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Chijioke commented on The journey to equity: Community Theatre for Immunisation

Hi Ashley Tillman Thank you for asking. We do not incentivise people to attend the shows, even though we provide light refreshments. However in implementing the intervention through the health facility and in engaging stakeholders in the community to take the lead in convening community members for the show, community members attend in good numbers. This is because they see the show as a part of their engagement with the health facility and by proxy, the Government and the health system. The lesson there for us, has been to reinforce the need to align the activity with EPI and wider health system interventions in the target communities, as a key thrust to sustaining community engagement and interest.

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Chijioke commented on The journey to equity: Community Theatre for Immunisation

Hi Estela Kennen We recognise that the goals are ambitious and totally agree with the fact that we could have a positive impact and yet fail to reach those goals. In that regard, we had planned to embed questions directly related to the theatre exposure in the quarterly assessments mentioned previously. The quarterly assessment tracks source of information on immunisation for caregivers that are surveyed, and present an opportunity to track direct effect of the theatre exposure on the evolution of sources of immunisation information. We would also look to incorporate a quick before/after knowledge & attitude survey of a subset of attendees and of the community members that perform the theatre. We hope that these can give us some intermediary measure of progress, outside of the goal itself. Thank you again for the thought-provoking questions. They have been quite helpful for our team.

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Chijioke commented on The journey to equity: Community Theatre for Immunisation

Hi Estela Kennen Thank you so much for your comments and questions, and thank you Isaac Jumba for all your support on this.

We have already developed a guiding script for some of the key themes. However, as we would like the participating community members to draw from their real experiences, there will be a significant amount of ad-lib in the rehearsals and actual performances. Our guiding scripts have so far been developed on Diseases that Vaccines Prevent, Polio, Measles, Losing a child due to a Vaccine-preventable Disease like Pneumonia or Diarrhea, the economic importance of Immunization, Where to find Immunization services, When to take Immunization (the Immunization Schedule), What our religion says about Immunization, Suffering an Injection Abscess after Vaccination and Suffering Fever after Immunization.

We have developed a Checklist with the criteria for recruiting community members, focusing on young caregivers (less than 35 years) with at least a primary level of education, knowledge of English language, fluency in the local language of the community, and at least one encounter with the Immunization program. This has been used in the test communities, and was successful. We also made a decision to not conduct an extensive audition for the community participants, as there will be extensive support from the State cultural society during rehearsals, and also for the fact that this will quite clearly be amateur theatre. So we engage the community leaders, share information on criteria for recruitment, and set a date to meet with interested community volunteers to discuss, plan and commence rehearsals.

In the test communities, we committed to a total of 7 hours rehearsal time per community, with a preceding 12 hours total of rehearsal time for the technical team from the cultural society working with us, and who have expertise at theatre performances.

The performances so far in the testing, lasted for 30 minutes on average. We expect that over a one year period, we will have 4-6 performances per community, targeting 56 communities. Over the last year, we have been conducting quarterly community level assessments on Immunization, and we have mapped communities with less than 50% coverage for select antigens, despite the availability of Immunization services. We look to being able to change those outcomes through interventions like this, that strengthen demand.

We definitely foresee pregnant women as being a major part of your audience. If you look at our user experience map uploaded here, pregnant women are our ideal users and a key part of our target audience. We will be targeting them through working with the health facility and community health volunteers to line list and directly invite them to the performances.

As an output of the quarterly assessments mentioned earlier, we have consistently identified that the caregiver not being fully motivated to prioritise immunization sessions over every day economic activities, has been a key gap in the demand component. As a result, we have been working with the Government and partners to increase outreach services and strengthen planning of immunization sessions with the communities, to ensure that services are convenient for caregivers. The community theatre piece will in this regard be complementing other health systems activities.

Our pathway to scale, is to strive for incorporation of the community theatre into annual end of the year State-wide community dialogues in the target communities. These dialogues are held at the end of the year to develop the Reaching Every Ward/Settlement Microplan for the coming year, and are typically organised in December. If we succeed in securing buy-in from Government, by demonstrating value over the one year, the theatre performance can be incorporated into these annual major community dialogues, as a part of the Immunisation program.

Thank you again for your comments and questions. We would be happy to entertain more, and to maybe hear you share any experiences that you may have around similar interventions that you have been a part of, or know of.