SOCIAL MOBILIZATION GUIDE FOR

VACCINATION CAMPAIGN AND ROUTINE

IMMUNIZATION

Corinne JUMEL
IFRC - Geneva
Table of Contents
ABBREVIATION AND ACRONYMS.............................................................................................................2
BACKGROUND AND CONTEXT .................................................................................................................3
ENGAGING RED CROSS WITH PARTNERS ................................................................................................4
SUMMARY CHECKLIST FOR CONDUCTING ROUTINE IMMUNIZATION ...................................................6
SUMMARY CHECKLIST FOR CONDUCTING SUPPLEMENTARY IMMUNIZATION ACTIVITIES (SIAs) .........7
Summary Checklist for Conducting SIAs – National Level .......................................................................9
Summary Checklist for Conducting SIAs – District Level .......................................................................12
VACCINES ...............................................................................................................................................14
1. COMMUNICATION ........................................................................................................................16
1.1. Vaccination Objectives .............................................................................................................16
1.1.1. Routine immunization ..........................................................................................................16
1.1.2. Supplementary Immunization Activity .................................................................................16
1.2. Social Mobilization ....................................................................................................................17
1.3. Communication Methods .........................................................................................................17
1.3.1. Advocacy visits .....................................................................................................................18
1.3.2. House to house strategy for communicating .......................................................................19
2. STRATEGY DESCRIPTION ...............................................................................................................19
2.1. Team selection/composition for social mobilization ...............................................................20
2.2. Planning ....................................................................................................................................21
2.2.1. Selection of targeted areas ..................................................................................................21
2.2.2. Number of supervisors/teams .............................................................................................21
2.2.3. Number of Households ........................................................................................................22
2.3. Definition of Team Working Area/Micro-Planning for H2H Visits ...........................................22
2.4. Field visits and data collection..................................................................................................24
2.4.1. Format for Registration of Targeted Children for the SIA ....................................................24
2.4.2. House to House Register for Vaccination Campaigns ..........................................................24
2.4.3. House Markings, If Used, for Visited Households ................................................................25
2.4.4. Summary of House-to-House Registers by the Local Supervisor .........................................25
3. TRAINING FOR CONDUCTING A HOUSE TO HOUSE MOBILIZATION .............................................25
3.1. Training of Trainers and House-to-House Teams .....................................................................26
3.2. Town criers ...............................................................................................................................26
3.3. Supervisors ...............................................................................................................................27
4. MESSAGES .....................................................................................................................................27
4.1. Main messages .........................................................................................................................27
4.2. Specific messages .....................................................................................................................28
5. GETTING THE RIGHT COMMUNICATION CHANNELS ....................................................................28
5.1. Getting the right Media Mix .....................................................................................................28
5.2. Media for Social Mobilization ...................................................................................................29
5.3. Banners, Posters and Radio ......................................................................................................30
5.4. Networks ...................................................................................................................................31
5.4.1. Advocacy in social networks ................................................................................................31
5.4.2. Advocacy with the political networks ..................................................................................31
5.4.3. Advocacy with religious leaders ...........................................................................................31
6. MONITORING AND EVALUATING THE SOCIAL MOBILIZATION CAMPAIGN .................................32
6.1. Difference between monitoring and evaluation ......................................................................32
6.1.1. Monitoring ............................................................................................................................32
6.1.2. Evaluation .............................................................................................................................32
6.1.3. M&E Plan ..............................................................................................................................33
6.1.4. Indicators ..............................................................................................................................34
6.1.5. Data Quality of data collected..............................................................................................35
6.2. Training on indicators, data sources and data collection .........................................................36
6.2.1. Staff training .........................................................................................................................36
6.2.2. Supportive supervision .........................................................................................................36
REFERENCES ...........................................................................................................................................38
ANNEXES ................................................................................................................................................40
Annex 1 – Disease preventable by immunization .................................................................................40
Annexes 2 A and B – SIA strategies........................................................................................................44
Annex 3 - SIA Information Form ............................................................................................................48
Annex 4 – Survey - Assessing awareness of an upcoming SM ..............................................................51
Annex 5 – Volunteer Form .....................................................................................................................52
Annex 6 – SUPERVISOR CHECKLIST........................................................................................................54
Annex 7 – SUPERVISOR SUMMARY FORM ............................................................................................55
Annex 8 - Specific messages in a frequently asked question format ....................................................57
Annex 9 - Checklist and form for SM monitoring and supervision........................................................58
Annex 10 - Example of an action plan at the local level ........................................................................59

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ABBREVIATION AND ACRONYMS
ACSM Advocacy, Communication, and Social Mobilization
AEFI Adverse Events Following Immunization
CBHFA Community-based Health and First Aid
CHW Community Health Worker
DFID Department for International Development
DPT Diphtheria, Pertussis, Tetanus
FAQ Frequently Asked Questions
HH Household
HW Health Worker
H2H House to House
ICC Inter-agency Coordinating Committee
IEC Information, Education and Communication
IFRC International Federation of Red Cross and Red Crescent Societies
IPC Inter-Personal Communication
JICA Japan International Cooperation Agency
M&E Monitoring and Evaluation
MoH Ministry of Health
NCC National Coordinating Committee
NGO Non-Governmental Organization
NS National Societies
RC/RC Red Cross and Red Crescent
RCM Rapid Convenience Monitoring
RI Routine Immunization
SIA Supplementary Immunization Activity
SM Social Mobilization
SMS Short Message Service
SOP Standard Operating Procedure
TT Tetanus Toxoid
UNICEF United Nations Children's Fund
USAID United States Agency for International Development
WHO World Health Organization

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BACKGROUND AND CONTEXT
Immunization protect children against diseases in childhood. Routine immunizations are
provided in all countries. All children, including those who are disabled, need to be
vaccinated according to the national vaccination schedule. Pregnant women need at least two
tetanus vaccinations before given birth.
A successful immunization programme depends upon effective vaccine supply and logistics,
but it is just as important that the community has confidence in, and supports and demands,
safe and effective immunization services. Immunization services must meet the needs of
communities and work with them to ensure their involvement and participation. To do this,
both managers and health workers (HWs) need to form a close partnership with communities,
while using effective communication skills and tools. Community participation in
immunization programmes has been shown to result in higher coverage, and ultimately to
reduce the number of incidences of vaccine-preventable diseases.
Each country determines its own immunization schedule and chooses vaccine presentations.
A lot of campaigns are conducted to maintain a good coverage however it happens that it is
necessary to reinforce the communication in order to improve the immunization coverage and
reduce drop-outs for infants and pregnant women and to identify and target the unreached.
The goal is to reduce mortality and eventual elimination of diseases through strong
vaccination coverage. With support of multiple partners, International Federation of Red
Cross and Red Crescent Societies (IFRC) wants to make significant progress in achieving
these goals.
Communication for diseases control is a two-way process of exchanging information with
caregivers to ensure that all children susceptible for infection receive their vaccinations.
Social mobilization (SM) engaged individuals and communities primarily through
community influencers, public address systems, door to door campaigns, distribution of
materials and discussions within community groups and other community initiatives.
This guide will focus on the tools and techniques relevant to communication focused on
social mobilization (house to house visits). House-to-house (H2H) mobilization visits are
recommended by the initiative as a strategy to increase community demand. House-to-house
social mobilization combines multiple communication channels but largely promotes
interpersonal communication (IPC) between Red Cross and/or other community volunteers
and the caregivers (mothers, fathers, guardians, and community leaders).
This guide provides the how to conduct a step by step approach to an effective and fruitful
house to house mobilization visit. It is to help health workers and communities to conduct
social mobilization.
The main objective of this document is to:
▪ Provide evidence-based guidance on conducting practical social mobilization and
communication for vaccination campaigns conducted by Red Cross and Red Crescent
(RC/RC);

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 ▪ Facilitate the systematic application of SM within RC/RC to ensure a more coherent
and comprehensive approach;
▪ Motivate volunteers through a consistent approach, supportive supervision and clearly
defined tasks;
▪ Develop and conduct training for volunteers;
▪ Establish Standard Operating Procedures and train community members, volunteers
and Community Health Workers (CHWs);
▪ Expand to other countries the work done in some countries.
IFRC takes the lead in the development of this guide and to facilitate the successful
implementation of SM and provides guidance and direction to National Societies and their
partners in relation with Social Mobilization,

ENGAGING RED CROSS WITH PARTNERS

Public Sector
The public health sector includes ministries of health, public hospitals, and government
health facilities at the local, district, other sub-national, and national levels. Public health
officials formulate policies, standards, and guidelines for national immunization programs.
They monitor immunization coverage and disease incidence. They are responsible for
ensuring that all immunization service providers, including those in the private sector,
comply with the national immunization schedule, maintain the vaccine cold chain, practice
injection safety, and follow other policies governing equity and quality. Health personnel
from the public sector provide the majority of vaccination services in most developing
countries.
▪ Role of the Ministry of Health
The Ministry of Health (MoH) should be involved in the planning and implementation of
communication programs. Prior to campaigns the MoH should help to develop the
overall communication messages to be used. During campaigns they will help to adjust
or retarget communications to address issues. Post campaign they will evaluate the
effectiveness of the communication campaign to determine the impact of the activities.
Private Sector
The private sector includes non-governmental and for-profit components.
▪ Non-governmental organizations (NGOs)
They are non-profit groups that provide curative and preventive health services directly
and/or support government provided services. They range in size and scope from small
religious or community-based organizations to large international groups with hundreds
and even thousands of employees.
▪ For-profit providers
It consists of individuals and organizations that provide services or products for monetary
gain. For-profit service providers include professionally-trained health workers,
traditional practitioners, private hospitals, and clinics. This sector also includes
manufacturers and sellers of pharmaceuticals, health products, and equipment, as well as
companies that provide laboratory services, fleet management, equipment repair and
maintenance, training, and other services.

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Inter-agency Coordinating Committee (ICC)
The public- and private-sector individuals and groups involved in immunization service
provision or support need to coordinate their activities at all levels. Inter-agency Coordinating
Committees (ICCs) have been formed in many countries to respond to this need at the
national and, sometimes, other levels.
These committees usually include:
▪ Ministry of Health staff (e.g., the national immunization program manager and the
director of preventive services)
▪ Staff from related ministries (e.g., the Ministry of Finance and Ministry of Planning)
▪ Multilateral donors [World Health Organization (WHO) and United Nations
Children's Fund (UNICEF)]
▪ International development banks
▪ Bilateral agencies [e.g., United States Agency for International Development
(USAID), Department for International Development (DFID), Japan International
Cooperation Agency (JICA)]
▪ Non-governmental organizations
ICCs work with national and sub-national immunization personnel to assist with multi-year
and annual planning and reviews; coordinate financial and other resource needs; and analyse,
design, implement, monitor, and supervise immunization services. One of their most
important tasks is to ensure that adequate funding is available for immunization. ICC sub-
committees are often formed to focus on specific technical issues, such as vaccine supply,
logistics, or social mobilization.

The Role of ICCs

Technical
▪ Development of a national policy framework for vaccines and immunization that
gives priority to immunization activities, sets targets, and provides guidelines.
▪ Sponsorship of periodic in-depth assessments of national immunization programs.
▪ Advisory body for national strategic plans of action
▪ Support for the implementation of strategies
▪ Monitoring of service performance; tracking of disease surveillance data
▪ Monitoring quality control and adherence to international standards
▪ Development of proposals for program support
Financial
▪ Evaluation of the use of resources
▪ Financial planning
▪ Mobilization of additional resources when necessary
Political
▪ Advocacy for increased commitment to immunization at all levels
▪ Social mobilization
Capacity Building
▪ Development of government capacity for managing and delivering immunization
services

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SUMMARY CHECKLIST FOR CONDUCTING ROUTINE IMMUNIZATION
BEFORE IMMUNIZATION SESSION FOR SELECTED POPULATION ATTENDING THE AFTER THE IMMUNIZATION SESSION
IMMUNIZATION SESSION
DID YOU: DID YOU: DID YOU
Check if enough quantities of vaccines and diluents Greet the child and caregiver Correctly assess if open vials can be used in
are Check vials for the following and take Review the immunization card the next session
appropriate action: Determine eligible vaccinations Discard open vials that should not be used
✓ Expiry dates Reconstitute each vaccine Record date of opening on vials that can be
✓ Open vials dates Fill syringes just before administration used and place them in the “use first” box in
✓ VVM status Administer each vaccine the refrigerator
✓ Freezing status available for the session? Immediately dispose needles/AD syringes in Return unopened vials to the refrigerator
✓ Place vial in the appropriate place in the safety box after injection Complete session summary report
immunization area Record vaccination List the names of children who missed the
Ensure enough supplies are available for session Communicate key messages vaccination and require follow-up
including: Handle full safety boxes correctly
✓ Auto-disable syringes Take appropriate action to ensure sufficient
✓ Reconstitution syringes vaccine stock for the next session
✓ Safety box Inform community of date and time of next
✓ AEFI kit session
✓ Immunization register
✓ Immunization tally sheet
✓ Blank immunization cards
Wash your hands with soap

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SUMMARY CHECKLIST FOR CONDUCTING SUPPLEMENTARY IMMUNIZATION ACTIVITIES (SIAs)
Please choose between the table below or the other tables (National level and District Level)

Before the campaign, important activities for the mobilizers are to:
▪ communicate with each of the target villages, cantons and neighbourhoods;
▪ identify key partners and stakeholders to mobilize, including community leaders, religious leaders, teachers and community health
workers;
▪ fix monitoring indicators, define a timeline and responsibilities, and check implementation stages against the timeline; conduct
advocacy meetings with local leaders;
▪ communicate with health personnel and school leaders (public and Koranic, where present);
▪ get input from individuals and groups on how to spread the campaign messages – they can make suggestions for spreading the
word, such as announcing the campaign at major meetings and cultural events (traditional festivals, weddings, baptisms, funerals),
and sporting events;
▪ prepare communication materials in advance so that they are distributed on time (some are produced at the central level, like
posters, brochures, banners, which must be distributed). They must be displayed in front of health centres or on busy streets.
display the posters in health centres, schools, mosques, churches, markets and other relevant, visible public places;
▪ prepare a ceremony for the launch of the campaign in all prefectures, subprefectures, heath centres and health posts;
▪ advocate to the local government authorities, to support the mobilization of the population to the vaccination posts;
▪ spread the word in partnership with associations, NGOs and other community-based organizations, community workers, and
religious leaders;
▪ advertise the campaign in public places using town criers and megaphones;
▪ identify communication strategies to reach marginalized populations;
▪ establish a timetable for advocacy, social mobilization and communication activities; and
▪ estimate the technology requirements for the social mobilization campaign.
During the campaign, the mobilizers need to:
▪ strengthen the participation of organized community groups (e.g. women’s and youth organizations);
▪ announce the contribution of different groups and organizations, which encourages continuing support for other national events;
▪ involve teachers, parents and children. Children are usually very effective in searching for other children who are affected by the
campaign;

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▪ inform the public through print media and radio programmes (e.g. provide radio stations with press releases); and
▪ hold a formal ceremony to launch the campaign.

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SUGGESTED
WHO ACTIVITIES/ITEMS CHECK
TIMING
Meet with district leaders and health officials
(initiate microplanning meetings) □
Conduct microplanning workshops at the
regional/district level □
Conduct microplanning meetings to finalize
plans □
Finalize plans and obtain endorsement by the
9 to 6 months NCC □
before SIA Develop and finalize plan for social mobilization,
advocacy and communication □
Develop/update logistics spreadsheets and ensure
consistency of calculations □
Develop national SIA guidelines □
Transfer operational funds to the district level □

Summary Checklist for Conducting SIAs – National Level

SUGGESTED
WHO ACTIVITIES/ITEMS CHECK
TIMING

NATIONAL LEVEL
Develop budgeted microplan with a timeline
(plan funds for pre- and intra-campaign □
monitoring and post-campaign activities)
Hold meetings with ministries of health and
finance regarding allocation of funds for the SIA □
At least 12 Submit application to partners (e.g. local
months prior to partners, etc.) for additional funding, if □
SIA applicable
Once the focal points, mobilizers and town criers
have been recruited, it is necessary to train them □
to allow the campaign to run smoothly.
Establish and plan the meetings of the national
coordinating committee (NCC) □
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SUGGESTED
WHO ACTIVITIES/ITEMS CHECK
TIMING

NATIONAL LEVEL
12 to 9 months Establish and plan the meetings of technical
before SIA subcommittees with clear terms of reference □
Meet with district leaders and health officials
(initiate microplanning meetings) □
Conduct microplanning workshops at the
regional/district level □
Conduct microplanning meetings to finalize
plans □
Finalize plans and obtain endorsement by the
NCC □
Develop and finalize plan for social mobilization,
advocacy and communication □
9 to 6 months Develop/update logistics spreadsheets and ensure
before SIA consistency of calculations □
Develop national SIA guidelines □
Transfer operational funds to the district level □
Review and validate microplans at the national
level □
Budget revision and adjustment according to the
microplans □
Develop social mobilization materials □
Transfer operational funds to the district level □
Review and validate microplans at the national
6 to 4 months level □
before SIA Budget revision and adjustment according to the
microplans □
Develop social mobilization materials □
At least 4 NS to decide if it would like to support SM activities
months prior to around the SIA □
SIA
3 to 4 months To discuss their potential participation with
before SIA MoH, UNICEF, WHO and partners □
Print and distribute supervisory checklists
3 months
including SIA Readiness Assessment Tool, tally □
sheets, AEFI forms, summary forms, cards
before SIA
Develop and distribute training materials and
tools □

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SUGGESTED
WHO ACTIVITIES/ITEMS CHECK
TIMING

NATIONAL LEVEL
Confirm the workplan for monitoring and
evaluation of the SIA □
Conduct supervisory visits to provincial /district
levels to assess SIA readiness and identify □
8 weeks before problems
SIA Start preparation for launching ceremony □
Verify availability of transport for supervision,
social mobilization, etc. □
4 to 2 weeks Conduct supervisory visits to districts with
before SIA problems to check readiness □
Designate supervisory teams for SIA
4 to 2 weeks implementation □
before SIA Conduct training of mid-level trainers (training
(continued) sites, refreshments, notebooks, pens, other □
materials)
Conduct supervisory visits to selected districts to
2 weeks before
SIA
confirm preparation and identify and address □
readiness gaps
Set up a national operations control room to
follow the SIA and provide back-up support to □
1 week before the subnational level
SIA Conduct SIA readiness supervisory visit □
Intensify all social mobilization activities □
Day of the H2H
social
mobilization □
start
Perform H2H Visit □
Volunteers Complete the volunteer form □
Every day of
H2H social
Meet with the supervisor at the end of each day □
mobilization Supervise H2H and complete the supervisor
implementation checklist □
Supervisor Review data forms filled by volunteers □
Complete the supervisor summary form □

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SUGGESTED
WHO ACTIVITIES/ITEMS CHECK
TIMING

NATIONAL LEVEL
Conduct HH follow-up visits for HHs where
caregivers do not want to take children for □
vaccination
Attend MoH review meetings and give feedback
on the day’s observation □
Upload and send data together to M&E officer □
Support daily monitoring meetings at district,
regional and central level with key stakeholders □
M&E officer Summarize all supervisor’s data forms
completing excel Data Analysis Form □
Project Complete Final Report and share it with Partner
Coordinator National Society (PNS) □

Summary Checklist for Conducting SIAs – District Level

SUGGESTED
WHO ACTIVITIES/ITEMS CHECK
TIMING

DISTRICT LEVEL

Verify the availability of operational funds to be

transferred from the national level □
Hold meeting with the subdistrict and local-level
4 to 3 months Project
SIA coordinators – assign schedule and task lists □
before SIA Coordinator
Distribute the Social Mobilization Guide for
Vaccination Campaign and Routine Immunization □
to the subdistrict and local coordinators
Initiate local social mobilization □
Confirm House to House social mobilization
strategy □
8 weeks before
Conduct supervisory visits to assess readiness □
SIA Conduct second round of pre-campaign
supervisory visits to selected sites □
Initiate House to House social mobilization
activities □
Conduct training of vaccination teams □
Facilitator Conduct 1-day ToT training □
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SUGGESTED
WHO ACTIVITIES/ITEMS CHECK
TIMING

DISTRICT LEVEL

1 week before
SIA
Trainees Conduct the half day volunteers ‘training □
1 to 2 days
before H2H
social
Confirm deployment of supervisors □
mobilization
Day of the H2H social mobilization start
Perform H2H Visit □
Volunteers Complete the volunteer form □
Meet with the supervisor at the end of each day □
Supervise H2H and complete the supervisor
checklist □
Review data forms filled by volunteers □
Complete the supervisor summary form □
Every day of Conduct HH follow-up visits for HHs where
H2H
implementation
Supervisor caregivers do not want to take children for □
vaccination
Attend MoH review meetings and give feedback
on the day’s observation □
Upload and send data together to M&E officer □
Support daily monitoring meetings at district,
regional and central level with key stakeholders □
M&E officer Summarize all supervisor’s data forms
completing excel Data Analysis Form □
Project Submit coverage results and reports (technical
Coordinator and financial) □

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VACCINES
Vaccines help the body’s defences (antibodies) learn to recognize and kill germs do not make
people sick. This is called immunity. Vaccines work when given before the disease enters the
body. Sometimes a vaccine needs to be given multiple times, in series, to help the body
recognize the germ and develop immunity.
Vaccines are safe, especially when compared to the diseases they prevent. Serious complications
rarely occur. Because vaccines contain weakened or inactivated forms of a germ, they can
sometimes cause a mild fever, redness or swelling at the injection site. It is, however, safe to
vaccinate a sick child who is suffering from a cough, cold, diarrhoea, fever or malnutrition.
Vaccines are given in different ways. Most are given by injection. Some, like polio vaccine, are
given by mouth. Newer vaccines for influenza can be given by inhaling through the nose or
mouth. Some vaccine can protect against several diseases, for example DPT is a vaccine that
protects against three diseases: diphtheria, pertussis and tetanus. DPT is given by injection to a
baby at the age of six weeks, ten weeks, and fourteen weeks.

All people in the targeted age, sick or not should be immunized.

Diseases preventable by immunization

Several diseases exist and are controlled under an immunization programme.
Causative agent, reservoir, transmission’s mode, symptoms, vaccines and prevention of diseases
are summarized under the table 1 (Annex 1).
You will find more details on schedule recommendations from WHO position paper summaries
which are available online at
http://www.who.int/immunization/policy/immunization_tables/en/index.html.
Routine immunization
Strong routine immunization (RI) systems are critical foundations for achieving and sustaining
high levels of population immunity to vaccine-preventable diseases.
Immunization is beneficial and effective in the prevention of disease, death and disability from
vaccine-preventable diseases. Worldwide, more than 2.5 million childhood deaths are prevented
by immunization each year.
Immunization services must be provided and used throughout the year, every year, to enable
each new cohort of new-borns and women of childbearing age to become adequately protected.
Immunization campaigns are only successful if they are managed well, and if the community
understands their significance. The importance of communication with parents and community
leaders about the benefits of immunizing infants aged under one year and women of childbearing
age (15 to 49 years) is very important.
Immunization prevents illness, disability and death from vaccine-preventable diseases including
cervical cancer, diphtheria, hepatitis B, measles, mumps, pertussis (whooping cough),
pneumonia, polio, rotavirus diarrhoea, rubella and tetanus.
Routine immunization is to decrease in morbidity and mortality from vaccine-preventable
diseases across the life-cycle of all individuals.

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Its objectives are to:
▪ Contribute to country efforts towards sustained routine immunization programmes;
▪ Set global priorities in the attainment of immunization for all persons targeted;
▪ Ensure global, regional and country coordination among immunization partners and
stakeholders in routine immunization activities and plans;
▪ Align new vaccine introduction, accelerated disease control and prevention and
programme monitoring activities with a joint goal of routine immunization programme
support, both in relation to coverage improvement and system strengthening efforts.
Global partners must ensure that routine immunization coverage, equity and the actual delivery
of vaccines to hard-to-reach populations remain high on the global health agenda by raising
awareness of their importance, benefits and synergies among governments, donors and the
global health community as a whole.
Many countries that have achieved very high routine immunization levels were able to prevent
the occurrence diseases. Maintaining high routine immunization is the most important
intervention to preserve achievements after reaching cessation of transmission.
ROUTINE
CAMPAIGNS
IMMUNIZATION
High coverage with all Reduce transmission of
Objectives
antigens. selected disease(s).
Expanded to children of
Children under one and
Target groups other age groups and women
pregnant women.
of child-bearing age.
Ongoing: Daily, weekly, Intermittent, defined by
Frequency
monthly, quarterly. disease epidemiology.
Fixed, outreach, door-to-
Fixed, outreach, mobile. Service delivery strategy
door, extra posts, mobile
supplementary doses are
tallied but not recorded on
Doses are considered
child health card (except for
routine, recorded on child Recording/Reporting
maternal and neonatal
health card.
tetanus elimination
activities).
High, with event-based
Limited. Visibility launches and high media
attention.
substantial input from Often donor-funded and
government; often under- Funding driven; usually better funded
funded. than routine.
For routine immunization, for example, the general objectives are to achieve high coverage with
all antigens in the target group of children under one and with tetanus toxoid (TT) in pregnant
women. By contrast, campaigns generally seek to reduce the transmission of particular, selected
diseases in an age group (of children) that is expanded for the duration of the campaign.
For routine immunization, services are usually offered on a daily, weekly or monthly schedule
through a combination of fixed and outreach services, plus mobile services in some places. By
contrast, the frequency of campaigns for accelerated disease control is intermittent and depends

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upon the epidemiology of the particular diseases. Services are expanded for a temporary period
to include not just fixed and outreach, but also many extra vaccination posts and sometimes
door-to-door services.
National supplementary immunization activities
Ideally, an SIA is built upon a strong RI programme. SIAs provide opportunities for
strengthening vaccination services through building national capacity, reducing inequity of
service delivery, advocating for RI, improving immunization practices and providing further
public health benefits through integration of other public health interventions with the SIA.
Strengthening RI programmes is in turn critical for sustaining gains made through the SIA. SIAs
are a proven strategy for increasing vaccination equity.
SIAs also have the effect of rapidly increasing population immunity by reducing the number of
susceptible individuals in the population, which can result in protective “herd” immunity.
Mass immunization campaigns, or supplementary immunization activities (SIAs), are one of the
four pillars of eradication. This supplementary immunization is intended to complement – not
replace – routine immunization.
Supplemental strategies are used to reach children who have not been vaccinated or have not
developed enough immunity after previous vaccinations. Strategies differ according to the
epidemiology of the disease. Some of the common features are: the target age group is
expanded, all children are vaccinated regardless of their immunization status, immunizations do
not need to be marked on vaccination cards, volunteers are used, and civil society is mobilized.
When too many people are at risk for a disease that can be prevented by vaccination, health
officials may organize a national or sub-national supplementary immunization activity. Polio and
measles vaccination campaigns have been frequently organized in countries most affected by the
diseases. Supplementary immunization activities are conducted for other diseases including
rubella, yellow fever and meningitis.

1. COMMUNICATION
1.1. Vaccination Objectives
1.1.1. Routine immunization
The goal of routine immunization are as follows:
▪ To vaccinate 90% of targeted people with targeted diseases vaccines, regardless of
previous immunization history;
▪ To provide supplemental health interventions as needed. For example, Vitamin A
supplementation;
▪ To ensure safe injection practices and proper waste disposal during vaccination
campaigns;
▪ To effectively mobilise communities, with emphasis on the hard to reach populations, to
have their children vaccinated during the campaign.

1.1.2. Supplementary Immunization Activity

The goal of mass vaccination campaigns are as follows:

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 ▪ To vaccinate 95% of targeted people with targeted diseases vaccines, regardless of
previous immunization history
▪ To provide supplemental health interventions as needed. For example, Vitamin A
supplementation
▪ To ensure safe injection practices and proper waste disposal during vaccination
campaigns
▪ To effectively mobilise communities, with emphasis on the hard to reach populations, to
have their children vaccinated during the campaign.

1.2. Social Mobilization

Social mobilization activities should focus on conveying:
▪ that the greatest number of people possible is needed to have good vaccine coverage;
▪ the people specifically targeted and specifically excluded for the campaign;
▪ the risks associated with not being vaccinated and with being vaccinated (e.g. AEFI);
▪ how to cover areas of most difficult access, where the diseases start; and the most
vulnerable populations which have very little or no access to health facilities.
The value of the social mobilization:
▪ Organizes and promotes the behavioural responses of a broad range of individuals and
institutions ranging from behaviours of individuals affected by or at risk of the outbreak
to the behaviours of a host of others;
▪ Provides information;
▪ Raises a call to action.
Social mobilization brings together community members and other stakeholders to strengthen
community participation for sustainability and self-reliance. Social mobilization generates
dialogue, negotiation and consensus among a range of players, including decision-makers, local
media, NGOs, opinion leaders and religious groups.
Social mobilization thus involves
▪ local authorities,
▪ leaders
▪ Social mobilizers.
It reaches all members of the community through the traditional channels of the social networks,
including via town criers.
Social mobilization also includes mobilizing the public to participate in immunization activities.

1.3. Communication Methods

Communication is a continuous process where the sender sends some message with specific
objectives to a receiver and the receiver responds to that message.
There are different levels of communication:
▪ Intrapersonal
▪ Interpersonal
▪ Group
▪ Organizational

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 ▪ Societal
▪ Global
Multiple channels must be used for communicating critical information for successful
campaigns. A mix of communication channels is recommended for all campaigns. The list below
provides the commonly used channels that should be used:
▪ Advocacy visits to community leaders (traditional, religious and civil);
▪ House to house visits;
▪ Counselling at health facilities;
▪ Announcements at community events (meetings like burials, courts, marriage
ceremonies, public meetings etc), markets, and transportation hubs;
▪ Places of worship (churches and mosques);
▪ Print media (Journals, newspapers and magazine supplements and advertorials);
▪ Electronic media (Radios, TV, Mobile phones and internet);
▪ Printed materials (Booklets, Posters, Brochures, Leaflets, flyers and banners).

For rural people the best channels are:

➢ Health Workers
➢ Local leaders
➢ Groups
➢ In some cases, radio

1.3.1. Advocacy visits

Advocacy and social mobilization techniques can be used to inform political leaders, community
members, and partners about upcoming events and activities and increase their participation in
them. Health worker at all levels should talk with leaders and other influential people
individually, hold joint planning meetings and provide informational materials. The
communication techniques discussed above can also be used to mobilize the community.
Historically, social mobilization has been used more frequently to build support for campaigns
than for routine immunization.
The objective of advocacy activities surrounding a vaccination campaign is to ensure that
government officers remain committed to implementing the campaign. Advocacy often focuses
on influencing decision-makers through a variety of channels, including meetings between
various levels of government and civil society organizations, news coverage, official memoranda
of understanding, and other political events.
Programme advocacy targets opinion leaders at the community level on the need for local action.
Media advocacy highlights the relevance of the campaign, puts issues on the public agenda, and
encourages local media to cover related topics regularly and in a responsible manner, to raise
awareness of possible solutions and problems.
Advocacy activities should also be directed at ensuring that national governments remain
committed to implementing vaccination campaigns through a variety of channels, such as
meetings with various levels of government and civil society organizations. It is common to plan
meetings in the provinces and districts.

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All the district managers, communication focal points, religious leaders, relevant non-
governmental organizations (NGOs), educational staff, health staff and mobilizers should be
invited to the provincial meetings.
All the canton chiefs, priests, imams and religious leaders, NGOs working there, educational
staff, health staff, mobilizers, and town criers should go to the district meetings. These are
important meetings for the campaign. Local and religious leaders may be invited to speak about
the vaccination campaign.

1.3.2. House to house strategy for communicating

The door to door vaccinations strategy is used as a supplemental immunization strategy to reach
families that are not served at health facilities and other collection points.
House to house (H2H) social mobilization combines multiple communication channels but
largely promotes interpersonal communication (IPC) between Red Cross and/or other
community volunteers and the caregivers (mothers, fathers, guardians and community leaders).
This guide therefore provides the how to in conduct a step by step approach to an effective social
H2H social mobilization.
The house to house strategy for communication is ideal because it allows for direct interpersonal
communication between the Red Cross volunteer and caregiver of the child. It creates an
opportunity for interactive conversation between an informed (trained) volunteer and the
household (HH) members. In addition to providing informed view-points about vaccinations, the
strategy also gives the household member an opportunity to receive answers to their unresolved
questions or concerns that other channels of communication do not provide.

2. STRATEGY DESCRIPTION
The house to house strategy for vaccination campaigns involves a trained change agent (in this
case a Red Cross volunteer or other community resource person) conducting at least one visit to
all the households in a defined area.
A household (HH) must be defined and understood as the smallest family unit where members
cook and eat together. It may refer to an actual house, a makeshift dwelling or a tent. In some
cultures, you will find compounds with several households, the team should strive to identify
and visit each household separately.
At each HH, the Red Cross volunteer delivers the information regarding vaccination in general
with emphasis on assuring that all children are fully vaccinated. At the same visit, the Red Cross
volunteer makes a count of targeted children in the household in order to obtain more accurate
demographic estimates. In addition, the Red Cross volunteer creates a dialogue opportunity for
the HH members to ask questions and voice concerns they have about vaccination before
seeking their consent to take their children to the designated vaccination point closest to them.
Before conducting the house visits, the Red Cross Volunteer should contact the nearest health
facility to know where the vaccination points are going to be during the vaccination campaign
(see Annex 2).

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If being used at the end of the visit, each HH should be marked as indicated in the campaign plan
(see section 2.4.3 for possible house-marking). If the households are in a shared compound, the
entrance to the compound should also be marked to indicate that it has been visited.

2.1. Team selection/composition for social mobilization

Each department should have a communications focal point (Red Cross volunteer or other
resource community member), who is a key person in the vaccination campaign. Remember, a
region is divided into departments, so a region could have up to three or four communications
focal points, one in each department. These communications focal points are key to the
implementation of communication activities. The functions of a focal point include:
▪ Planning communication activities;
▪ Coordinating communication activities in each department, province and district;
▪ Organizing communication committees at the provincial and district level;
▪ Working with local radios to get them to talk about the campaign and inform the
population;
▪ Organizing advocacy and sensitization meetings with the local authorities, religious
leaders and opinion leaders;
▪ Mobilizing social networks at the district and village level, including town criers;
▪ Visiting local leaders and using the traditional communication channels;
▪ Overseeing the mobilizers, community relays, members of the committees and town
criers; and
▪ Monitoring the process and outcomes of the communication activities and applying the
monitoring tool for community communication.
Selection of house-to-house (H2H) mobilization teams should be based on contextual
understanding. Recruiting mobilizers is an important step that requires some consideration. The
criteria applied to the recruitment process should be developed keeping in mind the functions of
the social mobilizers. Social mobilizers provide information and support to communities and
engage community members in strategic dialogues. Therefore, the successful candidates should
be:
▪ Selected from the community in which they will be working;
▪ Resident and known in the community;
▪ Able to read and write in most situations;
▪ Credible and respectable to the local population;
▪ Adept in verbal communication;
▪ Experienced in field work, and physically and mentally capable of completing the work;
▪ Humble, and not see themselves as superior to other members of the community;
▪ Knowledgeable on immunization;
▪ Able to understand others;
▪ Honest and attractive leadership;
▪ Reliance/faith on others;
▪ With Communication skill;
▪ Patient and conscious.
It is desirable that each house to house mobilization team be composed of two persons. This
composition allows the team to:

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 ▪ Educate the household members while at the same time identifying and observing the
other non-verbal expressions;
▪ Divide tasks of communication and documentation of household information during the
visit;
▪ Complement each other at the dialogue session as two heads are always better than one;
▪ Ensure the safety of the team.
To improve access to households it may be necessary to have at least one female team member.
However, this should be decided locally depending on the gender values held in the country.

2.2. Planning
2.2.1. Selection of targeted areas
In general, implementing a high-quality nationwide SIA is the optimal approach to achieve the
greatest impact on disease burden. However, in some settings, subnational SIAs targeting
geographic areas may be more programmatically feasible and can be considered. These settings
include the following.
• Settings where, due to limited programme capacity, achieving high-quality SIA is a
challenge: subnational SIAs, targeting geographical high-risk areas that can achieve high
coverage and interrupt disease transmission may be an option.
• Settings where there is substantial heterogeneity in the immunity profiles within a
country: specific subnational SIAs targeting high-risk or accumulating susceptible
populations may be a more economical option.
• Settings where small, localized outbreaks are occurring implementing smaller, area-
specific SIAs can be an effective option as these SIAs can be prepared and executed in a
shorter time with fewer resources than nationwide SIAs.

The primary goal of SIAs is to find and immunize populations missed by routine
vaccination services (e.g. special populations include: urban poor and migrant populations;
remote, difficult to reach groups; persons living in areas of civil conflict or insecurity;
populations resisting vaccination; etc.). Therefore, targeted areas should include populations
with low coverage rates.

2.2.2. Number of supervisors/teams

The number and distribution of teams and vaccination posts depend on the population and
setting. House to house social mobilization may occur separately (e.g. before or during a
campaign) or with the vaccination team (e.g. during the campaign). Typically, each supervisor
oversees 5-10 social mobilization teams (comprised of two volunteers each). The number of
teams depends on the targeted areas, and varies according to access, geography, catchment
population, etc. For instance, in urban settings teams may reach upwards of 100 households per
day while in rural or hard-to-reach settings 30-50 households per day is more likely.
To calculate the number of supervisors and teams required, the microplanning process is
important to determine the number of households in the catchment area. For instance, a targeted
area including 1000 households in a rural area would require a minimum of 2 supervisors and 40
volunteers.

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 Total Max number of Minimum Minimum no. Minimum no.
households households/team teams required of volunteers of supervisors
1000 50 20 40 2

2.2.3. Number of Households

As part of the microplanning phase the number of households to be visited during each of the
campaign days by volunteers should be determined. Daily household’s numbers may vary from
country to country based on the target area and number of volunteers mobilized.
Typically, however, urban and peri-urban areas are targeted for the house to house approach as
population density is greater in these areas, thus reducing the volunteer travel time between
households and increasing the overall number of households that can be visited each day. In
general volunteers should visit somewhere in the range of 30-50 houses per day (rural areas) to
over 100 houses per day (urban areas).
Depending on the number of volunteers available versus the target households it may be
advisable for the teams to split to increase the number of households visited each day. When
considering this option, volunteer safety and security should always take precedents. In areas
that are of concern volunteers should maintain the standard teams of two for all house visits. In
areas where the splitting of teams is appropriate safety should still be at the forefront. Volunteers
should maintain visual contact with their partners and never be outside of hearing distance. The
team should use a “leapfrog” technique for house visits which is described below.
▪ While Volunteer A visits the Household A, his partner Volunteer B visits the household
next door, Household B;
▪ When Volunteer A is finished, he will move two doors down to Household C. Volunteer
B will do likewise and visit Household D;
▪ This “leapfrog” structure will continue until all the houses within reasonable distance of
one another are visited.
▪ At all times the volunteers will be aware of the location of their partners and be as visible
as possible to ensure the safety of one another.

2.3. Definition of Team Working Area/Micro-Planning for H2H

Visits
Involving the community in planning, implementing, and evaluating services can improve the
quality and effectiveness of immunization programs.
Planning activities at district level
A country can be divided into regions or states. Usually, a health campaign covers the whole
country or a set of regions. The regions may be divided into departments, and the departments
further divided into provinces or subprefectures. Finally, the provinces are divided into cantons.
A health district may be at the level of a department or a province, depending on the country.
The district health centre is the focal point for nurses and health workers to prepare before the
campaign starts.

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In a mass vaccination campaign, communication and social mobilization activities take place
primarily at the district level. Local radio channels and town criers can be important factors in
convincing the people of the community to get vaccinated.
To garner support, the vaccination team must communicate, as appropriate, with the chiefs, the
traditional authorities and the district managers to ensure that these key figures are united behind
the vaccination campaign.
Each district also has town criers, whose function is to travel throughout the district’s villages
shouting the news, doing publicity, and communicating on issues of health, education, taxes,
agricultural issues, politics, jobs and so on. Field experience has shown that town criers are the
most important channel of communication in rural societies that have low income and education.
Half of town criers are illiterate or semi-illiterate.
Whereas mobilizers operate at the district and canton level, the town criers work at the village
level. The mobilizers use town criers to get the messages to hard-to-reach areas. Town criers can
go where the mobilizers cannot go and they can speak the local language. Importantly, they are
well known in each village and people believe them.
For each house-to-house team, a working area should be defined to ensure that all households in
the catchment area are visited. It is desirable that a catchment map is defined and if possible,
specifies which households should be visited each day.
Figure 1. Household Map Showing Dates of Volunteer Visit.

x xx
x x x x
x x x xx Day 1 x x x x x
x x x x xx
x x x x x xxx x
x x
x x Day 2 x
x xx xxx x x x
x
x x x x
x Key

x x xx x
Day 6 x Day 3 Health Facility
x x x x x
x x x x
x x x x
x x x x Households
x x xx x x x
x x
x x x
Day 5 x x
River
xx x x x
x x x
x xx x x Roads
x x x x
x x x x x
xx x x x
x x xx
Day 4 x x Wetland
x xx

1Km Vaccination Post

In the above illustrative sketch map, two volunteers will conduct the house to house visits over 6
days labelled “Day 1 to Day 6” to cover their catchment area. Please note that their map:
▪ Has a scale to define the size of their catchment area;
▪ Provides physical features of the area that in turn inform the route or movement plans;
▪ Shows the available immunization service delivery points that they will also
communicate to the households at the time of the visit;
▪ Has visitation dates planned in such a way that volunteers do not have to move more than
3 kilometres each day;

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 ▪ Assures that all households will be visited.
In all areas the Red Cross should work in partnership with the local representatives of the
Ministry of Health by participating in district meetings and helping to coordinate plans within
targeted areas. In areas where house to house visits will be conducted, supervisors and
volunteers should be introduced to the local vaccination teams that they will be supporting.
Coordination and partnership between the Red Cross and the Ministry of Health is essential for a
successful campaign.

2.4. Field visits and data collection

While the purpose of house-to-house mobilization visits is to deliver first-hand information
about vaccination and diseases, this visit can provide additional information needed for better
planning and monitoring of control/elimination activities. Documentation of house-to-house
visits will provide:
▪ Demographic information about the target populations (numbers and distribution);
▪ Immunization uptake, especially routine vaccination;
▪ Knowledge, attitudes and practices about immunization;
▪ Information to evaluate the impact of the program.
The data collected during SM could be:
▪ SIA Information form (Annex 3)
▪ Survey - Assessing awareness of an upcoming SM (Annex 4)
▪ Volunteer form (Annex 5)
▪ Supervisor checklist (Annex 6)
▪ Supervisor summary form (Annex 7)
▪ Excel Data Analysis form
All documentation forms are listed in annexes section except for the data analysis form that is
only accessible online.
Before you leave the household, ensure that your respondent has an opportunity to ask questions
or raise concerns regarding supplemental immunizations. To kick start this question and answer
(Q&A session), a volunteer should ask: What information have you heard about immunization in
your community?
A frequently ask question (FAQ) is provided as an illustration, if the government provides a
similar sheet please use that in place (see Annex 8).

2.4.1. Format for Registration of Targeted Children for the SIA

During house-to-house mobilization visits, basic information about target population such as
household numbers and other data should be collected. The format for house-to-house
documentation to be used by all Red Cross Volunteers is in Annex 5.

2.4.2. House to House Register for Vaccination Campaigns

Complete at each household, record:
a. The contact information of the household head in the columns indicated;
b. The count of children in the household that are in the target age range for the vaccination
campaign;

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 c. Ask for all the child health or immunization card(s) and proceed to count and record how
many children aged 9-59 months have a documented record of a vaccination dose;
d. Ask and mark as appropriate if the parent or caregiver has heard about the vaccination
campaign;
e. If the parent or caregiver has heard about the vaccination, probe for the source of
information before the volunteer visits. Then record the number that corresponds with the
source of information as outlined at the bottom of the page;
f. Ask and record the intention of household to participate in the forthcoming vaccination
campaign;
g. Finally, record reasons for any refusal to participate in the planned or any previous
campaigns. You will then record the number that corresponds with the reason for refusal
as outlined at the bottom of the page. For example, record “1” if the reason for refusal is
fear of injections;
Use the reasons for refusal to provide counselling on advantages of supplemental vaccination
doses.

2.4.3. House Markings, If Used, for Visited Households

If house markings are used all households visited during the house-to-house visits for
vaccination campaigns, should be marked. The mark helps the supervision teams monitor
households visited without contacting the residents. Secondly, this helps to assure that the
household is not re-visited by a straying volunteer team in the neighbouring catchment areas.
After a visit a mark on the front of the main house in the households can be made using chalk.
To ensure that all house marks are similar, a circled V shall be used to denote that a household
has been visited. Depending on guidance from the government immunization program, the house
mark shall also specify which team visited the household and the number of children in the
target age range found as shown in the table below.

T(n) Where:
V T Stands for Team
X/Y (n) Team Number
X Number of children in the target age range
Y Total number of residents in the household

2.4.4. Summary of House-to-House Registers by the Local

Supervisor
At the end of each day, add up the total number of children in the target age range for the
campaign. A supervisor activity sheet and report that summarizes major data from the household
visits are provided in the Supervisor Summary form (Annex 7).

3. TRAINING FOR CONDUCTING A HOUSE TO HOUSE MOBILIZATION

Conducting house-to-house social mobilization for vaccination requires that volunteers (Red
Cross or other community resource persons) are equipped with the knowledge and skills to
communicate effectively the reasons for SIAs. Secondly, the house-to-house team members

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must have culturally and socially relevant behaviours that allow for dialogue in the households
visited. Specially, the house-to-house teams must be fully aware of the norms and practices in
the area to assure acceptance by household members.
Training, reinforced by supervision and reporting requirements, can increase health workers’
knowledge and improve technical and communication skills. Where there are educational,
cultural, and economic differences that prevent effective communication between health workers
and community members, health workers may require special training to recognize and
overcome these barriers.

3.1. Training of Trainers and House-to-House Teams

The most effective training method is to use a training module with guidelines for social
mobilization developed for this purpose. Such a module should include the following
components:
▪ Objectives of the campaign;
▪ Target group(s);
▪ Messages;
▪ Criteria for recruiting mobilizers;
▪ Functions of the mobilizers before, during and after the campaign;
▪ Sample of poster;
▪ Samples of any other visual materials;
▪ Recruitment criteria (some recommendations);
▪ Data collection.
The training should cover the following key topics:
▪ Why a vaccination campaign is going to be conducted;
▪ Target age-group for the campaign;
▪ Facts about disease control and especially vaccinations, including the proper age for
routine vaccinations;
▪ Mapping of the catchment area to ensure that all areas and households will be reached
before or during the campaign. The Red Cross coach or supervisor should review and
discuss maps shared by all neighbouring teams to ensure that there are no
misunderstandings or overlaps in areas to be covered by each team;
▪ Interpersonal communication skills for conducting a household dialogue on vaccination;
▪ House marking and monitoring of households visited;
▪ Documentation (household visit registration form, immunization screening and summary
reporting) for the house to house visits.
The trainer will follow a facilitator guide to provide the training.

3.2. Town criers

They are best trained using a different method. It is better for the mobilizers to contact them and
explain to them their responsibilities in one or two hours, which includes briefings on:
▪ The campaign objectives;
▪ What the targeted disease is, how to prevent it and why vaccinate against it;
▪ The target group that needs to be vaccinated;
▪ The main messages that were developed at central level;

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After they are briefed, town criers could decide on how they would express their oral message
and agree on a common format. Remember, sometimes mobilizers and town criers are
translating the main messages to a region’s specific language.

3.3. Supervisors
Supervision plays a major role in supporting positive health worker performance.
Supervisors can monitor performance and identify both successes and problems and then help
plan corrections. They can help health workers monitor the impact of their activities. Supervisors
also can make sure that system supports are in place. They should provide feedback to health
workers, coach them, model positive behaviour, and include interpersonal communication skills
in performance evaluations.
The recognition must be emphasized. Parents and health workers alike feel motivated when
others notice and praise good performance. Some countries formally recognize a fully
immunized child by using a rubber stamp to mark a seal of completion on the child’s vaccination
card or giving a diploma.
Consider community leaders as experts in their own culture tradition and practices.
Consider community empowerment approaches and dialogues that help community members
feel empowered to act and/or develop action plans to prevent or end the disease in their
community
▪ Do not preach, teach or blame. SM is all about building trust;
▪ Include children and vulnerable groups in developing and disseminating appropriate
messages and approaches;
▪ Identify activities and messages through community dialogues and household visits;
▪ Adopt participatory (two way) communication;
▪ Recognize and promote people in their community who continue to practice; behaviours
that stop the spread of the disease and who help others to do the same.

4. MESSAGES
4.1. Main messages
The Red Cross Volunteer delivers the information regarding vaccination.
In a campaign, it is very important to have a set of main messages. The following five main
messages are effective and should be communicated:
▪ There is a vaccination campaign;
▪ The vaccination against (e.g. polio, measles, rubella, YF, etc.) will be from _____to
_____;
▪ During the preventive campaign, all children (precise the age), pregnant women
(depending of the disease), adults will be vaccinated;
▪ Get vaccinated at the nearest health centre or vaccination post;
▪ Vaccination cards and vaccines are free.
Specific or support messages – such as safety, mode of administration, mode of transmission and
the vaccination calendar – should be administered through communication channels like radio

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programmes, theoretical questions and answers, social mobilization, home visits, town criers
and/or interpersonal communications.

4.2. Specific messages

Campaign participants need a set of complementary information about the target disease and the
vaccination process.
Mobilizers need to explain the details of the vaccination campaign to the population when they
visit schools, public places or homes. Journalists need to know what the disease is, why the
campaign is taking place and how the vaccines will be administered. Decision-makers,
politicians and religious leaders need to understand the logistics of the campaign and why they
are involved in it.

5. GETTING THE RIGHT COMMUNICATION CHANNELS

5.1. Getting the right Media Mix
Media mix or channels mix is half of the strategy. The other half is the messages, but there are
no general rules for this mix. We select a mix of media or channels based on different reasons:
▪ The characteristics of the channels (e.g. attractiveness, closeness, audio-visual);
▪ The population that they reach and the resulting impact;
▪ How effective they are at delivering the messages;
▪ The costs;
▪ How frequently they can be used;
▪ Attitudes towards the channels;
▪ Technical feasibility.
In countries that are mainly rural, and have very low income and low literacy, the most efficient
channel mixes are town crier + radio + short message service (SMS). Other media or channels
can act as a support.
In many countries, cellular phones were developed before the national landline networks
attained mid-level development. Therefore, the main phone is the cellular phone, with all the
communicational advantages that it provides.
Audio messages, recorded in local languages, may make up another important component of the
communication campaign. Illiterate or barely literate people had cellular phones in rural areas. A
short audio message in the local language allows it to be communicated as though the town crier
had reached cellular phones.
Radio could be very flexible in broadcasting theoretical questions and answers during different
stages of the campaign, such as:
▪ The definition of the vaccination and the five basic messages (see Section 4), plus
messages such as “the last dates to vaccinate are …” and “use this opportunity to …”;
▪ Secondary support messages (e.g. safety of the vaccine, mode of administration and why
the vaccination campaign is happening);
▪ “Target” messages, reinforcing the main message;
▪ Why there is a mass vaccination campaign, which can be incorporated into interviews,
the news or micro-programmes; and

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 ▪ Messages about adverse events following immunization – for example:
o In a few rare cases, adverse reactions may occur;
o Most of the adverse reactions are harmless (benign), and may include fever,
headaches, muscle pain, joint pain and itchiness occasionally, there are severe
allergic reactions, but they are rare (1 case for every 100 000 vaccines
administered) and their onset occurs within minutes of immunization. Patients are
advised to remain at the place of vaccination for at least 15 minutes after the
administration of the vaccine, and the vaccinator is equipped to manage any such
reactions;
o Most benign adverse reactions can be treated at the nearest health centre. A
mechanism for investigating and treating suspected cases of severe adverse
reactions has been set up in referral hospitals, regional and district hospitals, and
in health centres.
Radio spots and micro-programme messages need to be short and straightforward to promote
behaviour change. Instead of trying to explain the symptoms of the target disease, discuss all the
arguments in favour of the campaign using radio panel programmes, social mobilization,
interpersonal communication, news programmes and so on. The principle is simple: use short
formats for key messages and long formats for supporting messages.
Do not use megaphones unless you must, and do not use audio buses or t-shirts. Audio buses
have been used by political groups as social mobilization channels, but they are noisy and
unclear, and did not work well for vaccination campaigns). The megaphones are a waste of
money in a society where valuables disappear very fast and become used in other unrelated
activities, such as propaganda, parties and marriages. This publication refers to campaigns based
on health centres and vaccinations posts. Aprons are more adequate for vaccination campaign
and could be reused for the next campaigns.
Equally important as production is materials distribution. It is important to make a distribution
plan based on the population that needs to be reached and their geographical location, and to
follow up its implementation in a specific timeframe. Ensure distribution of materials from
district to the subdistrict. A campaign shows good distribution when all the districts and villages
have materials.

5.2. Media for Social Mobilization

To create awareness among the illiterates the communication media should be visual. Everybody
can follow the language of pictures. Sometimes if a message is disseminated verbally it is not
well accepted. The media for organizing social mobilization are:
▪ Song, Poem. Story;
▪ Poster, Leaflet, Banner, Signboard, Billboard;
▪ Loudspeaker;
▪ Rally;
▪ Radio, Television, Cinema, Newspaper;
▪ Popular drama.
Social mobilization is developed on certain key message. To make the message acceptable and
reliable to the mass people a variety of media require to be used.

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 5.3. Banners, Posters and Radio
Banners can be used as signals – for example, in the health centres where vaccination posts are
located.
Banners can also be used as informational tools; they could be placed on the main road of the
district, to spread the word about the vaccination campaign.

Posters, meanwhile, can be used as informational and motivational tools. They can be pasted in
schools, mosques, churches, health centres, markets, shops and other public places. Usually, a
poster shows the basic five messages (see Section 4) and invites people to get vaccinated.
Posters can also be used as a signalization tool (e.g. posted on a tree behind the rural vaccination
post).

For communication by radio, it is often best to provide the scripts to the radio stations at the
regional level. Local radios have their own recording resources, their own voices and their own
language style. They will produce their own versions in local languages. Only national radio will
do standardization in English or French.
It is very important to respect the local radios, for they are opinion-leaders in their regions. If
national standardized scripts are used, it is important that the language is appropriate. It is
usually more cost-effective to produce a local version. The most effective approach has been

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found to be a regional campaign using local radios, and a mix of radio spots, micro programmes
and press releases. The micro programmes could be useful for the local health authorities and
leaders to show their support for the campaign. Local radio costs much less than national radio.
The synergy between the two will impact not only the population, but the chiefs, religious
leaders and decision-makers.

5.4. Networks
5.4.1. Advocacy in social networks
Tips for advocating in social networks:
Social networks are considered the main communication channel in many countries, but there is
not much research about their structures. Therefore, it is necessary to assess social, political and
religious networks in these countries.
▪ Despite how well social networks are working during a campaign, it is necessary to
monitor the process;
▪ Get commitments from schools and the Ministry of Education. Keep schools involved in
spreading immunization messages. Promote the dissemination of messages through
teachers. Schools are ideal in reaching the target group;
▪ Involve schools and plan according to school hours. Crowds of young people and danger
for children can be avoided if the campaign is done in line with school hours. The mobile
posts should dedicate a certain amount of time to each school; in this way, thousands of
children and young people can be vaccinated. It is cost-effective, as a large group of
people can be vaccinated in a short amount of time;
▪ Improve the sensitization of women and youth social groups as socially organized
groups;
▪ It is important to continue outreach and sensitization activities into the hard-to-reach
areas, to ensure that vulnerable populations are reached.

5.4.2. Advocacy with the political networks

Suggestions for advocating in political networks include:
▪ Sensitization must be directed at local authorities and councils, as these are important
groups. There is a tendency to misunderstand these local advocacy meetings at different
administrative levels;
▪ As well as sensitization, it is important for the authorities to be vaccinated themselves
during the campaign. When people see leaders getting vaccinated, it reduces the risk of
resistance or rumours about the quality of the vaccine;
▪ Regional advocacy meetings alone are not enough, for there are prefectures and cantons
before you reach the village level, where the town criers should be found. They are the
main communication channels in rural and low-literacy areas. This is the way
information and commands spread in these societies; radios alone are not enough.

5.4.3. Advocacy with religious leaders

Tips for advocating with religious leaders are:

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 ▪ Religious and cultural leaders should also be specifically targeted for sensitization
through meetings and workshops. Muslim populations in many countries have been very
receptive to the campaign messages thanks to this kind of advocacy;
▪ The Ministry of Health should be involved in this aspect of the campaign by issuing a
communication to the religious leaders, showing the importance of the campaign and
advocating for the involvement of their followers;
▪ If it is possible, religious leaders should be encouraged to talk about the campaign during
religious services, on the radio and on television;
▪ Three channels that have been shown to work in a synergistic way are messages from
priests and pastors, posters in churches, and mobilizers in churches, referring people to
the vaccination posts;
▪ Usually Fridays and Sundays are religious days for Muslims and Christians. The
campaigns should use this opportunity to establish vaccination centres in mosques and
churches. A radio message stating that the vaccination will be held in the main mosques
and churches would help the outreach of vaccinators and mobilizers.
Annex 8 provides specific messages in a frequently asked question format.

6. MONITORING AND EVALUATING THE SOCIAL MOBILIZATION

CAMPAIGN
Monitoring and evaluation (M&E) are used to design interventions, measure progress toward
short- and long-term targets, and assess overall performance. The goal of M&E is to generate the
data and lessons learned that program managers need to conduct strategic planning; promptly
identify problems; appropriately allocate resources; and improve program quality, efficiency,
and effectiveness.
Key stakeholders such as NTPs, donors, and service providers often require different types of
data and evidence of how ACSM activities contribute to TB program objectives. Programs
ideally coordinate and streamline their internal M&E efforts to meet these competing demands
without duplicating data collection or conducting wasteful or repetitive analysis.

6.1. Difference between monitoring and evaluation

6.1.1. Monitoring
It refers to ongoing and routine collection, analysis, and reporting of program activity data,
usually by project staff. It tracks the actual results of a project against its projected results or
targets. Monitoring indicates if activities are happening as planned and if any changes are
needed in project implementation or resources.

6.1.2. Evaluation
It is less frequent yet more in-depth analysis of program performance that helps determine how
well the activities were implemented and what effects those activities produced. Evaluation
activities are designed to answer specific questions about program implementation or results at
different stages of the project. While monitoring shows if activities happened and when,
evaluation goes further to determine how the activities were conducted and what effects they
produced.

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Table 2 illustrates the key differences between monitoring and evaluation.
Table 2. Comparison of monitoring and evaluation.
Monitoring Evaluation
Action Routine collection and Periodic activity to answer
analysis of activity data. specific questions about
performance.
Frequency Ongoing Specific times in the project
Primary questions - Are we on track? - Are we doing what we
- How well did we had planned?
perform? - What effect did our
activities have?
Focus Program implementation Program effectiveness
Effective monitoring can often lead to evaluation. If routine monitoring reveals an unexpected
data trend, an evaluation could help understand what is happening and why.
An example of checklist and form for SM monitoring and supervision is provided in Annex 9.

6.1.3. M&E Plan

Monitoring and evaluation help collect the important details of what ‘s happened and document
the evidence of program successes. Creating and using an M&E plan helps ACSM programs
identify the story they want to tell and what information they need to tell that story.
An M&E plan is a “master strategy” for how programs plan to monitor and evaluate their
activities. A comprehensive M&E plan includes an M&E framework, indicators, guidance on
how to collect and analyse the indicators, a data quality assurance plan, a data use and reporting
summary, an evaluation summary, and a budget (Figure 1).

Each of these components contributes a different piece of a program’s ACSM story: Do not wait
▪ Framework: illustration of the story; until your
▪ Indicators: the best evidence for the story; activities are
planned and
Page 33 of 62 underway to
decide on an
M&E
strategy!
 ▪ Data collection: ways the evidence will be gathered;
▪ Data quality: accuracy and credibility of the story;
▪ Data use and reporting: who should hear the story and when;
▪ Evaluation strategy: in-depth description of what worked well and why;
▪ Budget: cost to develop and tell the story.
Example of an action plan at the local level is provided in Annex 10.
Monitoring and evaluation are an important part of the social mobilization campaign.
Example of Checklist of activities at district level
Activity District 1 District 2 District 3

Translate information, education and Well done Well done Well done
communication materials/ At local radio At local radio Radio
messages into local languages
Distribute IEC materials from the district to Well done Well done Well done
the subdistricts Well done Posters and Posters and Posters and
brochures brochures brochures
Sensitize religious/cultural leaders in Done Done Well done
meetings and workshops
Sensitize health subdistrict staff in meetings Done Well done Well done
and workshops
Sensitize councils Done Well done Well done
Sensitize women and youth social groups Done Well done Well done
Involve schools, disseminating immunization Done Done Done
messages, and disseminate messages by
teachers
Organize outreach Well done Well done Well done
Hold orientation workshops for health care Not done Not done Not done
workers to promote interpersonal
communications
Conduct film show in every subcounty Not done Not done Not done
IEC, information, education and communication.

6.1.4. Indicators
After developing an M&E framework, the next step in M&E planning is to select indicators to
measure the inputs, activities, outputs, outcomes, and impact of the interventions. Indicators are
the signs or markers that “indicate” a particular result occurred. By using indicators as a
consistent unit of measurement, data become more uniform and easier to compare over time.
Thus, it is possible to identify trends.
There are no standardized indicators to measure ACSM results, however there is a general
consensus on what ACSM is meant to achieve. These indicators should be for examples:
▪ Number of households covered during the SIA;
▪ Number of volunteers participating to the SIA;
▪ Number of vaccinations realized during the SIA.

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Table 4 provides examples of basic indicators that can be used to measure the overall results of
different ACSM activities.
Table 4. Common outcome indicators in ACSM (example for TB).

Expected result Possible indicator

Supportive policy environment for TB. MOH approves community-based TB

Improved media coverage of TB.
Decreased stigma.
Communication
Increased awareness about TB.
Improved quality of TB services.
Decreased stigma.
Social Mobilization
Increased awareness about TB.
Increased demand for diagnosis and
treatment services.
Improved service delivery.
Enhanced sustainability and community
ownership of TB services.
services.
Percentage of articles about TB in national
daily newspaper with correct information.
Percentage of population reporting
stigmatizing attitudes toward people with
TB.
Percentage of population with correct
knowledge of TB symptoms and services.
Percentage of patients reporting positive
experiences with DOTS providers.
Percentage of health care workers reporting
stigmatizing attitudes toward TB patients.
Percentage of population with correct
knowledge of TB symptoms/services.
Number of people with TB symptoms
arriving at DOTS facility for diagnosis.
Number of people with TB symptoms with
two sputum smear test results.
Number of CBOs providing TB treatment
support services.

6.1.5. Data Quality of data collected

An M&E plan should describe what measures will be taken to ensure that collected data are
accurate, complete, and unbiased.
High-quality results begin with selecting and clearly defining indicators. Data will be more
consistent when all program staff and partners agree on common definitions and reporting
procedures from the beginning. Complete indicator descriptions also help promote quality and
consistency when there are changes in staffing or reporting responsibilities.
There are five basic elements of data quality, which are like the characteristics of strong
indicators. Data should fulfil the following criteria:
▪ Valid: The data represent what happened;
▪ Reliable: Everyone collects and interprets the indicators in the same way, using the same
data sources and methods of calculation;
▪ Precise: Data and indicator descriptions have enough detail and the units of measurement
are very clear;

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 ▪ Complete: Primary data sources include all the values needed to calculate indicators, and
no values are missing;
▪ Timely: Data are consistently collected and reported according to internal and external
deadlines. Data are analysed frequently enough to be useful in management decisions.
Another issue related to data quality is integrity. Integrity means that data are true, safe from
deliberate bias, and have not been changed for political or personal reasons.
To be proactive, make routine verification of data an expectation from the beginning. Integrate
random verification checks into standard supervision practice and ensure that everyone’s data
are routinely verified as part of the M&E system. Include guidance on how to verify data in all
indicator descriptions.
Table 8 offers some examples of how to verify the quality of data for common ACSM activities.
Table 8. Ensuring data quality for ACSM monitoring.
Type of monitoring data Quality assurance strategy

Mobile phone records of a networking Verify a 10% random sample.

intervention.
Audience participation log for radio spots. Conduct a listening audit of a 10% sample
Crowd estimates for social mobilization Compare with independent media estimates
events.
Dissemination statistics for t-shirts, posters, Periodic audits of materials at distribution
and calendars for a communication effort. points
List of participants at ACSM training Verify a 10% random sample.
events.
A clipping service provides media coverage Request to review a 10% random sample.
statistics.
Signature counts on petitions. Verify a 10% random sample
Routine data collection can generate poor-quality data if program staff are not properly
supported and data review is not part of routine supervision. Poor data are less likely to be used
if managers do not trust the results. This wastes the resources used to collect the data in the first
place. Regardless of the specific strategies chosen, programs with a robust commitment to data
quality consistently utilize the following three practices in their routine monitoring.

6.2. Training on indicators, data sources and data collection

6.2.1. Staff training
Adequately and frequently train all relevant staff on indicator definitions, data sources, and data
collection procedures. This greatly improves reliability and precision. Training should include
exercises with “practice” data so that M&E officers and other staff who report data understand
the indicators and how to collect, analyse, and report them.

6.2.2. Supportive supervision

Reinforce initial training through ongoing supervision and feedback. During a site visit, a
supervisor should review volunteer form, supervisor summary forms, or other data collection
records for completeness and accuracy using a standard supervision checklist of key variables.

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Always conduct supportive supervision at regular, frequent intervals. Problems become more
difficult to correct the longer they remain undiscovered. Repeated, consistent supervision
strengthens staff capacity, quickly identifies weak spots, and stresses the importance of having
complete and timely data to manage the program effectively.

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REFERENCES
CROIX ROUGE (CR) – Mobilisation sociale dans la vaccination
eCBHFA Volunteer manual, module: Community mobilization
Ebola communication preparedness implementation kit 2015
http://ebolacommunicationnetwork.org/wp-content/uploads/2015/09/Ebola-Comm-
Preparedness-Kit.pdf
Field Manual for House-to-House Social Mobilization for Measles and Measles/Rubella
Supplemental Immunization Activities (SIA) and Routine Immunization
World Health Organization (WHO) Global Routine Immunization Strategies and Practices
(GRISP).
http://apps.who.int/iris/bitstream/handle/10665/204500/9789241510103_eng.pdf?sequence=
1
World Health Organization (WHO) Immunization in Practices, a practical guide for health staff,
2015 update.
http://apps.who.int/iris/bitstream/handle/10665/193412/9789241549097_eng.pdf?sequence=
1
Organisation Mondiale de la Santé (OMS) – Communication et mobilisation sociale dans les
campagnes de vaccination contre la fièvre jaune – 10 points basés sur l’expérience de
terrain.
http://apps.who.int/iris/bitstream/handle/10665/156055/WHO_HSE_PED_CED_2015.1_fre.
pdf;sequence=1
USAID – Social Mobilization – Lessons from the CORE Group Polio Project in Angola, Ethiopia,
and India, 2012. https://coregroup.org/wp-content/uploads/media-
backup/Polio_Initiative/smreport-online.pdf
USAID – Guide to monitoring and Evaluation of advocacy, Communication and social
mobilization to Support Tuberculosis Prevention and Care, 2013.
https://path.azureedge.net/media/documents/TB_acsm_me_guide.pdf
USAID Overview of Advocacy, Communication and Social Mobilization
World Health Organization (WHO) Planning and Implementing High Quality Supplementary
Immunization Activities for injectable Vaccines, Using an example of Measles and Rubella
Vaccines – Field Guide, 2016. http://www.who.int/immunization/diseases/measles/SIA-
Field-Guide.pdf
World Health Organization (WHO). Communication for Behavioral Impact. Geneva: WHO;
2012. Available at:
http://www.who.int/ihr/publications/combi_toolkit_outbreaks/en/index.html.
World Health Organization (WHO) – Communication and social mobilization in yellow fever
mass vaccination campaigns – 10 points from field experience

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 http://apps.who.int/iris/bitstream/handle/10665/156053/WHO_HSE_PED_CED_2015.1_en
g.pdf?sequence=1
World Health Organization (WHO). A Guide to Monitoring and Evaluation for Collaborative
TB/HIV Activities. Geneva: WHO; 2009. Available at:
http://www.who.int/hiv/pub/tb/hiv_tb_monitoring_guide.pdf.
World Health Organization (WHO). Compendium of Indicators for Monitoring and Evaluating
National Tuberculosis Programs. Geneva: WHO; 2004. Available at:
www.who.int/tb/publications/tb_compendium_of_indicators/en/index.html.
World Health Organization (WHO) – Microplanning for Immunization Services using RED
Strategy, 2009. http://www.who.int/immunization/documents/RED-strategy-
document.pdf?ua=1
WHO recommendations for routine immunization - summary tables
http://www.who.int/immunization/policy/immunization_tables/en/index.html.

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ANNEXES
Annex 1 – Disease preventable by immunization
Disease Agent Affected Transmission Symptoms Vaccines Prevention
Population

Diphtheria Toxin-producing People all ages From person to sore throat, loss of Pentavalent or maintain a high
bacterium person in airborne appetite and mild DTP for infants level of
(Corynebacterium droplets fever immunization in
diphtheriae) the community
Meningitis Haemophilus Children under from person to pneumonia and Hib Hib-containing
and influenzae type b, Two years of age person in droplets meningitis combined with vaccine given in
pneumonia bacterium in developing DTP and HepB infancy or before
caused by countries vaccines, or 24 months of
Haemophilus pentavalent age.
influenzae vaccine
type b disease (DTP+HepB+Hib),
Hepatitis B Virus Children and contact with fatigue, nausea, Hepatitis B Early vaccination
adults blood or other vomiting, abdominal (HepB) or at birth is
body fluids pain and jaundice combination important
from an infected (yellowing of the (pentavalent or
person skin and eyes) quadrivalent
DTP+HepB)
formulations
Human Virus Females Sexually a bivalent vaccine Vaccination of
Papillomaviru transmitted. Skin- (HPV types 16 and females aged
s infection to-skin contact 18) and a nine to 13 years
and cervical quadrivalent Condom use
cancer vaccine (6, 11, 16
and 18)

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Disease Agent Affected Transmission Symptoms Vaccines Prevention
Population

Japanese Virus People all ages By mosquitoes flu-like, with sudden Inactivated Vero Vaccination
encephalitis onset of fever, chills, cell-derived
headache, tiredness, vaccine
nausea and vomiting Live attenuated
(weakened)
vaccine
Live recombinant
vaccine
Inactivated mouse
brain-derived
vaccine
Measles Virus Children from person to high fever Measles- vaccination
person containing
through sneezing, vaccines (MCVs)
coughing and
close personal
contact
Meningococca bacterium young children, from person to sudden onset of Polysaccharide Immunization
l disease but older children person via intense headache, vaccine (Bivalent,
and young adults airborne droplets fever, nausea, Trivalent,
living in crowded vomiting, sensitivity Quadrivalent)
conditions can to light and stiff neck Polysaccharide-
also be at high protein conjugate
risk vaccine
Mumps virus children of by airborne Pain on chewing or in combination Immunization
between five and droplets swallowing. with measles and
nine years of age Fever and weakness rubella vaccines
and adults (MMR)
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Disease Agent Affected Transmission Symptoms Vaccines Prevention
Population

Pertussis Bacterium Infants and young from person to symptoms similar to in combination Immunization
(Bordetella children person in droplets a common cold with diphtheria
pertussis) produced by appear and tetanus
coughing vaccines (as DTP)
or sneezing
Pneumococcal Bacterium Infants and from person to Fever and shaking or PVC vaccine Vaccination
disease elderly people person by chills
coughing,
sneezing or close
contact
Poliomyelitis Poliomyelitis children of less by the faecal-to- minor illness, usually OPV live Vaccination
virus – serotypes than five years of oral route with fever, headache attenuated
1, 2, 3 age and sore throat (weakened)
poliovirus vaccine
IPV inactivated
poliovirus vaccine
Rotavirus Virus infants of by the faecal-to- mild loose stools to rotavirus vaccines
gastroenteritis between three and oral route severe watery (RV)
12 months of age diarrhoea and
vomiting leading to
dehydration.
Rubella and Virus Children, adults in airborne mild fever, rubella vaccine Vaccination
congenital and pregnant droplets conjunctivitis (more
Rubella women to foetus often in adults) and
syndrome swollen neck lymph
nodes may occur
Seasonal Virus Children under in droplets and fever, cough, sore trivalent vaccines, Annual
Influenza five aerosols released throat, runny nose, containing two vaccination
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Disease Agent Affected Transmission Symptoms Vaccines Prevention
Population

years of age, headache and muscle strains of influenza particularly for

pregnant women, and joint aches A and one strain of high-risk groups
the elderly (over influenza B
65 years of age)
Tetanus Toxin-producing people of all ages from person to muscular stiffness in Tetanus toxoid immunizing
bacterium person the jaw (trismus or vaccine (TT), also women of
(Clostridium lock-jaw) is a available in reproductive age
tetani) common pentavalent, DTP with
first sign of tetanus and dT/DT tetanus toxoid,
combinations. either during or
before pregnancy
Tuberculosis Bacterium People of all ages from person to general weakness, BCG vaccine Vaccination
(Mycobacterium person weight loss, fever before 12 months
tuberculosis) and night sweats of age
Yellow Fever virus people of all ages mosquitoes include Live attenuated Immunization
fever, muscle pain, (weakened) virus
shivering, loss of vaccines
appetite, nausea and
vomiting, congestion
of the
conjunctivae and
face and a relatively
slow heart rate
during fever

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Annexes 2 A and B – SIA strategies
Annex 2A Fixed or Mobile Posts with H2H Strategy

2A - FIXED OR MOBILE POSTS WITH HOUSE TO HOUSE STRATEGY

Strategy description
This vaccination strategy is only recommended in areas where the communities may be
hesitant about vaccination or need additional motivation in order to seek vaccination. This
strategy can also be helpful in reaching the urban poor and migrant populations.
This vaccination strategy with added social mobilization element involves the use of an
additional trained volunteer/community mobilizer (referred to as a “canvasser”) who goes
house-to house informing caregivers about the SIA. She/he works in coordination with the
personnel at the vaccination post. Therefore, the full vaccination/canvassing team includes a
volunteer canvasser going house-to-house and the vaccinator(s) and an additional volunteer(s)
who remains at the vaccination post. There should be one supervisor for every four
vaccination/canvassing teams.
The geographic area of responsibility of the house-to-house canvasser should match that of
the vaccination teams. A trained canvasser conducts visits to around 50 to 100 households
with eligible children in a defined area for the duration of the post during the SIA. In most
cases there is one house-to-house canvasser in the area of responsibility of each team. As the
canvasser should be a member of the community being vaccinated, there may be a need for
training several canvassers per vaccination team but only one canvasser will be working in any
given area. Some countries have specific community canvassers for performing household
visits during SIAs and routine immunization. If these are successful, the countries should
continue with their own approach.
Canvassers must be able to read and write and should be selected from the local community.
Prior to each vaccination day, canvassers will receive workplan sheets to track progress, a map
of the designated neighborhoods to be visited, and a form to indicate the number of houses
visited and the total number of eligible children in the area. Visits should be planned so that
the canvasser does not cover more than 3 to 5 km daily. If complete and accurate maps are
not available, simple diagrams showing the limits of the designated neighborhood should be
provided. An example of such diagrams is shown below. The diagram should include
the following:
• approximate size of the catchment area;
• labelled area to cover in a day;
• useful landmarks in the area to inform the route and movement plans

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Household visits
1. During each visit, the canvasser should do the following:
▪ courteously introduce himself/herself as a health centre (SIA) volunteer, and explain
the reason for the visit;
▪ seek informal consent of the household head to discuss the immunization status of the
children;
▪ inform the head of household about the disease, its control, and need for vaccination
(the messages should be short and concise, e.g. what vaccine will be administered/
why it is important, and should stress the importance of routine vaccination and the
need to have each child fully vaccinated);
▪ determine the number of children eligible for the SIA;
▪ encourage the head of household to bring all eligible children to the SIA vaccination
post – emphasize times, dates, and location of nearest vaccination post;
▪ when leaving the household, mark the main door with chalk or a pre-printed sticker,
with the date of the visit and any other marking agreed by the country.
2. Fill out the house-to-house canvassing form indicating the number of houses visited, the
total number of children in the target age group in the area covered.
3. Report any household in which caregivers refuse vaccination to the vaccination team and
supervisor, so she/he can visit the houses and provide further advice.
Responsibilities of the vaccination/canvassing team supervisor
There is one supervisor for four vaccination/canvassing teams. The supervisor should use the
same maps/diagrams as the canvasser. The responsibilities of the supervisor include:
1. checking the vaccination activities at each of the four assigned vaccination posts 3);

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2. checking the work of each house-to-house canvasser:
a. assessing every day that each of the canvassers have completed all household visits in
the assigned area, by checking the house-to-house canvassing forms and doing spot
checks on some of the houses to verify that they were visited and marked;
b. if possible, revisiting all houses in which the canvasser reports that the family refuses
vaccination;
c. providing feedback to the responsible next-level supervisor regarding the need (or
not) to keep teams in the same area the following day.
There are a number of variations of the canvassing approach, and every country may have a
preferred procedure. An ideal scenario is for the canvasser to count the SIA-eligible children in
each household, or even write down their names, to share with the vaccination team so they
can confirm that they have been vaccinated. Although this can substantially increase the
workload of the canvasser and the vaccination team, it can be used in places with a sufficient
number of volunteers. Additionally, canvassers can record the vaccination status of all age
appropriate children within the household, to help identify zero dose children for future follow
up through the routine immunization programme. Such thorough approaches to canvassing
have been used successfully in some countries in the African Region.

Annex 2B - H2H Strategy

2B – HOUSE TO HOUSE VACCINATION

Strategy description
The house-to-house vaccination strategy involves a two-person vaccination team (usually one
health worker who administers the vaccine and one volunteer), conducting at least one visit to
all households in a defined area each day. The vaccination team will administer vaccine to all
eligible children directly and mark the door of the house accordingly.
This strategy is best used as a mop-up strategy for areas shown by RCM to have people
refusing vaccination as it provides an opportunity for informative dialogue. The vaccination
team must be well trained to avoid vaccination-related errors and the multi-dose vial policy
should be applied according to the national policy.
Given the effort and distances involved, the use of this strategy means that vaccination teams
will be able to vaccinate fewer (approximately 50 to 75) children per day, rather than then
expected 100 to 150 in urban or 75 to 100 in rural areas for temporary and mobile teams. As
with house-to-house canvassing, it requires strong supervision: one supervisor for every four
vaccination teams (depending on the setting).
The geographic area of responsibility of the house-to-house vaccination team must be clearly
defined and made available to the vaccination teams and the supervisor.
Responsibilities of the house-to-house vaccination team
The responsibility of the team is to visit all households in the assigned geographic area,
vaccinate all eligible children found, appropriately mark all households, and return to any
households with remaining unvaccinated children to vaccinate them.
Each vaccination team should be provided a map/diagram of the catchment area, which, if
possible, includes a scale to define the size of the area, any prominent physical features that

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inform the route or movement plans, and have visit dates planned in such a way that the
vaccination team does not have to cover an area larger than 3 km2 each day.
Household visits
During each visit, the vaccination team should do the following:
1. courteously introduce themselves as health workers and/or a health centre (SIA)
volunteer, as appropriate, and explain the reason for the visit;
2. ask the parent or caregiver about the immunization status of their children;
3. inform the parent/caregiver about the benefits of vaccination, and encourage the family to
vaccinate all children, including in the routine immunization programme;
4. determine the number of children in the household eligible for the SIA;
5. vaccinate them all, if present;
6. fill out the SIA vaccination card or immunization card, ensuring that SIA doses are not
recorded as routine doses, for each vaccinated child;
7. when leaving the household, mark the household with the date of visit and indicate if a
revisit is needed (either because the eligible children were absent at the time of the visit or
the caregivers are refusing vaccination or it is unknown if there are eligible unvaccinated
children);
8. record any households refusing vaccination and inform the supervisor that further
assistance is needed (GPS equipment may be used to record the specific location of
households refusing vaccination).
Ensuring safe vaccination in house-to-house vaccination strategy
The best approach is to use single-dose vials. If single-dose vials are not available, and
multi-dose vials (5, 10, or 20 doses) are being used, the options to avoid safety issues
are the following.
a. Once a vial is opened in a household, the vaccinator stays and continues to vaccinate
at this site, while the volunteer visits the houses nearby to bring other eligible children
for vaccination. Once the vial is finished, the team moves to the next unvisited house. In
this case, the houses from which children are brought for vaccination should be marked
appropriately.
b. If there are no eligible children living nearby, and if there are concerns about vaccine
safety, it may be advisable to discard the open vial rather than move from house to
house with an open vial.
Responsibilities of the house-to-house vaccination supervisor
There should be at least one supervisor for every four house-to-house vaccination teams.
His/her responsibilities include:
1. overseeing the vaccination activities of each of the four vaccination teams assigned
him/her
2. checking the proper marking of the households using spot checks;
3. assessing daily that the four assigned teams have completed all household visits, including
repeated visits to households with unvaccinated eligible children;
4. revisiting all houses marked as having unvaccinated children at the end of the day,
regardless of repeated visits by the house-to-house vaccination team, and attempting to
encourage vaccination;
5. using the findings to advise corrective actions (e.g. best times for vaccination in the area).

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Annex 3 - SIA Information Form
American Red Cross: Information Form for SIAs Receiving Red Cross Support
DESCRIPTIVE INFORMATION FOR THE SIA PLEASE PROVIDE ANSWERS BELOW
1. Name of Country
2. SIA Antigen (M, M/R, MMR)
3. Other SIA ‘Add-Ons” (e.g. Vitamin A, bed nets, deworming)
4. SIA Start Date: Year / Month / Day
5. SIA End Date: Year / Month / Day
6. Is the above vaccination activity National or Sub-National?
6A. If Sub-National, what are the names of the main geographic
areas that are targeted?
7. Target Age Group
8. Target Population for this SIA
9. National MCV1 Coverage from WHO Data
10. Year of WHO data for above MCV1 coverage
11. Specify designation used to refer to the following subnational levels:
11A. 1st: (Region, Province, State, County, Other)
11B. 2nd (District, health zone, Wareda, Other)
RED CROSS SUPPORT
12. Am Cross Total Funding in US$
12A. What are the names of the geographical areas supported by
RC society house-to-house social mobilization activities?
13. Total number of volunteers
14. Total number of households visited
15. If revisited, total number of households revisited
POST SIA INFORMATION
16. NID or SNID total administrative coverage
17. Was survey performed? Yes / no
18. If yes, NID or SNID total coverage by survey
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 19. Any comments?

20. Subnational Level Detailed Information: Select two or more comparison subnational levels as ‘controls’ to compare program impact.
‘Control’ areas should be as comparable as possible to Red Cross supported areas (i.e. urban vs. rural, socioeconomic status, anticipated
maternal education, ethnic groups.)
Name of Name of 2nd MCV Target Targete If yes, % If yes, # If yes, # Number of % of %
1st Subnational 1 % Populat d for of the Volunteer or % of Target Target Coverage
Subnation Level ion RC entire s households Population Population (Based on
al Level Support administ visited Vaccinated Vaccinated Survey
? Yes / rative (Based on (Based on Data, if or
No area Admin Admin when
targeted Data) Data) Available)
Red Cross Supported Areas
Yes

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‘Control Areas’ Not Supported by Red Cross
No

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Annex 4 – Survey - Assessing awareness of an upcoming SM
A survey is useful for assessing whether social mobilization efforts are effective, particularly in
high-risk or hard-to-reach populations. Spot-check surveys should begin 2 weeks before the SM,
allowing enough time to rectify any problems identified. Supervisors/monitors should also make
this assessment as part of the SM Readiness Assessment Tool used each week in the 2 weeks prior
to the SM. In each neighbourhood of interest, it is recommended to interview five
parents/caregivers of SM-eligible children. Interviews can take place at households, markets, bus
stops, etc

Date: ___/___/______ Interviewer:_________________Supervisor: _______________

Town: _____________ Neighbourhood: ____________ District: ________________

PARENT/CAREGIVER 1 2 3 4 5
Do you know that measles and rubella vaccine can save Y/N Y/N Y/N Y/N Y/N
the life of your child?
Do you know the dates of the SM? Y/N Y/N Y/N Y/N Y/N
Do you know which age groups will be vaccinated? Y/N Y/N Y/N Y/N Y/N
Do you know where the nearest vaccination post will be Y/N Y/N Y/N Y/N Y/N
located?
Do you know which hours you can take your child to be Y/N Y/N Y/N Y/N Y/N
vaccinated?
How did you learn about the SM?
1. Health worker/volunteer
2. Radio
3. Television
4. Poster, banner
5. Neighbour
6. Other source
7. Never heard

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Annex 5 – Volunteer Form

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Page 53 of 62
Annex 6 – SUPERVISOR CHECKLIST

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Annex 7 – SUPERVISOR SUMMARY FORM

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Daily OTHER key observations

DAY 1: DAY 2

DAY 3 DAY 4

DAY 5 DAY 6

DAY 7 DAY 8

DAY 9 DAY 10

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Annex 8 - Specific messages in a frequently asked question format
This questionnaire needs to be adjusted depending of the targeted disease.
What is <name of the Disease>?
<name of the Disease> is one of the most dangerous of all childhood diseases. <Describe the
signs of the disease>
What causes the disease?
<name of the Disease> is caused by <complete according the disease>. It cannot by seen with
the naked eye. Children who suffered from <name of the Disease> cannot get it a second time.
Most children who have been immunised against the diseases at the right age will not get them.
Why are <name of the Disease> dangerous disease?
<Provide an explanation>
Is it important to immunise children during the vaccination campaign?
Yes - It is very important to bring children for the extra <name of the Disease> injection.
Children who miss the immunisation might not be fully protected against the <name of the
Disease> <Virus or Bacterium>. All children in the targeted age range should be vaccinated,
even if they are ill.
I heard that the parents or guardians of children must sign a consent form before a child
can receive the extra <name of the Disease> immunisation. Is it true?
If a child is to be immunised at a school or creche where the parent is not present when the
immunisation is given, a consent form may be given to parents or guardians of children in
creches, day care centres and at schools in advance. It provides an opportunity to inform parents
or guardians about the extra <name of the Disease> injection.
In this case, if you agree to this immunisation, please complete and sign the form and send it back
to the school or creches. Your child will then receive the immunisation if consent forms are signed
and returned on time!

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Annex 9 - Checklist and form for SM monitoring and supervision
VACCINATION TEAM SUPERVISORS
Who: Selected from among local health staff experienced with immunization
programme activities, including SIAs. On average, one supervisor is needed
per four vaccination teams. In urban settings where the distance covered to
reach each team is small, one supervisor can supervise more than four teams;
in rural settings each supervisor can supervise fewer teams.
Responsibility: Supervision of the vaccination teams. Supervisors visit teams daily to ensure
they are performing according to SM guidelines and the local microplan, that
daily tally sheets and other forms are properly completed, that any
challenges that arise during implementation are being addressed, and ensure
efforts are made to reach every child.
Activities: Visit vaccination teams, at least once per day, for supportive supervision
using the supervision checklist. Compile vaccination team reports analyse
them and report to higher level; give attention to areas at risk of not reaching
entire targeted population. Attend and contribute to daily review meetings.
Review team performance and undertake corrective actions if needed.
Report to: SM coordinating team lead, specifically the health centre-level supervisor (i.e.
health centre coordinator/EPI chief) or district supervisors (this will depend
on the country’s health system structure).

Province/Region: __________ District: ____________ Subdistrict (area): _____________

Date of supervisory visit: __/___/____ Day of SM: ________________

Name of person completing supervisory visit: _____________________________________

NAME OF VACCINATION POST YES/NO ISSUES IDENTIFIED CORRECTIVE ACTION

(and person
responsible)
Social Mobilization
Post clearly identified by banner or
other means
Health workers/volunteers actively
search for unvaccinated children, and
direct them to vaccination post
Health workers explain to caregivers
about the vaccine and possible side-
effects
Recording and use of data
Tally sheets correctly completed
Number of vials used, and children
vaccinated as per tally sheet match
(wastage between 5 and 20%)
Zero dose children properly accounted
for (if the corresponding tally sheet was
used)

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Annex 10 - Example of an action plan at the local level
Time schedule
No. Activity Tasks Target Responsibility Output 26 3 10 17 24 31 7 14
group Apr May May May May May Jun Jun
1 Define the Select Mobilizers Focal point IEC ×
communication Recruit responsible
responsibilities by districts
for each and villages
community
2 Explain the Define main Mobilizers Focal point Messages × × × ×
message to messages and town known and
disseminate to Produce print criers agreed to
all of the copies and
mobilizers and distribute
town criers
3 Social Organize Communities Mobilizers Message
mobilization at meetings Recruit transmitted to
district level town criers the
Broadcast radio population
Programmes
4 Involve local Have IEC Local Regional Political ×
authorities in the meetings authorities authorities’ support and
organization of Focal point active
the campaign participation
of the
authorities
5 Involve Make contacts Traditional Focal point Participation x x x x
traditional chiefs Have meetings chiefs and of traditional
and religious religious chiefs
leaders leaders Advocacy

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 Time schedule
No. Activity Tasks Target Responsibility Output 26 3 10 17 24 31 7 14
group Apr May May May May May Jun Jun
from religious
leaders
6 Brief local Identify local Local radio, Mobilizers Messages x
media and radios and theatre Focal point disseminated
channels channels groups, through local
Provide them social media,
with scripts and organizations channels and
information organizations
Organize
informational
workshops
7 Town criers Calculate how Communities Local IEC Communities x x x
many town committees will be
criers will be Informed
needed about when
Recruit them and where to
Provide them go to get
with information vaccinated
and support
Confirm the
message to be
transmitted
8 Batteries for Calculate the Mobilizers Focal point Town criers x x x x x
megaphones needs. and
Enter them into mobilizers
the micro with
planning functional
megaphones

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 Time schedule
No. Activity Tasks Target Responsibility Output 26 3 10 17 24 31 7 14
group Apr May May May May May Jun Jun
Fill the
megaphones
Distribute them
in a strategic
way
9 Banners Plan the quantity Communities Mobilizers Population x x x x x
of banners will be
necessary for the informed
district about the date
Put them at the and the target
entrance of the group of the
district and in vaccination
front of health
centres
10 Disseminate Identify the Local Focal point Population x x x x x
information in radios Communities Mobilizers will be
national Get the scripts informed
languages at translated into about the
local radios the local campaign
languages
Disseminate
11 Distribution of Paste posters Population Mobilizers Population x x x x
posters, flyers Distribute flyers will be
and other print informed
materials about the
campaign
IEC, information, Education and communication

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