing evidence on the role of theatre in increasing awareness on key health and social issues. It also dovetails into the current National drive of assessing the effect of Immunization interventions using Quarterly Lots Quality Assurance Sampling surveys, which allow disaggregation to the level of the communities and allow monitoring of interventions.

This innovative intervention is majorly testing the hypothesis that caregivers will demand immunization services as a right, if they are engaged through a human-centered process of trust building, education and social support. It builds on documented evidence and best practices of community engagement and demand generation, whilst innovatively introducing a different design model.

Outcomes and Progress

This intervention is in its eighth month of implementation in Bayelsa and Rivers States. In implementing this idea, we work with sub-national expanded program on immunization teams, and Community Health Committees, Women Groups, Traditional and Religious leaders in target localities. These stakeholders are involved in the iteration, design, implementation and supervision of the strategy. This has so far ensured that the strategy is enshrined in current sub-national strategies to scale up Immunization in those localities. The first round of assumptions has been completed tested, with new iterations conducted based on the outcomes of the testing of these assumptions. An initial 24 communities have been identified and preliminary focused group discussions have been conducted, and the first rounds of co-creation of theatre content have been completed in target communities.

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