The ‘What’ and ‘How’ of communication for immunization – part two


“The way we communicate with others and with ourselves ultimately determines the quality of our lives”- Tony Robbins

Part one of this blog discussed the “what” of immunization communication. Today, we discuss the often-challenging “how”.

Communication and behavior change are part of social science, which – in the immunization context – can be applied in different ways depending on program needs, communities, networks, and country realities. Even with standardized guidance like the Reaching Every District (RED) approach, there is no one-size-fits-all for how to make communication most effective. Immunization programs do have several decades of experiences to build upon, however.

So, HOW is communication for immunization done??

At country level:

  • Supporting districts to identify and develop links/partnerships with community structures and networks (e.g. religious groups, women’s groups, NGOs, traditional leaders) and to strengthen this component within their RED workplans and strategies.
  • Enhancing community ownership by fostering community involvement in planning, monitoring and utilization of immunization services (e.g. conduct planning meetings with communities, provide them with status on immunization indicators, involve them in tracking newborns and immunization status of all children under two years of age, include them in organization of service schedules, locations and times).
  • Strengthening capacity (through training, supervision, feedback) of health workers/vaccination teams to plan and communicate immunization services effectively and actively with clients and the community (e.g. through communicating immunization data and using child health cards as reporting and information-sharing tools).

At global and regional levels:

  • Documenting and disseminating country best practices and commonalities in working with communities to empower them to strengthen services and increase coverage and utilization.
  • Adapting country experiences and case studies into electronic reference materials (e.g. websites, listserves), field guides and modules that address the community linkage component within RED.
  • Liaising with and provide technical support to inter-country experience exchange and to strengthen the immunization component in community activities of NGOs and field-oriented partners.
  • Promoting increased attention to linking communities and services through regional initiatives and fora.

Below are some additional references:

**This article was originally published on June 13, 2014, by Health Communication Capacity Collaborative

2 responses to “The ‘What’ and ‘How’ of communication for immunization – part two”

  1. As mentioned above that “even with standardized guidance like the Reaching Every District (RED) approach, there is no one-size-fits-all for how to make communication most effective” is a practical observation as clients with specific health care needs will differ in their social, cultural and economic backgrounds. Even people from same cultural and occupational backgrounds will understand and interpret communication differently based on education, gender and other associated factors such exposure, and experiences. However, at local level peoples participation for immunization is possible for social mobilization, tracking of left out/ drop out child and logistics support for organizing outreach sessions, whereas planning and execution which requires technical skills could be done by service providers. Hence, the term ‘communitization’ of health service is delimited to what community can do and what providers can do?

    I will like to share the strategic communication initiatives taken up by Department of Health and Family Welfare, Government of Jharkhand, India. The state communication strategy for mother and child health care is inspired from socio-ecological model for change. Individual (lactating mother) is considered at the center of behavioral change communication. Partners, family members, peers have considerable influences on her decision for adopting healthy practices (e.g. colostrum feeding which is first immunization for neonates) and services. Here IPC (Interpersonal Communication) by frontline functionaries and CBO (community based organizations) will help to reduce/overcome barrier. Service delivery, products and institutions lies next to inner circle where organized networks (women groups, NGOs, Civil Society Organizations etc.) exist. At this level, social mobilization efforts will favor access and quality of services to mothers. At outer periphery, advocacy effort focuses on creating enabling environment through policy framework, legal, political and social institutions. Individual communication needs can be grouped into four levels; Individual level – Needs knowledge (lack of information), Family level- I know but I need family support, Community level- I know and my family is supportive but I need communication interventions that will address my community or cultural norms and create an environment and Institutional level – I need communication interventions that will address the quality of health care services so that I can adopt or maintain health seeking behavior at appropriate provider or health center level. Apart from audience segmentation,state communication strategy emphasizes ‘continuum of communication’ i.e. same messages at district, block and village level.

    The issue of Information (knowledge), Motivation (Attitude, Beliefs), Ability to Act (Skills, Efficacy, Access) and Norms (Perception, Socio-cultural factors, Gender) needs action at family and community level. Hence, design and implementation of effective communication approach from family (mothers) to institutions is a tough task. Design & use of BCC (Behavior Change Communication) tools for four category of audience at different tier of health facilities poses another significant challenge. Communication occupies key role when new program begins. Recent, introduction of Pentavalent vaccine in universal immunization program in India and from Oct 2014 onwards in the state of Jharkhand will require careful but robust communication at community and system level. Lastly, for Jharkhand ‘ Reaching Every District’ is ‘Reaching Every Village’ or Reaching Every Child’ for achieving full immunization.

    • Thanks for these very astute and thoughtful comments. The work in Jharkhand is impressive. Under the USAID-funded IMMUNIZATIONbasics and MCHIP projects, JSI has been supporting immunization and community work in Jharkhand in close collaboration with the GoJ/MOHFW and partners, including WHO, UNICEF, CARE and others.

      This post and the success story document related to immunization work in Jharkhand may be of interest to you:

      For more information and to share your ideas, you could speak with Dr. Gunjan Taneja, Dr. Sumant Mishra, and Dr. Ajit Prasad.

      Some additional resources that may be of interest related to RED and India can be found on this site:

      Thanks and best regards, Lora

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