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Faith and Immunization: How the Local Church can Shape and Influence Vaccine Demand

The local church, a central institution in Malawi, can serve as a catalyst to influence community social norms for childhood immunization.

Photo of Amanda Patterson, World Relief

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

World Relief aims to ensure that all children in Vuso Jere, (Ntchisi District, Central Malawi), are fully immunized by creating an interactive calendar tool to empower caregivers while stimulating demand for vaccination through the local church.

Explain the idea (less than 2,000 characters)

Though vaccinations are one of public health’s most important advancements, children in rural communities plagued by extreme poverty like Vuso Jere, where only 45% of children under 2 (CU2) receive all age-appropriate vaccines, face insurmountable barriers to achieving full protection. Yet over 86% of Malawians identify as Christians and many look to religious leaders in churches as a primary source of guidance, a long-established structure that serves with locally-driven efforts. By embedding social and behavior change communication around vaccination into the established church, children and their caregivers can receive the necessary reminders, information, awareness, and social support to be protected from preventable diseases. This project will target 900 CU2. In addition to working with churches to disseminate sermon messages about immunization, World Relief has equipped churches to mobilize volunteers to address deeply-rooted norms around joint decision-making in caring for children. A weekly serial story that opens dialogue around cultural/sensitive topics, including childhood immunization, will be presented to groups of 6-8 mentor couples to promote behavior change. Each church will mobilize 2-3 Immunization Support Volunteers to liaise with the mentor couples and the local health system to identify beneficiaries and facilitate immunization. These volunteers will serve as reliable sources of information and social support for caregivers. Using locally available materials, volunteers will create a set of balls and a cloth ‘calendar’ playmat as visual reminders to nudge and track progress toward completion of each child’s immunizations. Children will receive a colored ball for each vaccine received and caregivers will track the weeks until their child’s next set of vaccines are due, 6 visits and 16 vaccines, using the calendar. Churches will display posters tracking progress to full immunization of each child in their community, creating accountability.

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

  • Southern Africa

Geographic Focus (less than 250 Characters)

This project targets Ntchisi District, Traditional Authority (TA) Vuso Jere, in Central Malawi. The project will target rural communities with a focus on households with children under the age of two years.

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

World Relief has been working in Vuso Jere since 2014, with a variety of programs including World Relief’s Families for Life, upon which this project will build. End users are families living in Vuso Jere, a population of 15,946, over half under age 18. World Relief will partner with 43 churches and their surrounding communities, in coordination with existing government health systems. Building from existing relational assets, community members are the project’s main actors including village heads, church leaders, health centers, and parents. This program aims to build ownership, targeting male and female community members to participate actively in all aspects of the project, with emphasis on ensuring that women take on leadership roles.

How is the idea unique? (750 Characters)

World Relief’s Church Empowerment Zone is a one-of-a-kind model for communities to multiply their untapped potential toward a unified goal, such as ensuring full immunization of children. Where other interventions focus on building knowledge to promote behavior change, our messages target the root of behaviors by addressing beliefs through the very structure that consciously and subconsciously shapes those beliefs, the church. Embedding dialogue and support into a couple-centered structure builds father support and promotes joint decision-making in the family unit, often overlooked in child health interventions. The visual tool ensures that all caregivers, regardless of literacy, have the ability to monitor immunization schedules.

Idea Proposal Stage (Select 1)

  • Pilot: We have started to implement the idea as a whole with a first set of real users. The feasibility of an innovation is tested in a small-scale and real world application (i.e. 3-15% of the target population)

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

It will take 1 year to implement phase 1 in 43 churches, the target impact of 80% 12-23 month-old children receiving all basic vaccinations.

Organization Name (less than 140 characters)

World Relief

Type of Submitter

  • We are a registered NGO or Non-Profit Organization

Organizational Characteristics

  • Indigenous-led organization
  • Locally/community-led organization
  • International/global organization (implementing in multiple countries)

Organization Location (less than 140 Characters)

Headquarters: Baltimore, U.S. ; Country Office: Lilongwe, Malawi

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

  • Global (within 2 or more global regions)

Website URL

https://worldrelief.org/

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

World Relief is a global Christian humanitarian organization that seeks to overcome violence, poverty and injustice around the world through love in action. World Relief’s response to the problem that one in ten persons globally does not receive basic lifesaving vaccinations directly addresses our strong programmatic focus on child health and family strengthening.

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

World Relief’s work is built upon strong partnership with local churches. In the Church Empowerment Zone where this project will take place, 43 churches of different denominations have been engaged and trained to identify needs, opportunities, and barriers to community development. Church leaders from these churches have formed four Church Network Committees, which operationalize and oversee the structure’s development initiatives, such as Families for Life, and have helped to co-design this intervention. This intervention will also be linked to the existing health system, collaborating with government Health Surveillance Assistants to stimulate demand for monthly vaccine campaigns and communicate accurate information about immunization.

How many people are on your team?

6

Tell us more about you and your team

World Relief has existed as a humanitarian organization since 1944, and as of 2019 employs 1,450 people globally. This specific project will build upon World Relief’s existing work in Vuso Jere of Ntchisi District in Malawi. This project will be supported by two staff at the World Relief Ntchisi district level, as well as receiving technical support from content experts at the Lilongwe and global level. In total, six staff members will work in various capacities to provide direct support to the project. World Relief Malawi employs 173 staff across 10 districts, including its headquarters in Lilongwe. World Relief envisions the most vulnerable people transformed economically, socially, and spiritually. This transformation is enabled as World Relief works with and through local communities worldwide, leveraging expertise from core programs including Disaster Response; Maternal, Child and Family Health; Child Development; Economic and Agricultural Development; HIV and AIDS.

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

While the need for our idea was confirmed by caregivers, church leaders, health workers, and field staff, user feedback and utilization of OpenIDEO resources led to a refined adaptation of our idea to address barriers to full immunization. User experience testing led us to alter the design of the visual calendar making it double as a playmat for CU2. The business canvas model revealed several channels to be capitalized upon that helped reduce costs and increase product sustainability. Prototyping support aided in gathering and incorporating feedback into our design, especially in ensuring alternative mechanisms for tracking completed immunizations if balls were lost. Expert webinars influenced our segmentation of customers.

Viability (3-4 sentences and activity upload):

https://canvanizer.com/canvas/r3Us4G9C7b2U8 Through this exercise, we firstly recognized opportunities for improving sustainability and cost-effectiveness via revenue streams (reducing waste, re-using materials for future children, leveraging locally available resources). We as well identified the need to engage community leaders in initial start-up activities and to share key messages with them in advance. We determined efficient feedback loops that will be built into volunteer reports at monitoring visits. Lastly we better understood the need to heavily emphasize the capacity building of the local church and church network committees to sustain training and supervision of volunteers to ensure high-quality implementation.

Feasibility (3-4 sentences):

We tested the visual calendar tool with caregivers of CU2, allowing them to first interact with the calendar without prior instruction, and noting what was intuitive about the product. Caregivers more easily understand the immunization schedule when tangible reminders (ties) for each vaccine received were attached to each pocket that represented a visit. Our prototyping support was very helpful in guiding how we gathered user feedback, and helped us to think critically about how intuitive the calendar tool is to the end user.

Desirability (3-4 sentences and activity upload):

Caregivers were initially hesitant to acknowledge that their community had challenges with full immunization, highlighting the need for transparency about community progress toward full vaccination, which can be achieved using immunization data poster at churches. Most caregivers are not introduced to the topic of childhood immunization until the birth of their child. Our introduction before birth through sermons and family groups prepares caregivers and stimulates demand by helping them understand why immunizations are important. The 9 and 15 month visits are the most difficult for caregivers to remember because of the long time interval. Our calendar tool and reminders from volunteers are especially critical for these later visits.

Community Focus (2-3 sentences):

Community members shared that immunization is an essential as way to protect children and whole communities, adding that the more children are fully immunized, the more effective disease prevention will be for everyone. Church network committee members were overwhelmingly supportive of this concept, contributing ideas about how to recruit high-quality volunteers and ensure that pastors are well-equipped to share effective sermon messages. This project leverages these relationships to contribute valuable human capital and community ownership, thereby promoting scalability and sustainability.

Community Impact (2-3 sentences):

Because current immunization completion rates are low in this community, this intervention not only anticipates a new norm for full immunization throughout Vuso Jere, facilitated by widespread social support and accountability, but also an improvement in childhood immunization rates, and a reduction in child morbidity at the end of a 1-year period. Church networks (and community health workers) were eager to address this issue, and expressed that they will sustain the efforts beyond the grant cycle through locally-generated human and financial resources.

15 comments

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Photo of Monique Lacey
Team

Amanda Patterson, World Relief Hey, I found it interesting that you are using churches to encourage people within the community to make sure their children receive immunization. Churches play a big part in the influence it has over the community that they reside in. Also, will the churches you have partnered with be working with local hospitals? I think that would be awesome because it would help you all keep a record of who has received their vaccinations. I love this idea, and I can not wait to see the impact it has on the community.

Photo of Amanda Patterson, World Relief
Team

Monique Lacey Apologies for the slow response on my end. Yes, the church in this particular community does partner with the local clinic however it has not yet to-date worked together towards full community immunization, which would take the partnership to a new level. We've found that linking church volunteers to the caregiver and the CHW/local clinic is also very influential in this process, to help caregivers remember key dates, etc. We too think that this could be an exciting prospect for this community in rural Malawi! Thank-you for the encouragement!

Photo of Yovi Ordonez
Team

Amanda Patterson, World Relief  Hey, I would like to tell you that your idea is amazing. I think that giving a background of where you are located and whom it will impact is extraordinary. I do wonder how these 43 churches will manage and educate the people. Also, will people be registered to have a modern way of tracking who gets the immunization? Overall, I have been inspired by this idea to do more for my community.

Photo of Amanda Patterson, World Relief
Team

Yovi Ordonez We’re so glad this idea inspires you in your own community! The tracking will happen through volunteers who will be trained to read vaccination cards and record on registers the status of each child. That information will then be entered into an electronic database for M&E reviews/analyses. One of the most exciting parts is sharing this data with the whole community through posters at the churches that show progress of the community toward full vaccination so that everyone can be part of the accountability process.

Photo of Naki J
Team

I agree Yovi Ordonez  that this is a very unique opportunity for the community! If the church and local hospitals are able to work as one, I can see this projecting helping a lot of people. I am interested to see how the locals take to this idea and what changes or adjustments will have to be made along the way. The process should be exciting!

Photo of Amanda Patterson, World Relief
Team

Thank-you Naki J ! We are pleased to see how the church grows as a centerpiece to serving the community after a few years (or less) of trainings and encouragement; we look forward to being able to partner with the local health clinics and CHWs to more specifically target low immunization rates!

Photo of Maidah Mir
Team

@Amanda Peterson, I really like your idea for a calendar and how you’re leveraging the church to create credibility. I’d like to know more about who these volunteers will be? Are they mothers from the community? Or can they be anyone? Will the couples be compensated? Will the calendars be used by the the volunteers so they can keep track of the immunizations or by the caregivers?

Photo of Anne-Laure Fayard
Team

Amanda Patterson, World Relief thank you for sharing your idea and the video. I really like how you're building on existing beliefs and cultural practices to empower people from the community. Like Maidah Mir I would love to know more about the recruitment and the training of the volunteers. I agree that her idea and her team idea Women Ambassadors for Vaccine Education (WAVE)  You might also want to check 3 other ideas Faithcination  by Juan Pablo Ramirez and his team https://challenges.openideo.com/challenge/briefsgates-vaccine-innovation/ideas/promoting-community-capacity-in-immunization-governance Ochola Amosiah  and https://challenges.openideo.com/challenge/briefsgates-vaccine-innovation/ideas/using-interfaith-religious-leaders-in-local-communities-to-influence-caregivers-to-seek-immunization-services sarah bareis 
I can see a lot of possible collaboration with these ideas.
Looking forward to seeing your idea evolving.

Photo of Amanda Patterson, World Relief
Team

@Maidah Mir, Thank-you for your well thought out feedback. These are good questions. The volunteers will be couples (beneficiary couples and lead couples) and are not compensated in order to reduce dependency and promote sustainability. World Relief has worked in this community with volunteers that come through the local church, and are not dependent upon compensation for programmatic implementation. This program is seen as a church-run initiative, not a “World Relief” program, and is preceded by vision casting around the role of the church in community development that emphasizes volunteer work like this. Serving the community is viewed as a critical part of being a member of the local church. Lead couples do receive training, WR support, manuals, and may receive something that identifies them as a volunteer (like a t-shirt) to add credibility and respect to their role. There are two cadres of volunteers in this concept — 1) Family's For Life lead couples, who are chosen by the church community as role models who are respected and model a good relationship with each other, and 2) immunization support volunteers who will be caregivers nominated by the community as well based on a set of criteria determined with the beneficiaries.

Photo of Amanda Patterson, World Relief
Team

Hello Anne-Laure Fayard, recruitment will be led by the local communities, with criteria for volunteers being determined by the community, and nominations being made by the local churches. Training uses a cascade model in which trainers at the church empowerment zone level (respected community members selected to represent their community/church interests with leaders from other communities) train those at the church network committee level (a lesser community engagement group that feeds vertically to the CEZ level, and individual church level) who then train the volunteers from each church on immunization messages, schedule, side effects, and barriers, as well as adult learning principles and monitoring/reporting. Wow, what a great flow of ideas using the church as the mouth piece for community behavioral change. We have seen faith-based community centers play a key role in behavioral change, and are happy to learn of other organizations seeing this change as well. Thank-you for sharing.

Photo of Anne-Laure Fayard
Team

Thank you Amanda Patterson, World Relief for this clarification. Very impressed by the thoughtfulness of your approach. I really like the community-centered nature of your approach.

Photo of Anne-Laure Fayard
Team

Amanda Patterson, World Relief This is really useful information. I really like your focus on intrinsic motivation to create a sustainable model. I personally believe in this approach and I'm glad to see that your organization has been able to implement it. Really interesting to see the community-centered approach you're taking in creating a program that is owned by the local churches. Good luck!

Photo of Maidah Mir
Team

Thanks for the details, Amanda! This was really helpful.

Photo of Amanda Patterson, World Relief
Team

@Anne-Laure Fayard Thank-you for this comment, it is encouraging to hear. By building up the local church and providing support via trainings and internal activities, this gives them a better platform to outreach into their own community and identify needs and address them. We are pleased to work with a number of churches globally who are able to sustainably act as positive forces for good behavior change. We are excited about the opportunity to involve vaccination programming into this already established model, and build upon much needed health activities!

Photo of Maidah Mir
Team

This idea seems very relevant to what we are working on Heather Riess Mohamed Ibrahim Amrut A Patil Anne-Laure Fayard