A study was conducted in Togo to investigate the lack of acceptance of childhood immunization from a social science perspective. In each village focus group interviews were conducted with approximately 12 mothers to discuss their beliefs and knowledge, social and cultural norms and practices, and experiences with health services that hinder or promote the acceptability of childhood immunization. The problem of failure to complete the immunization series was explained in terms of mothers' lack of knowledge of when to return or their forgetfulness rather than inadequate knowledge about the importance of returning. Other barriers included the requirement to keep and present a vaccination card, waiting time at the clinic, lack of information about available services, and laziness. Rather than endorsing strategies that target individuals, mothers suggested increasing the level of social control exerted by decision makers in their communities (the village chief could direct the town crier to announce the passing of each week to help parents keep track of time between immunizations) and increasing the level of social support by having a meeting to support the importance of completing the vaccination series and to organize mothers who go to the clinic to inform others in their neighborhoods about vaccination.

A project in Togo, West Africa, demonstrated that motivated and skilled district health teams can increase community involvement in promoting positive health behavior. Village health committees, village volunteers, health workers, itinerant health agents, and school teachers collaborated with district health personnel in village-wide efforts to increase the use of health services targeted to children under five years of age. The project also demonstrated that in areas where health services are accessible, high levels of service utilization can be achieved by villages through a combination of strategies that rely on person-to-person and group methods of communication. Village-level educational programs, which included theater, storytelling, patient education at health facilities, and child-to-child activities in schools contributed to improvements in immunization coverage levels in children twelve to twenty-three months of age after less than one year following the educational intervention. The major factors responsible for the success of the project are summarized, and issues related to project replication and diffusion are discussed.