Critical interventions for demand generation in Zambia, Nepal, and Senegal with regards to the 5C psychological antecedents of vaccination

Abstract

IntroductionChildhood vaccination is an effective intervention for lowering the burden of infectious disease. Progress was made to increase coverage globally, but vaccine hesitancy and refusal has threatened to erode said increases. The 5C psychological antecedents of vaccination (“5C”) model provides a validated measure of “vaccine hesitancy or confidence” to assess individual thoughts and behaviors behind vaccination. Our purpose was to investigate population-level factors that contributed to high and sustained vaccination coverage via interventions in Zambia, Nepal, and Senegal, and alignment with the 5Cs.MethodsFDGs and KIIs were collected at the national, regional, district, health facility, and community levels. We assessed the demand environment, as relayed by participants, and identified interventions that key informants reported as successful for demand generation, then retroactively aligned the interventions with the 5C constructs.ResultsDemand was positively correlated with high confidence and collective responsibility. Psychological constraints sometimes impacted demand. Physical constraints created barriers in some communities, particularly difficult to access (i.e., mountainous). Occasionally, physical constraints did not affect vaccination behavior - parents believed the benefits of vaccination worth pursuing. Factors negatively correlated with demand and intent, complacency and calculation, had limited impact. The most critical interventions were: targeted and tailored health education activities (i.e., media partnerships, school outreach); community engagement; community ownership; and involvement of community (i.e., community health workers, leaders, religious figures).ConclusionWe found similar interventions were used to generate demand, and those strategies aligned with the 5C constructs. Categorizing interventions by drivers of demand may help strategic planning and the division of resources; decision makers may choose to implement our suggested interventions. Assessing the 5Cs allows for decision-makers to operationalize demand generation into concrete interventions and policies, and determine the individual impact of these constructs on the population and focus efforts on interventions tailored to a specific need.

Success in vaccination programming through community health workers: A case study of Nepal, Senegal, and Zambia

“…As frontline health workers, CHWs play a critical role in routine vaccination programming by generating demand for childhood vaccination; connecting community members to the formalized health care system; and working closely with and in communities, schools, and religious facilities [9,10]. A concurrent analysis of our research showed that CHWs played a crucial role in demand generation in Nepal, Senegal, and Zambia [11][12][13][14]. The WHO health policy guidelines for CHWs program (2018) recommends the following: 1) community engagement in selection, 2) training, 3) remuneration, and 4) supervision.…”

Success in vaccination programming through community health workers: a qualitative analysis of interviews and focus group discussions from Nepal, Senegal and Zambia

“…As front-line health workers, CHWs play a critical role in routine vaccination programming by generating demand for childhood vaccination; connecting community members to the formalised healthcare system; and working closely with and in communities, schools and religious facilities 10 11. A concurrent analysis of our research showed that CHWs played a crucial role in demand generation in Nepal, Senegal and Zambia 12 13. The WHO health policy guidelines for CHWs programme (2018) recommend the following: (1) community engagement in selection, (2) training, (3) remuneration and (4) supervision.…”

Critical success factors for high routine immunisation performance: a qualitative analysis of interviews and focus groups from Nepal, Senegal, and Zambia

“…Further analysis of community health worker programmes and demand generation activities in Nepal, Senegal, and Zambia will be detailed in our upcoming publications. 31 …”

“…(National-level government stakeholder, Senegal) Further analysis of community health worker programmes and demand generation activities in Nepal, Senegal, and Zambia will be detailed in our upcoming publications. 31 Adaptation at all levels of the health system In Nepal, Senegal and Zambia, decision-makers and implementers at the national, subnational, and community levels demonstrated their ability to consider contextual factors, evaluate or reflect on quality data and tailor vaccine programming based on local needs and priorities.…”