In recent years, there has been increasing recognition of the crucial role of community engagement in the successful delivery of public health interventions in humanitarian settings, including for vaccine delivery. However, that evidence is fragmentary and has rarely been used as the systematic basis for planning public health interventions. The goal of Pulse is to establish an evidence base and practice network to support community-led vaccine deployment strategies in humanitarian contexts. The project will encompass three phases:
- Convening researchers and practitioners to define current best practice;
- Developing an evaluation framework through partnerships with National Red Cross Societies in both Ethiopia and Nigeria to assess how co-creation and community engagement affects vaccination uptake, the management of vaccination programmes and uptake and operationalisation of community insights by implementing organisations; and
- Producing guidance and establishing a durable community of practice for innovation in humanitarian vaccination.
Pulse brings together a consortium of researchers, led by the Geneva Centre of Humanitarian Studies in collaboration with London School of Hygiene and Tropical Medicine, Addis Ababa University School of Public Health (Ethiopia), and Childcare and Wellness Clinics (Nigeria). The project is implemented in collaboration with International Federation of the Red Cross and Red Crescent Societies (IFRC) and the National Societies of Ethiopia and Nigeria.
The programme is supported by the UK Humanitarian Innovation Hub (UKHIH), an independent humanitarian innovation initiative fully funded by the UK’s Foreign, Commonwealth & Development Office (FCDO) and hosted within Elrha – a global humanitarian organisation and the UK’s leading independent supporter of humanitarian innovation and research.
Since its inception in 2020, UKHIH has adopted an approach of brokering and facilitating high-impact collaborations that contribute to major advances in humanitarian innovation through a shared strategic learning process.
The Accelerated Innovation Collaborations (AICs), such as Pulse, are constructed around collaboration, evidence gathering, assessing concepts, and have adoption / scale partners built into each coloration.
A central component of the AICs has been the inclusion of lower-middle income country (LMICs) researchers through the UKHIH fellowship scheme.
UKHIH’s new online photography exhibition, Humanly possible: Community engagement on the frontline of vaccine delivery was displayed at the Geneva Health Forum 2024 conference (27 -29 May).
It highlights the collective action needed to promote the use of vaccines to protect people of all ages against disease.
The striking collection of portraits and stories from Nigeria have been captured by photographer Etinosa Yvonne, showcasing community engagement volunteers in Kano, who tell their personal story of their engagement with the PULSE vaccine programme.
Read the article from the United Kingdom Humanitarian Innovation Hub and view the beautiful online exhibition with photographer Etinosa Yvonne.
Mapping Community Engagement Tools for Vaccination in LMIC Settings
Introduction – community engagement for vaccination
Community engagement is increasingly seen as a core activity in humanitarian interventions, and as particularly important for ensuring effective vaccine uptake in complex emergencies (Ismail et al., 2022). Community engagement is broadly understood as efforts to bring together “traditional, community, civil society, government, and opinion groups and leaders; and expanding collective or group roles in addressing the issues that affect their lives” (UNICEF, 2020).
A range of community engagement tools exist in both the humanitarian and global health space to facilitate engagement, feedback and accountability to affected populations. Despite the recent emphasis on community engagement within vaccination programming, there appear to be gaps both in terms of evidence on what works and in terms of resources to equip implementers to carry out successful community engagement interventions in different settings with different populations.
About this resource – mapping tools that can be used for community engagement for vaccination
We sought to map and characterise available community engagement tools used for vaccination in low and middle income (LMIC) settings. This was carried out as part of the PULSE project which aims to establish an evidence base to support community-led vaccine deployment strategies in humanitarian contexts. We conducted a rapid, non-exhaustive search both online and with several key stakeholders and institutions involved in the PULSE project. We focussed on publicly available community engagement tools and guidance used for vaccination in LMIC settings. We then created a typology from these tools, our goal was to define the range of implementation guidance available for community engagement practitioners, what objectives these tools and guidance serve (e.g. managing misinformation), and to see where the gaps lie. This was not designed as an exhaustive search, however we hope that it can be used to highlight types of tools that may be more common, gaps in typologies, as well as provide a resource to implementers. To suggest additional tools or resources, please email us.
Tool typologies
We have listed 14 tools of relevance (with some of these containing sub-tools). Most tools focused on COVID-19 vaccination and were from the 2020–2022 period. This may reflect the removal of older resources from institutional websites. However, it also highlights the surge in interest in addressing vaccine misinformation and other aspects of the COVID-19 response, which brought community engagement into the spotlight during this period. Alongside this trend were the paradoxes in terms of implementing these kinds of tools during the COVID-19 pandemic when a very limited supply of vaccines in many LMIC settings meant supply could be overwhelmed if demand increased (Collins et al., 2021). In these kinds of vaccination contexts, addressing hesitancy and demand creation risks assuming that community behaviours are responsible for low vaccination rates, rather than supply and access challenges.
Tools tended to be either normative (e.g. statements on principles such as ‘shared decision making’) or they addressed very granular information delivery work such for key population groups (e.g. Q&A sheets for health workers vaccinating pregnant women). This means that many of the operational tools available are information driven and there appears to be an absence of operationally ready tools that can assist with other community engagement objectives such as building trust in vaccine services, working with opinion leaders, or redistributing decision making onto communities.
We categorized the tools according to the following four typologies:
- Normative guidelines for community engagement or risk communication and community engagement (RCCE)
These tools included recommended standards or frameworks that set out expected practices or principles for community engagement or RCCE. Tools collected included IFRC tools to design and evaluate community engagement and accountability activities in support of programmes and operations, and general guidance on how to create a community centred approach when vaccinating. - Operational tools
These were tools that were ready for operational use such as tools for community health workers to trace vaccine eligible children, behavioural science strategies and programme design, monitoring and evaluation tools. - Collecting feedback
These were tools which can be used to receive community feedback around a vaccination programme, for example templates that can be used to develop a structured feedback form, and coding matrices for the data collected from these feedback forms. - Managing misinformation/rumours and one way information delivery
Various tools were found that can be used to address rumours and deliver vaccine information. This included ‘Q&A’ communication tools for health personnel and vaccination teams for different population groups, an app to counter COVID-19 misinformation and vaccine hesitancy, games to introduce immunization, and at a policy level tools and guidance for developing national level strategies to counter misinformation and rumours.
We also found a range of other tools that, although outside our scope of interest, could be adapted for vaccination. The first was community engagement guidance for situations like health emergencies and outbreaks (e.g. minimum standards) these were not specific to vaccination but provide relevant guidance. The second was tools for vaccination in high income settings (for example: https://www.pih.org/united-states/vaccine-toolkit), these could be adapted to LMIC settings in many cases. The third area we saw a number of resources was for social science data collection, as this can inform community engagement programming it is of relevance to practitioners.
Discussion and gaps for practitioners
Our mapping of community engagement tools for vaccination indicates a focus on either normative guidelines or specific, granular information delivery. While these tools provide valuable resources for health workers and program designers, we have identified a gap in tools that address broader objectives for community engagement activities. Given that strengthening community engagement activities beyond information dissemination is essential, the development of further tools, resources, and knowledge products may be needed to fill this gap.
Reference list
Collins, J., Westerveld, R., Nelson, K.A., Rohan, H., Bower, H., Lazenby, S., Ikilezi, G., Bartlein, R., Bausch, D.G., Kennedy, D.S., 2021. Learn from the lessons and don’t forget them’: Identifying transferable lessons for COVID-19 from meningitis A, yellow fever and Ebola virus disease vaccination campaigns. BMJ Glob. Heal. 6. https://doi.org/10.1136/bmjgh-2021-006951
Ismail, S.A., Lam, S.T., Bell, S., Fouad, F.M., Blanchet, K., Borghi, J., 2022. Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review. BMC Health Serv. Res. 22. https://doi.org/10.1186/s12913-022-08653-4
UNICEF, 2020. Minimum Quality Standards and Indicators for Community Engagement. UNICEF.
Authors
Rose Burns, Luisa Enria, Rachel Cassidy, Karl Blanchet and the PULSE team.
