Strategic communications and social mobilisation are critical tools for government to prepare for, respond to and manage a crisis. When used effectively, they can create long-term demand for vaccines and other health interventions, empower communities to adopt behavioural changes that help to reduce transmission of disease, and assist health-care providers in sharing important health advice, ultimately helping to pave the way out of epidemics and pandemics.
Many African countries have significant experience mobilising communities in responding to public-health crises – one of the most well-documented is the 2014–2016 Ebola outbreak in West Africa. During this outbreak, capabilities, systems and structures to engage communities were established, such as call centres that served as a “lifeline” to communities for reporting suspected cases, and initiatives such as the Social Mobilisation Action Consortium. When Covid-19 began to spread, many of these same systems and structures were able to be harnessed. However, countries and communities that either had not experienced epidemics or had not implemented the lessons of past epidemics, nor continued to invest in these existing systems and structures, were put on the back foot in their response and had more difficultly effectively engaging their communities.
It is evident that success during a crisis cannot rely on dormant systems and the resurrecting of inactive structures to engage communities and mobilise. Rather, success is the by-product of years of dedicated and funded efforts in relationship and trust building between government and communities that require constant refinement, investment and expertise.
To enable countries to effectively manage ongoing and future epidemics and pandemics, it is critical to build resilient systems that can outlast Covid-19, integrate its lessons and put them into action. As we detailed in our most recent blog The Africa Vaccines Programme: Accelerating Vaccine Rollout and Strengthening Systems Across Africa, the Tony Blair Institute for Global Change (TBI) is working directly with African countries through its Africa Vaccines Programme (AVP) to support countries in this endeavour.
The Africa Vaccines Programme: Advisory Support to Mobilise and Engage Communities
Through the AVP, TBI has been working alongside African governments for the past year to ensure that the systems used to deliver Covid-19 vaccines today can create a legacy that better prepares countries for the next health emergency as well as persistent health challenges. A central pillar of this work is its support to governments to establish and consolidate strategic-communication and social-mobilisation programmes, a critical component to managing today’s pandemic and to wider health-emergency preparedness, response and resilience.
The AVP leverages TBI’s experience embedded in government during Sierra Leone's Ebola response, where lessons in social mobilisation from Ebola are being harnessed.
Today, there is ongoing work in Burkina Faso, Ghana, Kenya and Malawi to design, refine and implement strategic-communication and social-mobilisation programmes to complement vaccination efforts, create demand and ultimately boost vaccine uptake.
What Strategic Communication and Social Mobilisation Look Like
The AVP’s Vaccine Delivery Advisors (VDAs) in Burkina Faso, Ghana, Kenya and Malawi have detailed several on-the-ground examples of strategic-communication and social-mobilisation efforts and their impact.
Adaptive Approach to Strategies
The AVP team in Ghana has been closely involved in the design and implementation of a communication strategy – the Operational Social Behavioural Change Communication Strategy – to address vaccine hesitancy and vaccine apathy, as well as continuously updating this to meet shifting demands.
In Kenya, the VDAs are supporting on the development of media-engagement plans and assessing gaps in strategic communications, not only for Covid-19 vaccine outreach but also for communication and social-mobilisation efforts in vaccine initiatives for other infectious diseases, such as Human papillomavirus (HPV).
An adaptive approach to these strategies has been key to their successful implementation.
Coordination Mechanisms
Community engagement and social mobilisation to support vaccine rollouts involve the support of numerous development partners and stakeholders in an often complex web of overlapping roles and responsibilities. Effective coordination and stakeholder-management mechanisms can reduce confusion and duplication.
In Ghana, one of the VDAs regularly chaired and coordinated the efforts of the Essential Programme of Immunization (EPI) Covid-19 vaccine-rollout communication subcommittee. This subcommittee includes partners, non-governmental organisations and national regulatory bodies such as the Ghana Food and Drugs Authority and is responsible for cross-sectoral communication and coordinating resource-mobilisation efforts to ensure that there are enough funds to finance communication campaigns. This resulted in a sustained increase in the vaccination rate in Ghana as well as the mobilisation of finances to expand and extend social-mobilisation activities.
In Kenya, one of the VDAs embedded in the vaccine-delivery unit has been actively involved in planning and coordinating advocacy efforts. A recent example of this is the coordination of efforts to finalise advocacy and social-mobilisation materials with partners on the ground, including UNICEF, WHO, CHAI, JSI and USAID, which will lead to resources being rolled out throughout Kenya at the county level. These efforts directly resulted in the expansion of the reach of Covid-19 vaccination-campaign efforts in Kenya.
In Burkina Faso, the VDA designed a national guide to manage rumours, accompanied by training for national actors and media. This required coordination of various stakeholders such as UNICEF with respect to misinformation and rumours tracking, the Direction de la Prévention et du Contrôle des Maladies non transmissibles (DPCM), the Ministry of Health, PATH and the media. It also involved the coordination of vaccination-improvement efforts, which included the review of the tools used and the strategies deployed. These efforts resulted in an increased uptake in Covid-19 vaccinations in Burkina Faso.
In Malawi, the VDA has been coordinating activities of the National Steering Committee on Covid-19 vaccination. The aim of the committee is to raise the vaccination rate to 30 per cent by September, 50 per cent by December and 70 per cent of the total population by June 2023. The committee is made up of the EPI team, District Directors of Health and Social Services, Chief Health Education Officer, World Bank, WHO, UNICEF and other major stakeholders. The VDA has, among other things, supported in mobilising resources for the campaign’s communication and supervising vaccination.
Community-Centred Communication
Adopting localised approaches to community engagement has been effective at combatting vaccine hesitancy and apathy.
In Ghana, to create awareness and increase confidence in vaccine safety and benefit, community-centred approaches were used. This included health-care workers engaging in door-to-door advocacy; mobilising grassroots influencers such as community representatives, local government and religious and traditional leaders, along with politicians; and establishing health-promotion teams at the national, regional and district levels.
This was coupled with frequent strategic messaging from central government on radio and TV through radio jingles and TV documentaries of people that have been vaccinated. Airtimes, formatting and medium of communication were tailored depending on the local context.
In Kenya, an estimated 76 per cent of the population have been exposed to Covid-19 misinformation and rumours. Taking a community-centred approach to communication will help to mitigate any impact of this on vaccine hesitancy. The VDA in Kenya worked to coordinate the pre-testing of messages in small groups before finalisation and delivered the inclusion of sign-language communications to ensure deaf people could be reached. While in Malawi, the ‘’Vaccinate My Village’’ campaign placed communities at the centre and provided incentives to some village leaders to support people to get vaccinated.
Leveraging of Existing Initiatives and Vaccination Drives
Existing and well-known initiatives have been repurposed to boost vaccination – minimising the effort needing to be put into standing up new communications programmes. In Ghana, the Child Health Promotion Week was leveraged to support the country’s second nationwide Covid-19 vaccination campaign. In addition, the government has also integrated Covid-19 vaccination with yellow-fever campaigns in December 2021.
Many African countries, such as Ghana, have been running intensification campaigns for polio vaccination for decades. These vaccination drives were harnessed for Covid-19 and in February 2022, Ghana ran a five-day vaccination campaign – “Operation 2.5 Million Doses” – which met 80 per cent of its target. This minimised cost, increased likelihood of vaccination and contributed to trust-building in communities for multiple vaccines – not just Covid-19 – through the leveraging of trusted and ingrained community initiatives.
Conclusion
In the face of a protracted pandemic, the past two-and-a-half years have tested governments’ abilities to bring their communities along with them. The challenge of getting buy-in for vaccination programmes from communities will not recede with the pandemic. Ultimately, this is not just about Covid-19, it will be critically important to apply the lessons learned on demand generation and community engagement from Covid-19 vaccine-delivery efforts to both future and ongoing vaccination programmes.
As African countries prepare for a future with cutting-edge vaccines for children as well as adults – such as the malaria vaccine – the importance of continuously updating vaccination strategies, coordinating stakeholders, keeping communities at the centre, and integrating trusted and ingrained vaccination initiatives will be integral to building long-term trust for a long-term health dividend.