How Lagos used community influencers to bridge gaps in its measles vaccination drive

“Creativity in communication is necessary to elicit the desired action” – Health Compass, 2011

Otodo Gbame in Eti-Osa Local Government Area (LGA) in Lagos was like any other low income, high-density community in Nigeria’s largest city, but the events that took place in February 2016 changed that. A disease detected in Lagos State, at first described as a “strange illness”, broke out in the overcrowded settlement, killing 20 children. The community and local health authorities were caught by surprise by the illness that was later identified as measles.

Should this outbreak have come as such a surprise? Not if you think about the circumstances that led to the outbreak in the first place. Otodo Gbame is nestled between the more affluent areas of Lekki Phase 1 and Elegushi Housing Estate. However, unlike these more affluent areas, most of the housing in Otodo Gbame was set up illegally on unoccupied land. As a result, community services and social amenities that may have existed in other planned settlements were missing. As many of the residents, determined to make a life for themselves would have arrived from different parts of the country, keeping track of the immunsation history of children in the area would have been quite challenging. So, it was no surprise that high-density communities like Otodo Gbame would be a breeding ground for disease outbreaks.

Two years after this outbreak, the Lagos State government rolled out a measles vaccination campaign in 2018 to cover over 3.6 million children in the state, regardless of whether they had been immunized against measles in the past.

Even when local health authorities carry out advocacy campaigns to sensitise parents about the need to immunize their children, some parents remain resistant to the idea. In the case of Otodo Gbame, an urgent vaccination campaign had to be put in place in 2016 to ensure that children in the community were quickly immunised. When planning the 2018 measles immunisation campaign, the experience from the 2016 outbreak meant that something extra was needed to rally the local community. The Lagos State government very quickly reached out to local influencers to spread the word about the vaccination campaign.

A Social Mobilization Working Group (SMWG) made up of representatives from the Ministry of Education, Youth and Sports Development, Local Government and Community Affairs, State Universal Basic Education Board (SUBEB) was set by the state Commissioner for Health. Included in this working group were religious and non-governmental organizations as well as Ward Health Committees.

Calling on the Community influencers

At Shomolu Local Government Area, Mr. Sulaiman Abdulrazak Adegboyega, the LGA’s Health Education officer, pointed out that the social mobilizers used in this vaccination exercise were ‘influencers’ already known in these communities. They had managed to get a popular musician residing in the community involved in the social mobilization campaign. He was known for his live band that played at a neighbourhood pub, Mr Sulaiman said. “Rasheedi is his name. He would dedicate some time to accompany us on some of our road rallies. He also did a radio jingle for us”. The mobilization was particularly effective because it allowed local residents to hear about the campaign through an entertaining medium. Overall, just over 4,500 house-to-house mobilizers were deployed, responsible for encouraging parents to bring their un-vaccinated children for the measles vaccination and other vaccinations the child might have missed.

Akoka Primary Health Care Centre, one of the fixed vaccination posts during the measles vaccination exercise. Photo credit: Nigeria Health Watch

Jingles were made for the local Lagos community, with one jingle made specifically for the Shomolu LGA. “The turnout at vaccination posts was huge, and this was as a result of the sensitization activities and community engagement programs” Adegboyega concluded. The Monitoring & Evaluation Officer for Shomolu LGA, Mrs. Abosede Fanimokun, said the high turnout at the fixed and temporary vaccination posts across the community was owing to the creative approach to social mobilization, adding that the campaign saw a much larger turnout than she had seen in previous vaccination exercises.

Not too far from Akoka Primary Healthcare Centre in Shomolu LGA, another ‘influencer’ managed to stir up members of the community, and persuaded them to make their wards available. ‘Olamide’, an indigenous rap artist residing in the LGA, made a cameo appearance at one of the temporary vaccination posts in Bariga local council in Somolu LGA, with his child. “I couldn’t believe Olamide could come out, talk less of coming out with his child”, Mrs. Sefinat Agunbiade, a trader, said, adding that. “Even busy superstars can make out time to get their kids vaccinated.” Traders and mothers in that community made it a point of discussion, and wanted to emulate his actions by also bringing their children to be vaccinated.

Fathers at the Ikorodu LGA were not left out as some commercial bike riders were also sensitized. Photo credit: Nigeria Health Watch

However, not all mothers shared the same enthusiasm. Mr. Sulaiman mentioned the reluctance of some mothers to getting their children immunized, pointing out that the campaign had little impact on these parents. Nigeria is not unique in parental resistance to immunisation, and there clearly is a need to find ways for healthcare professionals to engage with parents to fully understand their concerns. More opportunities have been created to support advocacy efforts, with World Immunisation Week being a good example of a sensitization effort that targets parents, health practitioners and development partners.

On the other side of town is Ikorodu LGA. Marked with rough, untarred and hard to navigate roads, one could notice the contrast in development. “We didn’t have the luxury of having an international artiste on our side,” Mrs. Fatunbi-Lawal, the Health Educator for Ikorodu LGA said, and added with a chuckle, “…we had our own style”. Beaming, she recounted how a local drama group was engaged to perform at various strategic locations in the LGA. The group was able to capture the attention of on-lookers by having actors emerge from the crowd. The drama group, by the name of Aro Meta, is widely known amongst the people of Ikorodu. This approach to social mobilization allowed for widespread engagement of residents who may normally not have considered bringing their children out for immunisation activities.

Mascots in Ikorodu LGA schools for the measles vaccination exercise. Photo credit: Nigeria Health Watch

Despite all the creative tactics used by mobilizers, some schools refused to cooperate with vaccination activities, ordering their gates to be hurriedly shut when alerted of approaching vaccination mobilizers. This required an alternate method of sensitization, rather than to individual community members, instead to the owners of the schools. Other challenges despite the communications strategy included sensitizing reluctant mothers who heard rumours of the vaccines being harmful.

In Alimosho LGA, the government was able to obtain the support of RayPower FM, a private radio station. Raypower FM played a significant part in encouraging the local community to embrace the measles vaccination exercise. During some of the station’s popular radio programs, head-bobbing jingles were aired over a period of 2 weeks, in an effort to ensure every individual was informed about the vaccination exercise. Also, interviews on the radio station’s health programs were conducted.

The Redeemed Christian Church of God, the Catholic Church and some other religious organizations were not left out of this sensitization movement. They ensured mobilization of their members and children, making announcements of the exercise during church services. The State Health Educator, Mrs. Owojuyigbe, stated that these organizations urged medical professionals in their congregations to volunteer in setting up vaccination posts within their premises. Furthermore, some private hospitals had special days dedicated to sensitizing their clients about the ongoing measles vaccination campaign. Other private contributors included NGOs, private individuals and shopping malls. In her narration, Mrs. Owojuyigbe also acknowledged the efforts of the Palms Shopping Mall in Lagos for providing eye-catching locations within their premises. This afforded mobilizers the opportunity to talk to parents and shoppers about the vaccination exercise.

Charles Nwosisi, an immunisation specialist for the United Nations Children’s Fund (UNICEF), was convinced that Lagos State could achieve the 95 percent coverage as a result of the innovations consistently put in place by the state government during vaccination campaigns. These innovations over the years have included an increase in the number of vaccination days from four to six, active engagement of private organizations, the provision of counterpart funding for additional teams and an extra day for mop up.

A welcome outcome

Using community influencers such as artistes, drama groups, radio stations, and churches, in localised mobilisation drives in places such as Shomolu, Ikorodu and Alimosho, built upon the existing vaccination campaign strategies. Lagos State was able to cover 93.8% of its target in the 2018 measles vaccination campaign, according to Dr Joseph Oteri, Chairman of the National Measles Technical Coordinating Committee (NMTCC). Oteri said when the results of the vaccination exercise came out, “The whole world is happy with Lagos irrespective of their coverage, so what you got, 94%, is a further confirmation of the good work done.”

The influence of community mobilizers was effective because people respond to faces and voices they are familiar with. Community influencers are a trusted neighbour coming over to tell you, “Let’s go get that vaccination! I know it’s good for us.” That Lagos State was able to leverage on the communal nature of these influencers gave an added boost to the measles vaccination exercise.

Overcoming the fear of immunizations with risk communications which sees the involvement of local influencers helps overcome any trust gaps that may exist between health practitioners and local communities. This should be more widely adopted across the country to help drive up vaccine coverage rates.