My Village My Home: Community Empowerment to Increase Immunization Coverage

"Community participatory involvement can help identify immunization barriers at the village level and can make sustainable solutions..."

Community participation is one strategy the National Health System in Indonesia uses to provide maternal and child health services, including health promotion about immunisation (necessary because complete immunisation coverage was only 57.9% in 2018). Specifically, health cadres are formed to work with Public Health Centres (PHC) to implement Integrated Service Posts (ISP - Posyandu). Developed by the Maternal and Child Health Integrated Program (MCHIP), My Village My Home (MVMH) tool (see Related Summaries, below) is an effort to empower the community, via health cadres, to support the achievement of immunisation coverage targets. The purpose of this study was to analyse knowledge and attitudes about the use of MVMH among cadres and the community and the impact of the implementation of MVMH on immunisation coverage in selected villages in Surabaya City.

As explained here, cadres are agents for change who work in their communities to identify and overcome social determinants of health by mobilisation. They have a role as a bridge between the community and health workers. With their knowledge of the local conditions, they are well positioned to foster several levels of community empowerment through interpersonal (one on one) and group communication and home visits. The majority of cadres who are research respondents are aged 40-50 years. Age is closely related to the cadre level of trust: As the age of cadres increases, the higher the confidence and awareness to provide optimal service. Cadre strengths include accessibility, as well as cultural, linguistic, and service sensitivity in the local area.

MVMH is a community-level visual communication tool that provides a visual picture of infant immunisation status in the village, where the community as a whole can see and follow up on immunisation status for each baby. The MVMH aims to strengthen basic immunisation coverage services, not only in terms of quantity but also the quality of coverage.

As part of the intervention evaluated here, the PHCs' immunisation coordinators were invited to receive socialisation and training on management and how to fill in the MVMH tool. They went on to provide socialisation and training on MVMH to representatives of health cadres in each ISP.

Data were collected through interviews, document studies, and observations. The research respondents were 20 health cadres and 20 mothers who had children under 2 years old from 13 villages in 10 PHCs selected purposively based on the lowest immunisation coverage in Surabaya. Analysis of the impact of the MVMH implementation involved comparing the Complete Basic Immunization (CBI) coverage of routine immunisation programme reports before the application of MVMH in 2017 with figures when applying MVMH in 2018 in the selected villages

The study found that most cadres have good knowledge (80%) and attitudes (85%) related to the use and application of MVMH. Cadres also have a positive attitude towards the importance of repeat visits for immunisation, coordination with midwives, and recording of immunisation status correctly. Most of the mothers also have good knowledge (50%) and a good attitude (60%) towards MVMH. For example, they know the benefits and types of data displayed by MVMH.

The average CBI coverage before the implementation of MVMH in 2017 amounted to 78.81 then increased to 95.77 after the application of MVMH in 2018. The Wilcoxon Signed Ranks Test results showed that there were significant differences in CBI numbers between before and after MVMH implementation in the region research (P-value = 0.019).

Reflecting on the findings, the researchers indicate that MVMH is a tool that can strengthen community participation in immunisation programmes. This activity has the potential to increase demand for immunisation in health services and among communities. The tool can also help identify children who need immunisation, increase the accuracy of vaccination times, and increase coverage. Thus, "This method has strategic potential in an effort to increase immunization coverage."