Anatomy of a Consultancy: Reversing Moldova’s Decline in Immunization

By Paula Claycomb and Tess Stuart

Editor’s Note:

Rain Barrel has deepened its expertise around behavior and social change policy development through a series of contracts, mostly through UNICEF and its Communications for Development (aka C4D) staff. Our consultancies have involved intense interactions with UNICEF country offices and governments in Nepal, Timor Leste, Kyrgyzstan, South Sudan, Pakistan, and most recently, the Republic of Moldova.

Paula Claycomb and Tess Stuart, two of our top consultants in Behavior and Social Change Communication, recently completed the second phase of their consultancy with Moldova and filed this report (for a description of what Rain Barrel offers, go to our service category page). We believe our audience will be interested in their brief summary of the process around strengthening Moldova’s flagging immunization programs. It is a continuation of the November 2016 note that we posted in The Flow on the first phase of Rain Barrel’s support to the government and UNICEF to increase demand for immunization.

Our most recent task was to devise a strategy for public health authorities in Moldova to help restore its immunization rates to previously high levels. Over the past decade, Moldova has seen steady improvements in many indicators related to the well-being of its children. Immunization rates, in contrast, have declined despite government awareness that immunization is a key public health intervention to prevent infectious diseases. Indeed, the Government recognizes that immunization is “the best public health investment that contributes to social equity, and the social and economic stability of the family and society.”

Since 2007, full coverage of infants, children and even adolescents has been slipping. The MMR vaccine, for example, which prevents measles, mumps and rubella is now at less than 88 per cent coverage of children aged one year or older. The coverage rate for rotavirus vaccine, which helps prevent diarrhea, is even lower at 70 per cent.

Mindful of the dangers to children and adults alike if the country does not reach and maintain “herd immunity”, UNICEF, supported by the Ministry of Health and its National Center for Public Health, contracted Rain Barrel Communications to develop a long-term, multi-faceted communication strategy.

“Herd immunity”, also known as community immunity, occurs when the vaccination of a significant portion of a population (targeted at 95 per cent) provides a measure of protection for individuals who have not developed immunity.

Since last October, Teresa and I have had the special opportunity to get to know a small but important cross section of Moldovans. These included a Moldovan communication expert, Dorina Andreev, as well as doctors, communication specialists, civil society activists, media and social media professionals, religious leaders and even some mothers. They are dedicating time and effort to pull together a communication strategy that will involve many players in the campaign to increase the immunization level to 95 per cent by the end of 2020.

Our first visit in November 2016 looked at the reasons for the decline in immunization levels. On the supply side, we identified weaknesses in the health system, notably in providing support to family doctors and allowing other health professionals to spend the time that parents may require to understand how vaccines work and what the official schedule is. In addition, the health system has not systematically sustained an effort to create public awareness, or to advocate with members of parliament and ministers.

Equally important, on the demand side, mothers, fathers, grandparents and other caregivers do not always receive the information they need to make the decision to have their children immunized. In the absence of key information from their doctors, some parents seek answers on the Internet or speak with parents who sometimes have refused vaccination for various reasons. Few efforts have been made to respond to anti-vaccination sentiments. We know that these same conditions exist in the United States and may be exacerbated in the coming years, as the (which?) administration may be adopting an “anti-vax” approach, as unscientific as it tends to be.

With these concerns in mind, our consultations and research concluded that using many channels to communicate key messages with specific groups of people would be the appropriate approach. We proposed that they use individual and group behavior change theories that have proven successful in recent decades. The result is a multi-faceted communication strategy that involves everyone from health and media professionals to parents and their children and adolescents.

The strategy will disseminate strong, clear messages across communication channels like mass media (TV, radio, newspapers and magazines), social media (Facebook, Twitter) and the Internet. These channels will be supplemented with traditional print materials like posters, pamphlets and billboards and, importantly, interpersonal dialogue through community forums, religious gatherings, refresher courses for doctors.

Coming in at just over $1 million over the four-year period, the cost of implementing this communication strategy is modest. The cost of inaction is much greater, as many of the vaccine-preventable diseases are highly contagious, Neighboring countries have already experienced measles outbreaks and health officials hope to avoid similar outbreaks in Moldova.

In the coming months and lasting through 2020, the policy makers envision a country mobilized to protect all its citizens through immunization. About 38,000 babies are born every year in Moldova and the goal is that they should all receive their vaccines on time.

Though Rain Barrel’s work on this communication strategy is ending, we will follow the progress of Moldova in raising its immunization levels. We look forward to congratulating Moldova in 2020 or earlier on having attained the 95 per cent goal.