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Improving immunization uptake using organized community groups and tracing drop-outs in Karkar region, Puntland-Somalia.

SFHSO designed an innovative approach to increase uptake on immunization and reduce drop-out rate through active defaulter tracing

Photo of Jamal Mohamed

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Describe what you intend to do and how you'll do it in one sentence (required 250 Characters)

SFHSO aims to increase uptake of immunization services by dispelling myths and misconception on vaccines using father-to-father and mother-to-mother support group approach and tracing immunization defaulters in Karkar region Puntland Somalia.

Explain the idea (less than 2,000 characters)

The under-five mortality rate is 137 per 1,000 live births, 30% of which is contributed by vaccine preventable diseases. The overall rate of immunization coverage in Somalia remain very low; DPT3 of 31% and measles of 24% against the global target of >80%(WHO2018) . There is generalized misconception on the use of immunization services compounded by high illiteracy levels among care givers. The primary target audience are caregivers who have children aged below one year in Karkaar region. Using mother-to-mother and father-to-father support group sessions, the project aims at increasing knowledge on immunization while dispelling myths and misconception. The program targets to reach approximately 10,000 caregivers through group discussions and additional 20,000 through radio messaging and information education materials (IEC). We aimed to use 40 existing female and male champions at 40 rural health facilities across the Karkaar region Somalia to facilitate group sessions, create awareness and refer eligible cases for immunization. In addition, male champions will carry out fathers, elders and religious group meetings. The champions will undergo training using communication for development (C4D) strategy. Religious leaders and traditional elders command loyalty among the Somali society hence the project aims to engage them so as to shape opinions on immunization. The project will also conduct monthly testimonial campaigns using champion caregivers to depict their satisfaction and how the project benefited them. The project will hire local artists and communication experts to develop tailored messages and info-graphics on vaccination to create positive perception on immunization which can be disseminated through folk media and local radio channels. Focus group discussions targeting beneficiaries and in-depth interviews with health care providers and opinion leaders will be conducted at inception of the project to understand the specific barriers to immunizatio

Which part(s) of the world does this idea target?

  • Eastern Africa

Geographic Focus (less than 250 Characters)

The idea will be targeted Karkar region Somalia, the region separated from Bari region, it has five districts with an estimated population of 300,000

Who are your end users and how well do you know them? (750 characters)

Our end users are resident of Karkar region, we have prior engagement with the community, Since we were working on last two years. we currently implementing family planning project in partnership with Open idea through DFID funded project which targeted male involvement in family planing. Our role was to create awareness on family planning, maternal and child health services. Additionally we have skilled community resources persons whom we trained on different primary health care concepts. we organizing jointly mobilization campaigns with health authorities to respectfully discuss local communities, sheikhs, youth groups, women, how best they could address maternal health problems and come up with durable solution, to improve acces.

How is the idea unique? (750 Characters)

Firstly, this approach of using mother-to-mother and father-to-father support groups has not been piloted in Somalia. Besides, the Somali women have great role in raising children and influence decisions on health seeking for children. Since immunization services are provided free, there is high prospect of success for this project. The project shall involve men to support their families in accessing maternal and child health services as they control resources. The use of folk media, and testimonials are culturally accepted, act as edutainment and increase demand. This project will leverage on the existence primary health care facilities run by the Ministry of Health which can effectively respond to the demand created by this project.

Idea Proposal Stage (Select 1)

  • Prototype: We have done some small tests or experiments with prospective users to continue developing the idea.

How many months are required for the project idea? (140 characters)

24 Months. including prototyping, piloting, and implementation of the idea.

Organization Name (less than 140 characters)

Somali Family Health service organization

Type of Submitter

  • We are a registered NGO or Non-Profit Organization

Organizational Characteristics

  • Female-led organization
  • Women’s health/rights focused
  • Youth-led organization
  • Locally/community-led organization

Organization Location (less than 140 Characters)

the Organization is registered at government of Puntland Somalia, and based on Garowe the capital city of Puntland.

What is the current scale of your organization’s work?

  • National (expansive reach within one country)

Website URL

Tell us more about your organization/company (1-2 sentences)

Somali family health service organization aims to tackle community health problem. It is oriented towards this condition somewhere women and children get equal main concern as the Health and Education improvement than further group of the general public and make a nation that is model meant receive it easy through with access to quality reproductive and child health services which are affordable, sustainable and provided through an efficient and effective support system.

Who will work alongside your organization in the project idea? (750 characters)

We shall partner with ministry of health Puntland, who are providing immunization service at health facilities. We shall also work with different community groups such as religious leaders, community elders, women and men groups to create demand for health services. The engagement of above stakeholders will ensure ownership and sustainability of the project. More importantly, the religious leaders are most trusted stakeholders in the community and proved to be resourceful in our previous engagement.

How many people are on your team?


Tell us more about you and your team

we are a team of four members include Mr. Jamal Mohamed Warsame who has a master of Sexual reproductive health and rights from Dalarna University Sweden, have solid experience in maternal and child health programs. Dr. Mohamed Hussein who holds Bsc. in Community Health and Development and is pursuing a Master of Public Health from Kenyatta University. He is an expert in Health service management, worked with different international NGOs and UN agencies. Abdikani Hersi Shire, Master of Public health from Mount-Kenya University, Kenya, an expert of reproductive, worked with Save the children as Reproductive health manager. Saytun Abshir, has a BSc of BBA from East Africa University, Somali, she has experience in community mobilization. Our organization will play a vital role in prototyping, piloting of this idea. We are a partner with Ministry of health and jointly carry out health activities in regular base

Overview of How Your Concept Has Evolved (5-6 sentences):

The mother-to-mother and father-to-father support group tool was largely appreciated by both the participants, religious leaders, and the health care workers and is believed to achieve the intended result. Besides, the project will engage religious leaders to pass information through radio talk shows, Friday sermons, and TV channels. The project also use pictorial and folk media. The health authority suggests that immunization champions trace children who miss immunization appointment. More insight is found in working with community organization and health care workers. The expert webinar helped us to understand and internalize the process of behavior change and this helped us in the design of prototype questions

Viability (3-4 sentences and activity upload): First, we share project information with the Ministry of health and jointly agree on a clear implementation plan including conduct training for 40 immunization Champion as well as immunization workshop for 20 religious and community leaders, air 30 immunization messages on monthly basis using local media, conduct six radio talk show on a quarterly basis. Conduct 40 mother-to-mother and father-to-father group sessions, develop and disseminate information education and communication (IEC) materials on immunization and conduct project Monitoring and Evaluation. Finally, conduct daily tracing of those children who miss their appointment and refer eligible children from the community to healthfacili

Feasibility (3-4 sentences):

The group sessions approach was an effective strategy to create demand and empower caregivers. Somali people are oral society and this approach (meetings, open discussions, Q & N) could increase the level of knowledge of caregivers and is the preferred mechanism for information sharing. The testimonials from the most trusted people (religious leaders, community elders,) are the most powerful tools to nudge people to change their behavior. The initiative of tracing the children who miss vaccine appointment by champions and referral of eligible children can increase vaccine coverage

Desirability (3-4 sentences and activity upload):

Mothers and fathers were worried about the quality of vaccine and they have a misconception about it, they believe that vaccine contains toxic substances and could cause infertility and has other future negative consequence on the child’s health). Also, the caregivers believe they are Muslims and they believe in fate and only the things our God decreed for us will happen to our children. Fathers and grandmothers are decision-makers in the family and without their prior acceptance mothers can’t vaccinate the child. thus engaging men, religious leaders, and community elders are crucial for our programs to be effective and change community attitudes and behavior.

Community Focus (2-3 sentences):

The under-five mortality rate in Somalia is 137 per 1,000 live births; 30% of which is attributed to vaccine-preventable illnesses with very low vaccine coverage. This attributed to the low literacy of the community and misconception on vaccines. Our idea targets to empower key community gate-keepers (religious/community elders) to influence the perception of caregivers on immunization thereby increasing uptake of immunization and reduce child mortality. The project will largely use local resources and leverage on the existing support systems to ensure the sustainability of the project impact.

Community Impact (2-3 sentences):

As a result of implementing the idea it will improve health seeking behaviour toward demand and uptake of immunization with the scale of increasing 20% of caregivers who knows the importance and adhere to the schedules of routine immunization, Increase the number of fully immunized children by10% from the baseline in Karkaar region within 2years by understanding/prioritizing key influencers and desired change (norms, attitudes/ behaviors, practices). The idea will be carried out through partnership with Ministry of Health, Community influencers, NGO for impact, sustainability, and ownership.


Join the conversation:

Photo of Jamal Mohamed

Situation Update on Polio outbreak of Somalia.

Somalia has confirmed a new case of a 36-month-old child with circulating vaccine-derived poliovirus type 2 (cVDPV2)* in Bari, Bosaso. The date of onset of paralysis for the child was 8 May 2019.

To date across 2019, Somalia has confirmed three children affected by cVDPV2 (one from Sool, Las Anod, Somaliland, one from Buhodle, Togdher, Somaliland and another from Bari, Bosaso, Puntland).

Somalia has had 15 confirmed cases of children with cVDPV in the ongoing type 2 and type 3 outbreaks since they began (eight children with cVDPV type 2, six children with cVDPV type 3 and one with co-infection of cVDPV2 and cVPDV3).

There are genetic linkages among the cases of cVDPV in children from Togdher and Sool (both confirmed in 2019) and Hiran (confirmed in 2018). The most recent confirmed cVDPV2 case from Bari is linked to the two previous cases from Sool and Hiran.

No isolates of cVDPV were confirmed from environmental samples. The last positive specimen was collected from sewer samples in Banadir on 11 October 2018.

No new cVDPV3 isolates have been reported since 7 September 2018.

Case Response

As soon as a child with AFP is identified, polio teams are conducting detailed case investigations and take stool samples for further testing. Where possible, a wider community search is performed by conducting a cluster survey in the 30 surrounding households to determine immunization rates of neighbouring children, to avoid further spread.

Stool samples are being collected from the community (40 have been collected so far) to guide next steps.

Special efforts are being made to intensify vaccination during each campaign - ranging from detailed microplanning, to monitoring campaigns, and using real-time data to reach every child possible.

AFP surveillance is being scaled up in health facilities (traditional and non-traditional) through passive and active reporting.

Information is being collected on families that are refusing to have their children vaccinated during polio immunization campaigns, following which, teams of health workers, sometimes accompanied by religious leaders, are visiting these families to explain the benefits of vaccination

Photo of Marichu Carstensen

Hi Jamal, since it is the illiterate population you are targeting, the use of locally inspired visuals can be very helpful in your drive. Please let me know it you have a need to put your message across through better visuals. I would love to help. A picture is worth a thousand words.
Good luck on your idea, more strength and joy in the future!

Photo of Jamal Mohamed

Dear Marichu Carstensen
Thanks indeed for your suggestion, in fact, we planned and during our prototyping period, we realized that visuals will be very important as targeting rural and illiterate, and we will incorporate our idea.
Thanks once again for your suggestion.

Photo of Marichu Carstensen

Hi Jamal, you are welcome and do not hesitate to send me the art works. It would be good to do it in adobe illustrator. Easy to tweak and print friendly!
If you have a certain craft or medium that can be more appealing to the local community, it might help.

Photo of maymun Abdiaziz

Hi SFHSO team.
I really appreciate the tremendous work that you doing for the Somali community, as a humanitarian worker working with save the children international on nutrition and Food security programs I do believe like this idea will have a great impact on child health as well as dispelling of myths and misunderstanding.
right now we are implementing IYCF project in remote areas and created mother to mother support groups. hope fully father to father will work also, Since Somali people are oral society, and they strongly trust TBAs, sheiks and elders. One massage from above mentioned people can change easily for their believes.

Photo of Jamal Mohamed

Thanks much Maymun, for your feedback, we really appreciate your suggestions, and our path comes to cross again and see how this idea benefit for Somali child.


Photo of Ashley Tillman

Hi Jamal Mohamed great to see you in the Challenge, curious to hear what you've learned about what works to engage father's and religious leaders in a topic like this?

Photo of Jamal Mohamed

Dear Ashley Tillman.
Thanks much for your reading our idea and valuable question, in fact engaging men and religious leaders are among rare projects ever piloted in Puntland-Somalia which is very likely to to be successful.
Our study conducted during prototyping period, revealed that religious leaders and community elders are most trusted persons in the community, also study indicate that husbands exercise greater authority over decisions to access health care for women and children and without their prior decision and permission women can’t access health service including family planning, immunization and other reproductive health services since there is perceived cultural barriers to some of these services. Therefore, the buy-in of both religious leaders and fathers is a critical tool for a success in any project.
The Somalia are exclusively Muslim population and are highly conservative. The religious leaders are the key gatekeepers and influence a lot in the way the society perceives social services particularly religiously obscure/contentious issues related to reproductive health. However, if one gets the buy-in of these leaders then the acceptance of the society will be profound.
The Somali society is a patriarchal society and men have greater dominance thus their engagement as primary target audience is critical. Generally, men have many roles, in times of peace as well as in times of upheavals. They are members of their communities and have a critical role to play if appropriately engaged to be change agents. With the right strategy in place, some sensitive topics (FP & immunization) could be expanded and strengthened to be more culturally acceptable and gender transformative.
Given resource constraints and the health and social dimensions of working with men, male engagement must be integrated in to existing programs rather than being a stand-alone effort. In fact, reviews of program in this field of work seems to show an inclination towards more multi-sectoral approach that go beyond parallel programing. Evidence suggests that successful programs are more likely to have better reach and lasting impact while ensuring efficient use of resources.
In conclusion, to ensure the effectiveness and efficiency of topic like this, gatekeepers and community influencers should be engaging, more importantly, Somali people are oral society, and like this approach (meetings, open discussions, questions and answers, and testimonial from most trusted people) prone to result impact and be successful.
Men as agent of change with the right strategy in place, some sensitive topics (FP & immunization) could be expanded and strengthened to be more culturally acceptable and will increase demand for health service.
Thanks much

Photo of Ashley Tillman

Thanks Jamal for this very helpful information. I am curious how you will measure the success of your program?

Photo of Jamal Mohamed

Dear Ashley.
Thanks once again for your questions, in last week’s we were busy on Family planning campaign in remote areas while we were not able to access internet. in order to monitor our success our program, we firstly planning to conduct baseline assessment before the start date of the project, which we aimed to determine the coverage rate of the immunization uptake, also there will be end line assessment to measure and evaluate the impact of the project.
We will use the following indicators to measure success program.
GOAL1: increase the level of knowledge of caregiver among vaccine.
OBJECTIVE: Objective: caregivers can easily access immunization service, and all myths and misconception are dispelled.
• Caregivers are more knowledgeable of vaccination and it’s important and misconceptions held by caregivers about the vaccine are debunked
• # Caregivers reached through sensitization activities.
• The number of caregivers attended mother-to-mother and father-to-father meeting sessions.
• # of husbands reached through immunization sensitization activities:
• Male might engaging other responsibilities in the community.
• Religious leaders might not involve the activity.
• The mother might be involved on another day to day activity.
• Conduct prototyping and identify key barriers of misconception of the immunization.
• Consult with the community and identify a suitable time for meeting sessions.
• Train Vaccine campaigns on C4D strategy.
• Develop tailored messages of immunization and field guide for meeting sessions.
• Conduct father-to-father meetings session on a weekly basis mainly (15-20) participants.
• Conduct mother-to-mother meetings session on a weekly basis mainly (15-20) participants.
• Air vaccine messages from most trust people (sheiks, doctor, and elders) through local FMs on most suitable times.
Print out IEC materials and display it
GOAL2: child mortality rate will be reduced:
OBJECTIVE: Immunization coverage increases at health centers.
EXPECTED RESULTS: BEHAVIOR/ACTION: Increase uptake of immunization rate by 10%.
• % of reaches caregivers who accepted and accessed immunization services.
• % of reached husbands who demonstrate an understanding of immunization.
• % of reached Islamic leaders willing to spread positive messages about immunization.
• % of children referred to health centers.
• Possible side effect.
• Capacity and qualification of vaccinator.
• Vaccine supply.
• Community willingness to work with SFHSO.
• Routine vaccination of children under five years and pregnant women.
• Consultation with the community to identify suitable times for vaccination.
• Training of campaigns on interpersonal communication (IPC).
• Social mobilization by campaigns to create awareness and remind mother/caterers on vaccination dates/days
• Strengthening partnerships and collaboration with MOH and other agencies /
• Weighing of children under five in the health centers and in outreach with appropriate follow-up of vaccinated children and timely reporting of dropped children.
• Male religious leaders spread positive messages about vaccination to their congregants.
• Establish a referral system within the community.

Photo of Zaytun Abshir

Having such a unique ideas will be great for Somali children to access for better health, remove misperceptions, and survive from the death.
one of the key challenges that we as caregivers face is lack of awareness and misconception of vaccination.
when you talk and discuss Somali women and men regarding vaccination they told you a lot of wrong believes.
This idea will be beneficial and increase the demand of health service in general and vaccination in particular.

Thanks guys for you hard work, you always try to tackle most present issue in the Somali community which Somali people will thanking you (saving one child from the death is means saving whole nation).
#there will be no child whom die for vaccine preventable disease.

Photo of Jamal Mohamed

Thanks much Zaytun for your feedback and nice words, we will try our best to reach un-reached children.
Thanks once again.

Photo of Jamal Mohamed

The project will contribute to raise awareness among ‘caregiver (mothers and fathers) of the benefits of Immunization. Improve uptake of immunization service and increase it's demands in order to reduce neonatal and child mortality, in Puntland, Somalia.