How do you reach the urban hard-to-reach? Ask these health workers

“I have been able to determine the accurate eligible target population under one year of age in my urban or peri-urban setting through a combination of methods. First, I worked with local health authorities to access available demographic data on the area. Then I conducted a door-to-door survey of households with children under one year of age. This allowed me to verify the data and identify any discrepancies. Finally, I cross-referenced the data with the local health facility.”

“I was in an urban area, where administrative coverage was good, but surveys revealed many zero-dose children and under-vaccinated people, particularly in two health areas. The difficulty was that there were no street names or numbers. To collect the children, we, with the head nurse, named all the avenues and alleys, so we counted the children under two years old, and the zero-dose and the under-vaccinated children.”

“In 2009, when I started doing household visits, my main target was pregnant women, lactating mothers and children under five years of age. Mothers in my community strongly believed in traditional medicines, so quite a large number of children were not being immunised… 30% of Mathare residents had not taken their children to any hospital for vaccination… 14 years later, I’m very proud of my area because the zero-dose case rate is below 1%. This is because the community health workers have made up our minds to make sure that all the babies get immunisation.”

“I have encountered, during the enumeration phase which precedes vaccination, children who have never been in contact with vaccination services or who have received certain doses of vaccines and others not. This led us to train community relays, one of whose functions is to visit homes and begin to identify these children in their routine. They give tokens to parents and direct them to the nearest health centre so that children can receive the missed vaccine doses.”

“We have indicated to the heads of centres that it is necessary to advise them before starting vaccination, which will allow mothers to have psychological preparation in order to understand that certain vaccines can have side effects… We have learned that our community needs support, to be listened to, to remedy their health problems.”

“The experience is taking place in Côte d’Ivoire for the vaccination of underserved communities living in peri-urban areas. We involved neighbourhood community leaders, religious leaders and neighbourhood women’s associations. During meetings, we tried with them to identify the reasons for not vaccinating, their feelings about vaccination services, their wishes for improving vaccination performance in their neighbourhood.”

“We mobilised the volunteer youth health workers at a community meeting to carry out engagement, data collection, and data analysis to pinpoint areas with low vaccination rates… Volunteer youth health workers were trained to become advocates for immunisation, equipped with the knowledge to dispel myths and misconceptions surrounding vaccines. Girls and young women champions in the community will play a vital and crucial role in mobilising residents to attend the advocacy and participate in open discussions about the benefits of immunisation.”

“A programme was put in place to identify children when seen in health facilities during a visit for any reason and ask of their immunisation status. This gives the health care provider the opportunity to know the immunisation status of the children and ensure they are vaccinated and recorded in all relevant registers in the immunisation unit and another register for identified children. The caregiver is counselled on importance of initiating and completing immunisation from birth to five years and where to get the service, immunisation card handling and next visit.”

“We have noticed that since the distribution of mosquito nets to nine-month-old children who receive measles vaccine in vaccination services, many mothers are making efforts to have them vaccinated to take advantage of this opportunity. This system encourages mothers to come and have their children vaccinated.”

Have you read?

• Reaching the unimmunised: a VaccinesWork guide
• How Madagascar is rising to the challenge of vaccinating its unprotected kids

“In health areas where local initiatives have been taken to unite the efforts of stakeholders, coverage has improved. The main bottlenecks for sustaining these innovative actions at the local level are the lack of qualified human resources to provide full-time service wherever it is necessary.”

“Reaching zero-dose children and under-immunised populations requires a comprehensive approach that combines various service delivery approaches, communication methods, and engagement strategies.”