NPHCDA – National Primary Health Care Development Agency
Strengthening Routine Immunization in Nigeria through Community Engagement Strategy
NPHCDA – National Primary Health Care Development Agency
Outline
Why Community Engagement?A
Community Engagement Framework B
Role of Key Community Engagement Players C
D Challenges
E Tools – Line list
F Progress so far – Sources of information
NPHCDA – National Primary Health Care Development Agency
Rationale and objectives of community engagement framework
• Building on experiences from polio eradication, NPHCDA developed a community engagement
framework that seeks to engage and sustain community participation and responsiveness to
immunization and other PHC services through existing traditional and religious structures
• Community engagement therefore strives to leverage on influence and authority of these community
gatekeepers by working collaboratively with communities to enhance ownership of health programs.
The strategy hinges on religious and traditional leaders because:
o They are valued and trusted by the people and therefore highly influential
o They are very critical to the growth and development of the people and communities
o They play the role of counselors on both day to day and spiritual matters
o They are trusted sources of information and community gatekeepers
NPHCDA – National Primary Health Care Development Agency
Rationale and objectives of community engagement framework
• Community engagement strategy aims to address demand-side issues that
hinders immunization of Children before their first birthday
• The CE strategy shall be implemented as a civic responsibility of all
stakeholders.
• No financial incentives will be provided to traditional leaders to increase
ownership and sustainability, Non-monetary incentives will be provided to
recognize good performing traditional leaders
5**Facility to be equipped with SDDs or other passive storage devices1. Community Engagement Focal Person
2. CB-HMIS register includes line list of <1, DOB, and status of immunization; CHIPS: Community Health Influencers, Promoters and Services
Village Head
Imam/Pastor
TBA
Barber
Family/husbands
Community Head
Weekly
Community volunteers
District Head
NPoPC
▪ Vital birth registration
DHIS
Newborn line list/CB-HMIS
register2
LGA M&E
Emir
CHIPS, VCMs,
CBOs
Patent Medicine
Vendor
Others e.g. Head of
Market, Women
Leader
Child Health
Card
Monthly
reconciliation
meeting
Monthly
Summary register
Health Facility**
▪ Conduct daily sessions
▪ Vaccine availability**
▪ Optimal number of staff
▪ Registration by settlement
< 3 days
▪ # of children born
▪ # of children referred
▪ # immunized per ward to be obtained from DHIS2
and triangulated by data teamCEFP1
(CHIPS)Weekly
WDC
Reporting system Referral system Reports Work together Feedback
Framework for identification, registration, tracking, and linkages of newborns, defaulters, and left-outs to
health facilities
6
HRM, The Clan Head
NPoPC
LGA M&E DHIS
▪ # of children born
▪ # of children referred
▪ # immunized per ward to be obtained from DHIS2
and triangulated by data team
Monthly
Vital birth
registration
d
Bayelsa’s community engagement framework outlines key roles in order to improve follow up of all newborns
for timely vaccination
SOURCE: NPHCDA, Bayelsa SPHCDA
d Reporting system Referral system Reports Work Update Feedback
Framework for identification, registration and tracking of newborns and referrals to health facilities in Bayelsa state
Pastor
TBA
House to House Mobilizer
Heads of Youth Groups
Maritime Union
Patent Medicine Vendor
Heads of Women Groups
Community Volunteers
<3 days
Compound Chief /
Community Appointee /
House to House
MobilizersAmayanabo /
Amananawei
CEFP1
(CHIPS)
Health facilityxx
▪ Conducts daily RI session
▪ Registration by settlement
▪ Child health cards for all children vaccinated
Monthly HMIS
forms
Weekly
Summary registerNew born register/Line-
list2
Weekly reconciliation
meetings
WDC
xxFacility to be equipped with SDD fridges or other passive storage devices
1. Community Engagement Focal Persons
2. CB-HMIS register includes line-list of <1, DOB and status of immunization; CHIPS: Community Health Influencers, Promoters and Services
DHIS RI data shared with HRM
Clan Heads Health Council each
month
NPHCDA – National Primary Health Care Development Agency
Stakeholders of community engagement at all levels
NPHCDA – National Primary Health Care Development Agency
At the community level, all stakeholders will participate in ensuring all children are fully immunized
Relatives, Women,
Youth groups, and
trade unions
CHIPS and CBOs
Patent medicine
vendors
Town announcers
Barbers
TBAs
Imams/Pastors
Community Head
RI service provider
Ward CE focal person
PartnersOther
community members
NPHCDA – National Primary Health Care Development Agency
Emirate council on
health/advisory
committee on health
District head
Village head
Ward head
State CEFP/SERICC
LGA
CEFP/LERICC/RIFP
Ward CEFP/WDC
RI service provider
Leadership, governance, monitoring of implementation and provision of
feedback will take place at different levels
▪ Emirates and Chiefs Council
Committee on Health meeting
▪ SERICC
▪ State CEWG meeting
▪ LERICC
▪ LGA monthly performance review
▪ Ward monthly performance
review
▪ Monthly reconciliation meeting
using line-list and child
immunization register
Traditional system Health system Fora for engagement
Le
ad
ers
hip
an
d G
ove
rna
nc
e
Existing fora can be leveraged for conduct of LGA and Ward performance review meetings
Feedback channel Reporting channel
NPHCDA – National Primary Health Care Development Agency
Community Head roles and responsibilities
Community
Head
▪ Write down the name of all eligible children in the settlement and maintain an updated line-list
▪ Pass immunization messages during naming ceremonies in your community
▪ Work with TBAs, barbers, Imams to identify, track and mobilize eligible children back to health facility
for vaccination
▪ Work with health facility RI service provider to plan RI sessions and refer parents to HF for vaccination
▪ Send out town announcers to inform the community of fixed and outreach sessions
▪ Attend ward performance review meetings
▪ Reconcile line list with health facility child register together with RI service provider at reconciliation
meeting
▪ With support from HF, track defaulters and left outs to the HF for vaccination
▪ Report linked visits to the HF to the village head
▪ Report to the village head, all unsatisfactory behavior of health workers to caregivers or to their duties
at the health facilities
▪ Seek assistance if unable to read and write
NPHCDA – National Primary Health Care Development Agency
District Head and Village Head roles and responsibilities
Village Head
▪ Supervise activities of the Community Head including their training and involvement in mobilizing children for immunization
▪ Work with Ward CEFP to plan and review progress on linked visits Community Head
▪ Review number of linked visits by Community Head and take appropriate actions based on the data
▪ Provide update on progress and challenges faced during community engagement to the District Head
▪ Report unsatisfactory behavior of the HWs, Community Head and caregivers to the District head
▪ Actively participate in LGA CEWG and monthly RI review meetings
▪ Provide update on progress and challenges faced during community engagement to the ECCOH
▪ Supervise all activities of the village heads (both training and implementation)
▪ Address all unsatisfactory behaviors of the village heads and HWs and flag up to the ECCOH
▪ Work with LGA CEFP to plan, monitor and ensure the implementation of strategy
▪ Ensure RI messaging during Friday prayers
District Head
12|
TBA, Traditional Barbers and Town Announcers will play key roles in the
mobilization and referral for immunization
▪ Sensitize mothers on the importance of immunization
▪ Report all newborns to Community Head for line listing and referral for vaccination
▪ Refer all newborns to health facility for vaccination
▪ Work with Community Head to track newborns never vaccinated and defaulters
Responsibilities
Traditional Birth
Attendants
(TBAs)
▪ Sensitize fathers on the importance of immunization
▪ Report all newborns to Community Head for line listing and referral for vaccination
▪ Refer all newborns to health facility for vaccination
▪ Work with Community Head to track newborns never vaccinated and defaulters
Traditional
Barbers
Town
announcers
▪ Mobilize caregivers to health facilities or outreach/mobile
session points for immunization
13|
Imams and Pastors will play key roles in the mobilization and referral for immunization
Responsibilities
▪ Conduct sermon on the importance of child health as a
responsibility to parents including immunization during naming
ceremony of all newborns and child dedication. Right of child to:
‒ Exclusive breastfeeding and good nutrition
‒ Good health including immunization
‒ Good education
‒ Good up bringing
▪ Conduct sermon on the importance of child health as a
responsibility to parents including immunization during Friday
Mosque prayers/Church services
▪ Conduct sermon on right of mother to good nutrition and health to
enable her breastfeed baby and importance of exclusive
breastfeeding
Imams/Pastors
14|
HF community engagement focal person (CEFP) roles and responsibilities
Every month…
RI service provider
▪ Maintain updated child register (by name and settlements)
▪ Attend monthly ward reconciliation meetings
▪ Reconcile Community head’s line list with child register to identify
defaulters and left-outs
▪ Provide on-the-job mentoring on filling the line list register for
Community head’s
▪ Sensitize all Imams on the importance of RI
▪ Inform Ward CEFPs of Community head not attending reconciliation
meetings
15|
Ward community engagement focal person (CEFP) roles and responsibilities
Every month…
Ward CEFP
▪ Work with Community heads to update line list of under-ones in the ward
▪ Schedule and submit reconciliation meeting calendar to the LGA CEFP
▪ Hold and attend monthly ward reconciliation meeting (including Village Heads)
▪ Reconcile Community heads’ line list with health facility registers during monthly meeting
▪ Conduct all ward-level activities at health facility central to all the Community heads in the ward
▪ Share phone number with Community heads and Health facility RI service provider
▪ Combine, update and submit Community heads’ line list and contact information to LGA CEFP
▪ Work with Community heads to track defaulters and provide solutions to community engagement
problems within the ward
▪ Discuss and submit reports on progress and challenges faced during community engagement to the
LGA CEFP and Village Head
▪ Train, mentor and supervise health facility staff in ward on name-based community engagement
process
16|
LGA community engagement focal person (CEFP) roles and responsibilities
Every month…
LGA CEFP
▪ Schedule and submit reconciliation meeting calendar to the state CEFP
▪ Hold and attend LGA CEWG meeting (including District Heads) two times
▪ Work with the Traditional leaders (e.g District Heads, Village Heads e.t.c.) to track
defaulters and provide solutions to community engagement problems within the ward
▪ Combine, update and submit Community heads’ line list and contact information to
State CEFP
▪ Update LGA Dir PHC on community engagement issues and progress
▪ Discuss and submit reports on progress and challenges faced during community
engagement to the LGA Director PHC, State CEFP and District Head
▪ Train, mentor and supervise Ward CEFPs on name-based community engagement
process
17|
State community engagement focal person (CEFP) roles and responsibilities
Every month…
State CEFP▪Schedule, hold and attend State CEWG meeting two times
▪Ensure timely submission of monthly CE data by LGA CEFPs and analyze
for decision making
▪Discuss and submit reports on progress and challenges faced during
community engagement implementation to the State CEWG, STLC,
S/ECCOH and STFI
▪Train, mentor and supervise LGA and Ward CEFPs on name-based
community engagement process
18|
State Health Educator roles and responsibilities
Every month…
State Health
Educator
▪Supports State CEFP to monitor implementation of community
engagement strategy:
o Attend State CEWG, STLC, S/ECCOH and STFI as scheduled to
discuss progress and challenges faced during community engagement
implementation
o Participate in advocacy visits to traditional and religious leaders and
other stakeholders
o Train, mentor and supervise LGA and Ward CEFPs on name-based
community engagement process during routine RISS visits
NPHCDA – National Primary Health Care Development Agency
Where community engagement is being implemented, some challenges still hamper effective implementation of CE activities
Inability to write
Line-listing
Some Community Heads are not able to read or write
in English or Arabic and do not have scribes
Conflicting activities
of RI Service Provider
Health facility worker unavailable for reconciliation
meeting due to conflicting activities
Advocacy/
Orientation
Absence of line listSome Community Heads do not have exercise books
for line listing of new-borns and under 1s
Funds constraintAbsence of funds for orientation and training of
stakeholders in the traditional and health institutions
IssuesCategory Details Recommendation
Utilise community resource persons to
support line listing
Poor quality of
training
Request for stipends
Not aware of meeting
venue and time
Reconciliation
Community Heads cannot develop line-lists as they
were not adequately mentored by the health workers
Some Community Heads request for stipends to carry
out CE activities
Community Heads not aware of the venue and time
of reconciliation meeting
Continuous on the job mentoring and
refresher trainings in small clusters
Explore non-monetary incentives for recognition
and motivation of traditional leaders
Orient on CE strategy and develop schedules
for meeting with Community Heads
Develop reconciliation meeting schedules for
all community Heads factoring other activities
Provision of line list registers by SHCDAs of
exercise books by Traditional leaders
Leverage on existing activities and partner
resources
Poor identification
and tracking
Weak coordination
Defaulter tracking Some health workers are unable to identify defaulters/
unimmunized children and document those referred
Community Heads do not know community resource
persons attached to support tracking of defaulters
Provide OTJ mentoring for HWs on defaulter
tracking
Identify, link and orient Community Heads and
community resource persons
20
Template for line list of newborns by the Community Heads
* Can be ruled into an exercise book. Detailed Community Based Health Management Register will be provided subsequently
Day Month Year 1 2 3 4 5
TOTAL
Referred Health
facility
Immunization visits
National Primary Health Care Development Agency (NPHCDA)Community Routine Immunization Register
State………………………………... LGA………………………………... Village…………………………… Ward…………………………….. Year…………………………..
S/NDate of
Reporting
Name of
parent
Phone
numberName of child Address
Date of Birth
NPHCDA – National Primary Health Care Development Agency
There is a need to ensure that community leaders are a better source of
information to address some of the demand side issues
Q1 2018 Q2 2018 Q3 2018 Q4 2018 Q1 2019
Proportion of caregivers who obtained information on RI services from community leaders(percent)
NPHCDA – National Primary Health Care Development Agency
In summary, implementation of the CE strategy is hinged on 3 main pillars and some key enablers
▪ Community Heads members
record names of children
under the age of one year
including newborns in his
settlement
Line listing
1 2 3
▪ The CEFP works with both
the HW1 and the Mai’
unguwa at an agreed time
and venue to compare Mai’
unguwa’s line-list and the
facility child immunization
register
▪ HW1 identifies defaulters and
generates a list
Reconciliation meetings
▪ Mai’ unguwa with support
from community members
and CBOs (TBAs, Barbers,
Imams, etc) refers identified
children to RI session site for
immunization
Tracking defaulters and left-outs
1. Strong coordination by CEWG including CEFPs
2. Supportive supervision by state, LGA and ward community engagement focal persons and provision of tools and job aids
3. Performance appraisal mechanism through conduct of state, LGA and ward level review meetings and recognition/reward of best performing TLs
Key enablers
NPHCDA – National Primary Health Care Development Agency
For a successful roll-out and implementation of Community Engagement, a number of activities need to be conducted
02Advocacy to First Class Traditional Leaders, State Council of Traditional leaders, Emirate/Sultanate
Council Committee on Health, Ministries of LG and Chieftaincy affairs, women affairs, religious affairs e.t.c
01Interview and appointment of State, LGA and Ward community engagement focal persons
03 Training of traditional leaders, community volunteers, CEFPs and RI service providers
05 Supervision of CE activities at health facilities and settlements
04 Provision of CE tools (Manuals, SOPs and community based line list register for Mai Unguwas)
06 Monitoring, evaluation and revision of strategies
NPHCDA – National Primary Health Care Development Agency
Practical implementation of community engagement activities
Health worker, caregiver and mai unguwa displaying the
child immunization register, child health card and community
child line-list
Dan Amar ward, Bauchi LGA, Bauchi
Health worker and mai unguwa reconciling the community
child line-list with the health facility child immunization
register
Madorawa/Takatuku ward, Bodinga LGA, Sokoto
NPHCDA – National Primary Health Care Development Agency
Thank you