Overview
The lives of millions more children could be saved each year if immunisation against preventable diseases was universally carried out. With effective community partnership and good planning this is within reach of all health programmes.
Equipment needs to be prepared, vaccines obtained and a cold chain maintained. The project needs to decide whether to use autodestruct, disposable or non-disposable syringes and needles, along with a policy on how to destroy any non reusable items.
Where available and affordable, single prefilled auto-disable devices should be used.
Care needs to be taken to avoid neeedlestick injuries and to ensure that any reusable needles and syringes are adequately sterilised. Schedules need to be calculated according to local and national guidelines. Immunisations should be given by teams of health workers who have been carefully trained, to communities whose awareness has been raised.
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Excerpt from setting up community Health programmes by Ted Lankester
Although most communities are now familiar with immunisation programmes and willingly join in, there are still many remote areas or family groups who are resistant and suspicious. It is also easy for a programme to become unpopular or for a wrong idea to take hold. To increase immunisation coverage we often have to work hard to gain, or regain the community’s co-operation. The immunisation programme should be carried out in full partnership with the community.
Health committee members or CHWs can help to plan and organise a vaccination session. They can help to raise awareness amongst parents – and amongst older family members who may oppose the programme.
It is common to see eager health workers forcing immunisations on unwilling people. Health workers will first need to spend time and patience in raising community awareness. Only when parents are ready should the programme be started.
No family should be forced to have immunisations against their will but we should try hard to encourage their cooperation.
Perhaps the most important and most difficult pary of any programme is creating awareness. Parents in remote locations may find it strange that we refuse to give antibiotic injections when their children have colds, but that we plan to give a whole series of injections when their children seem completely healthy
In raising awareness for any CBHC we need to make sure that we answer fears and objections.
Each individual and each community will have its own beliefs, and suspicions, about immunisation. Here are some common examples of what people may be thinking:
• We don’t understand why our children need these injections.
• The diseases you talk about don’t occur in our area.
• Your centre is too far away for us to reach.
• A child in our village died shortly after an injection and we don’t want you to come back.
• I’ve heard that these injections are a secret form of family planning.
• We can’t afford to lose half a day’s wages each time we have to bring our children.
• We always have to wait such a long time at the clinic and there’s not enough shade to sit in.
• The nurse shouted at us last time we came.
• We are afraid of making the spirits angry.
• We have heard that needles spread AIDS.
After discovering these fears we can then give appropriate teaching.
After discovering common objections we can give appropriate teaching. In doing this we can use a variety of methods, places and people.
Useful methods include: drama, puppetry, question and answer, flash cards, billboards, radio. Suitable places include individual homes, the clinic, a convenient meeting place in the community, the community health worker's (CHW) home or verandah, a temple, church, mosque or school.
Appropriate people to give teaching are CHWs, health committee members, mothers who have completed immunisations, members of women’s groups, youth and adolescents.
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