Communication Planning Guide

for IPV Introductionand

Routine Immunisation Strengthening

March 2015

What is the purpose of this guide?

This document offers guidance for designingaCommunicationPlan to support the introduction of the injectable Inactivated Polio Vaccine (IPV) in the Routine Immunisation (RI) programmes of countries.

Included in this document are“pick and use” guidelines, checklists, tools and best practices from previous experiences of new vaccine introductionand routine immunisation communication to enable countries to effectively plan, coordinate, manage and report on the implementation of Communication Plans related to IPV introduction in routine immunisation systems.

This document aims to support national authorities and partners in:

I)specifying the programmatic and behavioural objectives of the Communications Plan;

II)identifying key audiences and appropriate channels to reach them;

III)developing key messages;

IV)highlighting possible barriers and enabling factors to realizing objectives;

V)translating messages into effective communication products;

VI)monitoring and evaluating communication activities with clear benchmarks.

All of the elements described in this document represent the ideal for communication planning and implementation. However, experience shows that the ideal is sometimes not possible due to time or resource limitations. This resource is meant to give you options based on needs and capacity, but it is recommended that you go through all templates and checklists before deciding what to include or exclude in the final plan. It is also important to emphasise that you should feel free to incorporateyour own approaches to communicating about IPV vaccine into the overall plan based on local knowledge and context.

Who will benefit from this guide?

This planning guide is meant to assist Communications Planners as well as Health and Immunisation Managers in Governmentand partner organisationsat national and sub-national levels to plan and implement communication activities for IPV introduction and routine immunisation (RI) strengthening.

Importance of Communications for IPV introduction

This guidance document focuses on two key activities outlined in Objective 2 of the Polio Eradication and Endgame Strategic Plan 2013-2018; specifically,

1) Introduction of at least one dose of inactivated polio vaccine (IPV) in the routine immunization programmes of the 126 countries currently only using trivalent oral polio vaccine (tOPV),

2) Strengthening of immunization programmes in those countries as part of the introduction of at least one dose of IPV into their routine immunization programmes

The communication plan is part of the overall introduction plan that a country develops prior to IPV introduction. Apart from the communication plan, the introduction plan includes technical and operational planning, vaccine-management and cold chain assessment, and monitoring and evaluation tools and reporting mechanisms.

An effective Communications Plan for IPV introduction will at minimum focus on how to promote IPV vaccine acceptance by I) end-users (care-givers and parents), II) influencers (key opinion leaders) and III) actors involved in delivering the vaccine (healthcare providers).

Acronyms

CBO: Community Based Organisation
CSO Civil Society Organisation
EPI: Expanded Programme on Immunisation
FGD: Focus Group Discussion
ICC: Immunisation Coordination Committee
IEC: Information, Education and Communication
IPV: Inactivated Polio Vaccine
M&E: Monitoring and Evaluation
NGO: Non-Governmental Organisation
OPV: Oral Polio Vaccine
PIE: Post-Introduction Evaluation
RI: Routine Immunisation
TOR: Terms of Reference

Comprehensive Checklist

While developing a Communication Planfor the introduction of IPV, other new vaccines and routine immunisation, the following checklist will assist you and the planning team to ensure that all the key steps of the planning process have been followed:

☐Do you have a government-endorsed, multi-agency communications working group in place to supportIPV introduction/routine immunisation?

☐ Have you done your situation analysis?

☐ Have you done your behaviour analysis?

☐ Have you planned your messages and materials?

☐ Do you have your strategy planning matrix and plan of action?

☐ Have you pre-tested your communication products/materials?

☐Do you have a distribution plan for the materials?

☐ Do you have a crisis communication plan, including explicitly agreed partner roles and responsibilities and SOPs?

☐Have you identified and trained agreed spokespeople?

☐ Have you secured funding for the implementation of the plan?

Communication (C4D)Planning Framework

A number of communication planning frameworks have been developed and they typically follow a series of steps as shown in Figure 1. This may also be applied to the IPV introduction Communication Plan as well as any other new vaccine or RI Communication Plan.

Figure 1: The Key Steps in Communications Planning

Each of these steps are described in detail below, with a linear step-by-step guide to preparing your Communications Plan.

NAVIGATION PAGE

  1. Coordination & Preparation 7

1.1Establish or Reactivate Communication Committee 7

1.2Establish Rolesfor Partners and Allies 7

  1. Communication Analysis 7

2.1 Problem/Situational Analysis 7

2.1.1Formative Research 7

2.1.2Focus Group Discussions with Caregivers 7

2.1.3 Sample Template for Problem/Situational Analysis 8

2.2 Behaviour Analysis 8

2.2.1 Sample Template for Behaviour Analysis 9

2.3Channel Analysis 10

2.3.1 Sample Template for Channel Analysis 10

  1. Strategic Planning & Design 11

3.1 Develop SMART Objectives 11

3.2 Develop M&E Indicators 11

3.2.1 Sample Template for SMART Objectives 11

3.3 Strategy Planning Matrix 12

  1. Creative Strategy and Materials Development 12

4.1 Message Development 12

4.1.1 Sample Template for Message Development 13

4.1.2 Checklist for Good Messages 13

4.2 Materials Development 14

4.2.1 Sample Template for Materials Development 14

4.3 Pretesting and Revising 15

4.3.1 How to conduct a pre-test? 15

  1. Monitoring & Evaluation 15

5.1 Monitoring 15

5.1.1Checklist for Monitoring Implementation 16

5.1.2Checklist for Monitoring Quality of Interpersonal Communication

before RI session 16

5.1.3Checklist for Monitoring Traditional & Local Media before RI session 16

5.1.4Checklist for Monitoring Programme Interventions during RI session 16

5.2 Evaluation 17

5.2.1 Steps in carrying out an evaluation 17

  1. Annexes 18

Annex 1 – Suggested Composition of a Communication Committee 18

Annex 2 –SuggestedTerms of Reference of an IPV Communication Committee 18

Annex 3 – Guidelinesfor Formative Research for IPV Introduction 19

Annex 4 – StudyGuide: For Focus Group Discussions with Caregivers 21

Annex 5 –In-depth Interview Questionnaire with Service Providers 26

Annex 6 –Multiple Injection Questionnaire 28 Annex 7 –SampleM&E Indicators for Routine Immunisation and IPV 30

1.Coordination & Preparation

1.1 Establish a Communication team

Supporting the establishment or reactivation of a communication coordination committee/subgroup for IPV introduction at national and sub-national levels can contribute significantly towards ensuring Government ownership and partner buy-in throughout the planning and implementation process.

The IPV Communication Committee should be fully integrated within the existing national Immunization Coordination Committee (ICC) or the country’s National Immunization Programme and should include all relevant stakeholders to ensure effective mobilization of partners, community support and resources. It should include multidisciplinary teams of communication experts, social scientists, clinicians, health workers, and community representatives, as well as representatives of the ministry of health, line ministries, key partner agencies and community institutions considered important to the implementation of the communication component of the programme. See Annex 1for a more thorough suggested composition.

1.2 Establish roles for partners and allies

Failure to clarify collective and individual roles of collaborating partners can result in inactive and unfocused participation. See Annex 2for the suggested Terms of Reference of IPV Coordination Committee (within the Immunisation Coordination Committee). The IPV committee will also be responsible for identifying, training and supporting the Spokesperson to prepare and deliver messages in case of AEFIs.

2.Communication Analysis

2.1 Problem/Situational Analysis

The situational assessment should include gathering and analysis of secondary (e.g., desk review) and primary (e.g., interview or focus group) data to describe the scope and status of the current immunization situation, the anticipated impact of IPV introduction, and the associated programme objectives.

2.1.1 Formative Research

Formative research is likely to revealkey barriers or facilitators to be taken into consideration while developing the Communications Plan. Whether the collection and analysis of data is led by partners or a contracted consultant or agency will depend upon the scope of work, timeframe, and resources. See Annex 3for guidelines to conduct formative research for IPV introduction.

For example, research in one community might point to a high acceptance for injectable vaccines among caregiversand radio programming and political will as the main facilitators for high routine immunisation coverage and the acceptance of new vaccines. While in another area, negative attitude of health workers and frequent vaccine stock-outs might be identified as the main barrier for low RI demand and distrust in the health system. These findings are key for communication planning.

2.1.2Focus Group Discussions with Caregivers

If conducting formative research is not possible due to time or resource constraints, countries are encouraged to conduct Focus Group Discussions (FGDs) with both caregivers and health workers to generate information and variance based on geographical, ethno-linguistic, infrastructural, or other differences. See Annex 4for a FGD guide for caregivers and Annex 5for an In-depth Interview guide for service providers.

In-depth interviews with health workers might reveal their concerns related to the new vaccine introduction. For example, healthworkers might express concern about administering multiple injections to a child in one visit, heavy workload or other capacity related matters. Such findings can better inform training materials and respond to specific gaps in healthworker capacity, important not only for IPV introduction but also for the strengthening RI systems.

With the introduction of IPV, planned introduction of other new vaccines and the routine immunisation schedule, multiple injections in one health facility visit is likely to generate discussions and also raise concerns among healthworkers and caregivers. In order to develop evidence based communication and healthworker training plans to address the issue of multiple injections, countries are strongly encouraged to conduct research on the issue. See Annex 6 for a brief questionnaire on multiple injections.

2.1.3Sample Template for Problem/Situational Analysis

While undertaking a problem/situation analysis, the following questions should be kept in mind:

  • What barriers, behavioural and otherwise, might prevent achieving programme objectives associated with the vaccine introduction?
  • Which people will likely be affected and how that might influence programme objectives?
  • What inputs/resources, activities, outputs and outcomes will likely need to be achieved in order to effectively integrate IPV into the routine immunization programme (including political will to adequately finance all necessary activities to support successful introduction, including communication and social mobilization)?

The following is only a sample template in which the problem/situational analysis for only one target audience (caregivers, particularly mothers) has been outlined. A fully developed problem/situational analysis should also address other target groups as identified in the formative research. These can be specific family members, health workers, religious leaders and community elders.

Audience (Caregivers, Health workers, Family, etc.) / Problem / Impact / Causes
Caregivers related / System/Service related
Caregivers, particularly mothers of children under 5 years of age. / IPV non-immunisation or under immunisation of children in accordance with national immunisation schedule. / Increased risk of morbidity and mortality from vaccine preventable diseases among children. /
  • Parental knowledge (not knowing child’s age, when and whereto go, hours of operation, value of immunisation and benefits of IPV)
  • Fear of side effects from IPV or other vaccines
  • Religious/cultural/social beliefs/norms and rumours
  • Distance/travel conditions, access
/
  • Lack of resources, stock outs that affects reliability, cold chain
  • Reliability (no cancellation of sessions – both fixed and outreach)
  • Distance/travel conditions to reach catchment area
  • Health staff’s motivation, performance/competence, behaviour and ability to communicate with mothers.

2.2Behavior Analysis

From step 2.1.3 problem analysis, determine which of those problem behaviors to focus on and analyze those in order to understand your key problems and a potential response better.

Questions to keep in mind:

  • Target audience groups that will be affected by and might affect IPV introduction and associated programme objectives
  • Their existing behaviors/practices that might help or hinder achieving programme objectives
  • The communication channels that are accessible and preferred by each audience group.

2.2.1 Sample Template for Behaviour Analysis

A sample behaviour analysis for primary caregivers (mothers of children under 5 years) is presented below. A fully developed behaviour analysis should also address other target groups as identified in the formative research. These can be specific family members, health workers, religious leaders and community elders.

Desired Behaviour / Actual Behaviour / Feasible Behaviour / Factors Encouraging Ideal Behavior
Caregivers bring their children for IPV/RI to service delivery points at the ages recommended in the national schedule with immunisation card /
  • Many caregivers take their children for complete immunisation at some point in time.
  • Delay in first immunisation based on practice of “staying in the home” after delivery and health workers not remembering to advise mothers.
  • Caregivers unable to locate vaccination cards.
  • Caregivers bring their children only one time to get the immunisation.
/
  • Most caregivers take their children to get fully immunized
  • Are aware of and follow the immunisation schedule
  • Maintain the Immunisation card
/
  • Understanding of the benefits of IPV and immunisation for the child
  • Awareness of immunisation schedule, place and date
  • Proximity to health facility.
  • Positive attitude of health staff towards caregivers.

Based on the communication needs and the research available, a similar analysis can be undertaken for different audience groups. These may include:

  • Primary audience –These may include, heads of households, Fathers and Guardians (includes grandparents and mothers-in-law) and extended family members.
  • Secondary audience groups – Thesemay include, community leaders, family members including grandparents and mothers-in-law, health workers, vaccinators, NGO and CSO workers, religious leaders/groups and social networks.
  • Tertiary audience groups:This include decision makers at the national and sub-national level. At the provincial and district level (sub-national) these may include, provincial and district government leaders, administrators, local health authorities, health professionals in the private and public sector, academics, business leaders and local media. At the national level, tertiary audience may include, public policymakers, parliamentarians, national government officials and national media and advocacy groups.

2.3Channel Analysis

The channel analysis will help to determine which channels of communication are available to reach the target audiences (from step 2.1.3).

Questions to keep in mind:

  • What channels and media are available and preferred by different audience groups? In which format – print, radio, TV, internet, mobile phones, interpersonal, group?
  • Which mix of channels is best suited to target audience engagement in the Immunization programme that could best lead to adoption of IPV?
  • What key messages are preferred and culturally appropriate for which mix of channels? In which languages?
  • What kinds of communication skills among healthcare providers, vaccinators and community groups need strengthening? In which areas?
  • What are the institutional capacity and capacity gaps in undertaking communication activities and media relations - of your team, government implementers, and NGO/CSO/CBO partners, including members of the coordinating group.

2.3.1 Sample Template for Channel Analysis

A sample channel analysis for mothers of children under 5 years (primary audience) and secondary audience (religious leaders) is presented below.A fully developed channel analysis should also address other target groups as identified in the formative research. These can be family members, health workers, religious leaders and community elders.

Target Audience(s) / Whom do(es) the target audience(s) consult on health issues? / Who else can influence the target audience(s) in health-related matters? / Channels to be used in EPI communication
Mothers of children under 5 years of age /
  • Elderly women in the community Health workers
  • Friends
/
  • Friends who are a positive example of the desired behaviour
  • Religious and community leaders (social norms related to new vaccines/RI)
/
  • Home visits
  • Peer-to-peer communication, Traditional media (theatre, puppetry etc),
  • Community dialogue involving elderly women.

Religious leaders /
  • Other/senior religious leaders
  • Senior health workers
/
  • District level administrators
  • Politicians
/
  • Community meetings
  • Religious gatherings
  • Flyers
  • Religious radio and TV broadcasts

3.Strategic Planning & Design

This section explains how to develop actionable plans based on the guidance presented in Step 2 above.

3.1Develop SMART Objectives

An objective is a way to articulate the change you want to make – in our case, this change might be from a problematic behaviour to a desired behaviour (e.g. non-vaccination to vaccination). Objectives must be specific and stated in a clear way. They should not be vague and should not be open to multiple interpretations. A good way to test whether the objectives you’ve set are appropriate is to ensure that they are SMART:

  • Specific: Who? (Target population and persons doing the activity) and What? (Action/activity)
  • Measurable: How much change is expected and how will you measure it?
  • Achievable: Can it be realistically accomplished given current resources and constraints, including time restraints?It is important to be realistic.
  • Realistic and relevant: Does it address the problem and propose reasonable programmatic steps?
  • Time-bound: Does it provide a timeline indicating when the objective will be met?

For more guidance on how to formulate SMART objectives, go to: