Community Engagement in Liberia: Routine Immunization Post-Ebola

Figures & data

Fig. 1. Decline in Penta 3 and measles coverage during the Ebola virus disease outbreak, 2014.

Fig. 2. Comparative coverage of Periodic Intensification of Routine Immunizations (PIRI) Rounds 1 and 2.

Fig. 3. Measles outbreak by county, December 1, 2014, to April 15, 2015, Liberia.

Fig. 4. Oral polio vaccine (OPV), measles, and mebendazole by target, total, and coverage percentage per county.

Fig. 5. Oral polio vaccine (OPV), measles, and mebendazole coverage percentage by county.

Table 1. Activities and participants per community visited in the study

County	FGD	District	Community	No. of group discussions	No. of interviews	No. of participants
Montserrado	Good vaccine uptake	Monrovia	Slipway	1		12
	Poor vaccine uptake		20th Street		3	3
	Positive leadership		Buzzy Quarter	1		8
Nimba	Good vaccine uptake andpositive leadership	Zoe-Geh	Bayleiglay	1		13
	Poor vaccine uptake	Sanniqueillie-Mahn	Tonwee	1		12
	Community clinic	Sanniqueillie-Mahn	Ganta	1		4
	Refugee camp	Zoe-Geh	Bahn		2	2
Bong	Good vaccine uptake	Sano Yea	Gbamo Kollie-Ta	1		8
	Poor vaccine uptake	Jorquelleh	Meleke	1		11
	Positive leadership	Zota	Waterside	1		13
Margibi	Good vaccine uptake	Kakata	Gwekpolorsne	1		18
	Poor vaccine uptake	Mambam Kaba	RIA Compound	1		16
	Positive leadership	Kakata	Gaygbah	1		12
Total				11	5	132

Note. FGD = focus group discussion.

Table 2. Additional interviews per county

County	CMC	DMC	gCHV	Total
Montserrado	1	1	3	5
Nimba	1	0	0	1
Bong	1	0	0	1
Margibi	2	0	0	2
Total				9

Note. CMC = County Mobilization Coordinator; DMC = District Mobilization Coordinator. gCHV = general Community Health Volunteer.

Table 3. Key themes

Barriers
	General avoidance of biomedical services
	Post-Ebola—fear of attending a health facility
	Post-Ebola—suspicion of health workers (and a more general frustration at poor health worker attitudes, limited services, and long wait times)
	Post-Ebola—concern over temporary vaccination sites at the community level
	Post-Ebola—distrust of routine vaccines
	Post-Ebola—suspicion that the measles vaccine was actually the trial Ebola vaccine
	Post-Ebola—suspicion that the campaign was a cover to infect children with Ebola (and take their blood)
	Post-Ebola—visuals (e.g., of PPE and other equipment) that evoked memories of the Ebola outbreak and response
	Religious convictions (e.g., within Fula communities)
	Other—too busy/caregiver illness during campaign
Drivers
	High level of awareness about the campaign
	Perception that vaccines were part of responsible child care (prevention of illness)
	Post-Ebola—prior experience of, and trust in, vaccines
	Post-Ebola—receiving vaccine from known and trusted source
	Post-Ebola—prolonged and repeated community engagement (particularly interpersonal, face-to-face dialogue)
	Positive social mobilization activities (gCHVs, radio, town crier, community meeting, dramas)
	“Wait-and-see” method/“seeing is believing”/“bearing witness”
	Influence of trusted community leadership and other community members (particularly mothers)
Community recommendations
	Mobilizers should speak softly, be gentle in their interactions, and not threaten communities with coercive action
	The integral use/involvement of the community as active participants in any intervention
	Involve community leaders/community members (who should receive training)
	Use the same community members in future interventions as they are now known and trusted
	Empower mothers to directly advocate to other mothers as “active partners” in EPI
	Target men, particularly fathers, in health education to encourage their support/permission
	Focus on frequent interpersonal dialogue, afford the community opportunities to ask questions
	Social mobilization activities should start earlier, last longer, and be ramped up during campaigns
	Social mobilization activities should occur during evenings and weekends and in farms as well as villages

Note. PPE = personal protective equipment. gCHV = general Community Health Volunteer; EPI = Extended Program of Immunization.