The Drum Beat 311 - Colombia: Immunisation and Communication

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La Iniciativa de Comunicación recently carried out a series of inquiries and interviews on how communication has been used to support immunisation goals, particularly in Colombia. This issue of The Drum Beat highlights some of the experiences and lessons learned that emerged from their research.

Please note: many of the items below are available in both English and Spanish; some are only available in Spanish.

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EXPERIENCES

1.Application of the Canalisation Strategy in the Expanded Immunisation Programme - Colombia
The strategy of "canalisation" (or channelling) was designed by staff of the Ministry of Health of Colombia, the Pan American Health Organization (PAHO), and the World Health Organization (WHO). It was based on fieldwork in the Huila area in 1981. Since then it has been widely applied for the improvement of outcomes of regular vaccination programmes developed by the Expanded Programme on Immunisation (EPI) in Colombia. This approach is based on the establishment of bonds between members of the community and health institutions by means of support and collaboration with community leaders. The objective is to channel the intended population towards health institutions or the personnel in charge of vaccination. The aim of its application is to develop vaccination programmes with the active participation of health personnel and the communities being vaccinated.
Click here for more details in English.
Click here for more details in Spanish.
Contact Ministry of Social Protection atencionalciudadano@minproteccionsocial.gov.co

2.National Vaccination Crusade 1984 - Colombia
The main goal established for the National Vaccination Crusade of 1984 was to increase vaccination coverage of children below 4 years of age by 50% from the then-current level of 40% coverage, in a 3-month period. In order to accomplish this goal, different strategies were used to involve all possible sectors, institutions, and people in the country around the issue of children's health. Strategies included: social mobilisation, "canalisation", social marketing, information systems (to gather, transmit, process, and disseminate results), and communication of technical standards/norms.
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Contact Ministry of Social Protection atencionalciudadano@minproteccionsocial.gov.co

3.National Vaccination Crusade 1985 - Colombia
On Sep 21, Oct 19 and Nov 30 1985, the second National Vaccination Crusade was carried out in Colombia with the following objectives: to vaccinate 80% of the susceptible minors below 1 year of age against Polio, Tetanus, Diphtheria, Pertussis and Measles; to vaccinate against Tetanus 500,000 women of fertile age, including pregnant women in endemic zones; and to complete the implementation of the canalisation (channelling) strategy in the areas where it had not yet been developed and to fortify it in those areas where it had deteriorated. Support strategies included social marketing, social mobilisation, advocacy, canalisation and community participation.
Click here for more details in English.
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Contact Ministry of Social Protection atencionalciudadano@minproteccionsocial.gov.co

4.National Plan for Infant Survival and Development - SUPERVIVIR - Colombia
The Plan Nacional para la Supervivencia y el Desarrollo was developed between 1984 and 1992 as an expression of Colombian government's commitment to guarantee the rights of children to the protection of their health. It was to be carried out by means of direct actions to reduce child mortality from causes that could be controlled, like complications during pregnancy, childbirth and post-childbirth, acute respiratory infections, diarrhoea, undernourishment and communicable diseases preventable through vaccination. SUPERVIVIR emphasises the influence of people's behaviour in health, taking into consideration the fact that changes in behaviour are obtained through education and the consequent modification of knowledge, attitudes, and practices. Of equal importance was the development of basic health services. Based on these principles, the plan worked through a combination of strategies, including community participation, interpersonal communication, and education and training.
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Contact Ministry of Social Protection atencionalciudadano@minproteccionsocial.gov.co

5.Plan of Eradication of Poliomyelitis 1987-1990 - Colombia
In 1985, despite the vaccination efforts made in previous years, Colombia was still experiencing cases of Polio. After an analysis of available technical capacity and technology, the country committed, along with others of the Americas, to eradicate Polio and to offer access to vaccination services to all children by 1990. Different strategies that had originated during previous vaccination experiences were applied and enriched with community work and participation through methodologies like the canalisation strategy, National Vaccination Days, and the strengthening of epidemiologic monitoring, among others.
Click here for more details in English.
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Contact Ministry of Social Protection atencionalciudadano@minproteccionsocial.gov.co

6.National Vaccination Days 1991 - Colombia
The Days of May 18 and Jul 27 1991 were carried out as part of the efforts by the Ministry of Health to eradicate Polio, to eliminate neonatal Tetanus, and to control other diseases like Measles, Pertussis, Diphtheria and Tuberculosis. Under the motto "Vaccination is a right of children and a responsibility of adults. So that the life lives", the campaign aimed to generate motivation for the vaccination of all children. In order to guarantee that all the population had access to vaccines, nearly 18,000 vaccination posts were established throughout the country. A letter was sent to journalists in an effort to secure the widest possible media diffusion; it emphasised as the central objectives of the Days the definitive eradication of Polio and neonatal Tetanus. In addition to this letter, a folder was enclosed that included a document on the National Vaccination Days in 1991, a synthesis of the Expanded Programme on Immunisation (EPI) and Colombia's main vaccine-related achievements, as well as information on neonatal Tetanus and Polio, including definitions, symptoms, and prevention.
Click here for more details in English.
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Contact Ministry of Social Protection atencionalciudadano@minproteccionsocial.gov.co

7.Puye Vaccination Campaign - Colombia
The name of this campaign makes reference to a game of words in which the term "puyar" signifies both the action of injecting the vaccines and the popular expression that means to demand, to hurry up, or to press for. The objective was to invite citizens to "puyar" children's vaccination in all possible senses: to the parents themselves, to be on the alert about the vaccines of their children; to neighbours and friends, to remind parents about vaccination; and, most importantly, to the authorities, to act in favour of vaccination of children of their municipality or department. The campaign included television spots, newspapers and magazines, visits to schools, and the municipal diffusion of local tools for measuring the coverage of the vaccination programmes.
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Contact Hernán Salamanca hernans@videomovil.com.co

8.Immunisation Poster Campaign - Colombia
This campaign utilised a communication strategy aimed at mayors and municipal authorities in order to stimulate action at the local level towards universal child immunisation and the eradication of polio. The strategy aimed to promote regular and continuous immunisation activities, rather than the concentrated but intermittent drives linked to national vaccination days, which had been the focus for most communication campaigns in Colombia and elsewhere up to that time. Proposals were offered to the mayors and their administrations for specific actions they might take, with precise objectives, for the benefit of children within their jurisdiction. The aim was to commit mayors and their administrations throughout the country so that they would assume a role of leadership and responsibility in striving to reach local immunisation targets that reflected the national targets set by the government. The campaign included the creation of posters and letters to be appended to these posters with data concerning the immunisation coverage of children under the age of one in each community. The posters were supported by television and radio ads as well as leaflets addressing the participation of community members in vaccinating all children.
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Contact Sonia Restrepo Estrada colinsonia@compuserve.com

9.Application of the Information, Education and Communication (IEC) Strategy for Immunisation - Colombia
An analysis of the vaccination situation in the department of Antioquia showed that vaccination campaigns held before 2001 had a low impact in relation to the investment made. In order to improve coverage in Antioquia's 125 municipalities, the Health Section Directorate developed information, education and communication strategies that included:

• confirming the relationship between media and health - efforts were undertaken to make people who work in mass media (radio, press, television and alternative media) aware of their social responsibility, with the purpose of actively involving them as strategic allies in the health campaigns.
• use of "non-commercial" media messages - unlike traditional campaigns, the messages were not transmitted as advertisements, but as part of the usual programming.
• addressing both parents and children - education processes were implemented so that parents learned to understand and to use the vaccination card in the right way, and messages were directed towards children in order to diminish or to eliminate their fears about vaccination.

Click here for more details in English.
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Contact Germán Salazar gsalazar@gobant.gov.co

10.Vaccination Week in the Americas - Colombia
Colombia has participated in the 3 versions of Vaccination Week since its launch in 2003. The fundamental objective has been to address the most vulnerable and least protected children; therefore, it has been centred in the municipalities on the country borders with low coverage (50%), in native populations, and in communities that have been displaced by armed conflict. Campaign mottos have included "a gesture of love" (2003),"love them, protect them, vaccinate them" (2004), and "who loves them, protects them" - a call to respect children's right to vaccination (2005). Diverse communication strategies have been used, such as social mobilisation, mass media messages, and training of health workers.
Click here for more details in Spanish.
Contact [in Spanish] e-mail@col.ops-oms.org

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EVALUATIONS

11.Evaluation of the National Vaccination Crusade 1985
In 1985, the second Crusade in Colombia was carried out. An analysis of achievements in 1984 showed coverage superior to 80% with Polio, Measles and DPT vaccines in children 2 and 3 years old. There was, however, persistence of immunisation-preventable diseases in children under 5 years old. The Ministry of Health set the 1985 vaccination goals at 80% of the susceptible children under 2 years old for Polio, Measles and DBT and at 30% of the women of fertile age in endemic zones for Neonatal Tetanus, corresponding to 343,499 women, 15 to 44 years old. The evaluation shows that education on the importance of vaccination in order to avoid diseases was high: 82.3% of the total population, 78.8% of the residents of rural areas, and 82.9% in the urban zone considered it important. This was in contrast to those who did not know the purpose of vaccines: 2.7% for the total, 2.4% in urban zone and 4.2% in the rural area. The evaluation found that the community did not use the ordinary service of vaccination offered by the health agencies for various reasons; residents in the countryside cited the difficulty of finding time for vaccination, the distance to the vaccination locations, and the lack of vaccines in the institutions.
Click here for more details in English.
Click here for more details in Spanish.

12.Evaluation of the "Puye" Vaccination Campaign in Colombia
In 2003 the Ministry of Social Protection led the "Puye" campaign with the purpose of improving vaccination coverage in the municipalities of Colombia. In 19 of the 21 departments, the percentage of improvement was greater in the municipalities where the strategy was applied than in those where it was not applied. Whereas an average of 77% of the municipalities where the strategy was applied improved throughout the 5 months of application of the strategy, an average of only 48% of the municipalities with no intervention improved.

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ADDITIONAL INFORMATION AND RESOURCES

13.Harnessing the Power of Ideas: Communication and social mobilization for UNICEF-assisted programmes. A case-study
by Colin Fraser
Fraser cites Colombia to illustrate how the use of a variety of media can mobilise the public for immunisation. He explains that Colombia's success with this strategy reflects, in part, the way in which mass media is organised there: radio and television stations are scattered all over the country, as evidenced by the fact that Columbia's "520 radio stations reach everywhere. In 1987, television was reaching about 70 per cent of the population, and the written press about 20 per cent". Fraser states that Caracol, a large radio network owning 123 radio stations (at the time of this writing), "became totally committed to promoting immunization during Colombia's drive towards UCI". Fraser describes the way in which this network approached other radio stations in the country to galvanise support; he also reviews the involvement of television and the written press. In short, "Colombia provides a prime example of an integrated and well orchestrated approach. The media became so committed that the population saw the campaigns as belonging to them rather than to the Ministry of Health."
Click here for more details in English.

14.Expanded Programme on Immunisation National Meeting (Reunión Nacional del Programa Ampliado de Inmunización) - March 4 2005 [PDF]
by Pier Paolo Balladelli, PAHO/WHO representative in Colombia
This report summarises the main results of the Expanded Programme on Immunisation (EPI) in Colombia:

• Polio: has been eradicated and there is a low AFP (Acute Flaccid Paralysis) rate of 1.43 cases per 100,000 inhabitants and 5 out of 5 parameters of monitoring fulfilled. It is necessary to focus attention on monitoring the following: Amazon, Casanare, Guainía, Guaviare, Vaupés and San Andrés and Providencia.
• Diphtheria: although protection decreased from 94% to 80% in 1997 and 1998, the joint efforts of the government and its allies led to a rebound to 92% in 2003.
• Neonatal Tetanus: frequency diminished 95%; there were 160 cases in 1998 and only 8 cases in 2004. However, it is necessary to monitor, and notify officials about, all new cases.
• Measles: in spite of the epidemic of 2002 with 140 confirmed cases, in 2004 there were no confirmed cases. This is the result of coverage that reached 93% in 2003.
• Rubella and Congenital Rubella: the great challenge is the implementation of the "Action Plan for Elimination 2004 - 2010." A Vaccination Crusade addressing adolescents and adults is being organised in 2005. If all goes as planned, the country will save US $60,000 for each child who is spared Congenital Rubella. Considering the 1,000 annual cases in the country, a savings of US $60 million per year would result.
• Mumps: there were over 9,013 cases in 1996 and only 1,278 in 2003.
• Meningitis: vaccination against Hemophilus Influenzae was introduced in 1998, with 91.8% and 87.7% coverage in 2003 and 2004, respectively.
• Hepatitis B: has decreased in the country since 1992, the year in which the vaccine was introduced.
• Yellow Fever: a contingency plan has been applied in the last 2 years in order to try to control Yellow Fever in people that could be infected.

Click here to download a PDF of the full report - in Spanish.

Interviews [in Spanish]

15.Hernán Salamanca
March 28 2005
Hernán Salamanca Uribe has been working for 14 years in the Social Department associated with the advertising agency REP/GREY and the television production company Video Móvil. He has participated in several health campaigns for the Ministry of Social Protection of Colombia.
Click here for the full interview in Spanish.

16.Rosa Cristina Parra
March 28 2005
Rosa Cristina Parra worked as Chief of Communications for PAHO between January 2002 and December 2004. She has also worked as consultant, producer, director and journalist in educational projects related to health for organisations like UNAIDS, Corporación Servir a Colombia, and Movimiento ¡No Más!. Currently she volunteers with the "Patrulla Aérea Civil de Bogotá".
Click here for the full interview in Spanish.

17.Martha Velandia
May 16 2005
Martha Velandia was the coordinator of the Expanded Programme on Immunisation in Colombia (National Institute of Health) between September 2002 and August 2004, where she was responsible for developing planning, execution, evaluation, social communication and monitoring tasks. Currently she is a member of the staff of the "Dirección General de Salud Pública" of the Ministry of Social Protection in Colombia.
Click here for the full interview in Spanish.

Statistics

18.Immunization Profile - Colombia: 1980-2003
Vaccines, Immunization and Biologicals: WHO
Click here for more details in English.

19. Colombia reported immunization coverage: 1980-2004
Vaccines, Immunization and Biologicals: WHO

20.Expanded Programme on Immunization in Colombia (Programa Ampliado de Inmunizaciones or PAI) of Colombia
Special bulletin issued from 1995-1999 by PAHO/WHO
Click here for more details in Spanish.

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This issue is based on research by Ligia Consuelo Macías Acuña in 2005.

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The Drum Beat seeks to cover the full range of communication for development activities. Inclusion of an item does not imply endorsement or support by The Partners.


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