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Hi Ashley, great questions – happy to clarify! We will identify champions from the groups of caregivers that attend our focus group discussions. They will be caregivers who are trusted and respected in their communities and who have demonstrated exemplary attitudes and behavior related to health – for example, they had their children vaccinated and can explain the importance of immunization. Of course they also have to be interested in the program and motivated to get their peers to vaccinate their children. These caregivers can be of any age, gender, or ethnic group – in fact we will look for a diverse group of Champions in order to foster personal connections between the Champions and their peers.

We will work with our local field staff, led by Lucy Achan, to develop a short and effective in-person training for Immunization Champions. This will include not only information about vaccinations (how they work, why they are important), but also workshops on communication. For example, how do you have productive conversations with people of different opinions and communicate your perspective?

Training and feedback will be maintained throughout the program via meetings between the Champions and our staff every 2-4 weeks, where we can address challenges as they arise, answer any questions the Champions might have, and incorporate their feedback into the design of the program. We will also link Champions to trainings by the Ministry of Health or other like-minded civil society organizations, to continue to grow their skills and knowledge.

Regarding incentives, certificates are effective incentives used in many different settings around the world, and have been the subject of academic research, including a study by JSI in Ethiopia. Our Technical Advisor Dr. Guttmacher has also used them successfully to reduce the dropout rate of volunteers in an HIV prevention program.

Of course, certificates are not the only incentive of the program – they are part of a collection of social incentives. These include sustained training in health and communication, as well as the public recognition by community leaders and government agencies during the celebration at the end of the program. Most importantly, the knowledge and recognition provided by the program give participating caregivers a stepping stone to a career in the health sector or as community health workers. This will be especially effective for motivating young caretakers who are looking for ways to find paid employment.

As additional incentives, we will outfit each Champion with a t-shirt printed with the text “I am an Immunization Champion!” in each of the languages represented in the settlement. This will build a community between the Champions and develop recognition and social status for the work they are doing. They will also receive a bag (made locally, if possible) with the resources they will need for their work, including additional immunization cards, training guides, and a book to record the work they do. We will use small incentives to maintain participation throughout the program, including bringing food to all meetings with the Champions.

We refrain from using financial incentives because they work only in the short run, are not sustainable, and can lead to conflict between community members who are selected as Champions and those who are not. Moreover, it may attract participants who care more about the money than the work, making the program less effective. The certificates and social incentives are sustainable,encourage participation by caregivers who are invested in the work, and benefit the Champions, as explained above.

Regarding your question about scaling community-based solutions, we have a number of strategies: 1. We are creating awareness and demand at a community level and linking that demand to supply at the local health facility level. 2. We ware building capacity for immunization at the heart of where the problem is, at the same time strengthening the response of the local health facilities and workers, to make sure that as more caretakers bring their children to the facilities, the health workers have the capacity to service them. Therefore, the foundation of this intervention is based on both community systems strengthening and health systems strengthening for immunization. This will enable the primary healthcare system to replicate, scale, and sustain the efforts that we have introduced in the long term - after the project funding is over.

Dear Estela, during our pilot studies, we learned about the specific barriers that this community faces, some of which involve the supply and use of necessary materials. For example, when the clinic runs out of immunization cards, they ask caretakers to purchase booklets to keep the immunization records. We can easily provide these booklets at what is little cost to us, but a significant cost to the caretakers.