Behavior Profile: Urban Immunization
Reduce maternal and child mortality
Urban caregivers complete a full course of timely vaccinations for infants and children under 2 years
In urban areas, percentage of children 12-23 months who received all 8 basic vaccines

Behavior Analysis

Strategy

BEHAVIOR AND STEPS

What steps are needed to practice this behavior?

Urban caregivers complete a full course of timely vaccinations for infants and children under 2 years

  1. Accept first course of vaccinations at birth
  2. If not a facility birth, seek vaccination within 7 days of birth
  3. Mobilize transport, resources, and logistics to attend immunization sessions or appointments
  4. Seek immunizations on schedule from a qualified provider
  5. Complete all immunizations per age requirements

FACTORS

What factors may prevent or support practice of this behavior?
Structural
Accessibility: Caregivers do not complete vaccination due to competing priorities such as income generation, housework, child care, illness
Service Provider Competencies: Caregivers complete vaccination because vaccination staff treat them courteously and fully inform them
Service Experience: Caregivers do not complete vaccination because they can wait up to three hours for their child to be seen
Social
Family and Community Support: Caregivers complete vaccination because community structures such as health committees and community health workers inform and encourage them
Family and Community Support: Caregivers do not complete vaccination because one or more family members object (husband, mother-in-law, other)
Norms: Caregivers complete vaccination because virtually every family in their community does
Internal
Attitudes and Beliefs: Caregivers do not complete vaccination because they fear side effects such as fever, discomfort, crying, or swelling at the injection site
Knowledge: Caregivers do not complete vaccination because they do not know about or remember the 2nd measles dose

SUPPORTING ACTORS AND ACTIONS

Who must support the practice of this behavior, and what actions must they take?
Institutional
Policymakers: Ensure effective, consistent collaboration with relevant ministries and with community structures
Managers: Improve services, community engagement, and record keeping
Providers: Communicate effectively with caregivers and document vaccination encounters as required
Community
Community and Religious Leaders: Actively support and encourage all families to fully vaccinate all their eligible children
Household
Family Members: Encourage and support primary caregiver to fully vaccinate infants and young children

POSSIBLE PROGRAM STRATEGIES

What strategies will best focus our efforts based on this analysis?

Strategy requires Communication Support

Enabling Environment
Partnerships and Networks: Collaborate with relevant ministries to ensure routine immunization information, services, and verification for families that might not regularly access child health services (e.g., street children, newly arriving migrants)
Partnerships and Networks: Engage community structures (community-based organizations, religious institutions, etc.) in support of routine immunization
Systems, Products and Services
Quality Improvement: Give each immunization unit access to a telephone or mobile phone credit for calling caregivers who have missed their appointment to remind them, problem-solve, reschedule, and update records.
Quality Improvement: Provide IPC training and supportive supervision to ensure providers can and do effectively educate and support caregivers on immunization.
Quality Improvement: Implement locally-appropriate ways to reduce wait times without sacrificing good interpersonal communication (IPC)
Demand and Use
Communication: Monitor social media to be aware of and respond appropriately to any emerging anti-vaccination activities
Communication: Focus social and mass media (radio, TV) efforts on timely completion, promoting the normalcy and positive impacts of routine immunization, and the positive experience caregivers have at health centers
Communication: Design and implement community-based programs that encourage family members, including male partners, to share accurate information about immunization and its benefits and to encourage and support primary caregivers to fully vaccinate (incl. taking child to appointments, assisting with household chores and child care to allow time for vaccination appointments, and reassuring about any mild side effects)
Communication: Develop or adapt, disseminate, and use support materials that are easy for caregivers to understand and use