With support from the Bill & Melinda Gates Foundation, PROMETRA International is conducting a research study to understand the cultural barriers that impact immunization programs throughout Africa

Why is this Project Necessary?

For decades philanthropic donors, development partners, governments, the World Bank and other financial institutions have been heavily investing in different forms of immunization strategies to improve the vaccination coverage rates of Africa's children and decrease childhood mortality from vaccine preventable diseases.  We must admit that the WHO and MDG vaccination coverage objectives have not been met by all African nations.  Are there cultural or traditional aspects that hinder or help vaccination programs be successful?  That is the reason why the Bill & Melinda Gates Foundation is supporting PROMETRA International to conduct a three year research project (2009-2012) entitled "Immunization Advocacy: Saving the Lives of Africa's Children".

Geographical Scope of the Project

The three (3) designated pilot countries are Benin, Nigeria, and Senegal where during the first year of the project teams of investigators conducted a knowledge, attitude and perception (KAP) study and mixed gender focus groups involving over 5,000 participants. Stakeholder groups that were interviewed included heads of households, modern and traditional health practitioners, women associations, community base leaders, religious leaders, political leaders and other  public health officials.  The emphasis of the research focused on traditional health practitioners and base community leaders who have traditionally been absent from the global conversation on immunization and public health.

In Nigeria, the work receives technical support from our two project partners - Rotary International of Nigeria and Nigeria Natural Medicine Development Agency. In Benin project partners include the Ministry of Health, the Association of National Practitioners of Traditional Medicine of Benin and the National Community for the Voodoo Cult in Benin (CNCVB). In Senegal the project partners include Federation of Senegalese Women's Associations (FAFS), Malango Traditional Healers Association, religious leaders and the Ministry of Health and Prevention.

As stated by the project Director, "all the KAP socio-anthropological and epidemiological research hypotheses were field tested and our final survey instruments were translated into local African languages before administration. Teams of investigators (65) were selected in each country, trained in survey administration and cultural norms.   Individual surveys, each containing 150 questions, were administered to traditional healers, religious leaders, voodoo priests, parents, health providers and community base leaders in the three geographical project regions of Senegal, Nigeria and Benin. 

What Barriers Exist?

The lay literature review on perceptions and misconceptions conducted by the project teams in the three (3) pilot countries, underlined, among others, some of the following factors influencing the immunization process such as:

- The non involvement of the community base leaders in health programmes,
- The impact of traditions and cultures towards immunization,
- The burden of religious  beliefs, rumours, taboos on the immunization process,
- The lack of appropriate training for health providers,
- The disrespectful attitude of health providers towards health centre users,
- The non availability of necessary items in the immunization programmes.

These factors have guided the design of the survey tools approved by international Advisory Council made up by government and major world Health institutions high ranking officials:

From L to  R : B. Onabolu (Rotary Polio Plus), E.M.Ndiaye (Senegal Ministry of Health), E. Gbodossou (PROMETRA), M. Compaoré (Burkina Ministry of Health), A. Ndiaye (FAFS Senegal), T. Okujagu (Nigeria  Ministry of Health).

According to the project Director the initial field testing shows very clearly that "the community base leaders and the populations did not associate the term 'immunization' only with vaccines.  It is clear that immunization is a much broader concept encompassing the immune system and its strengthening, nutrition, clean water and maternal child health issues, and body hygiene -- all the factors that contribute to make the vaccine more efficient".

The first steps in achieving Global Access to the outcome of our Immunization Advocacy Project have been made to the policy makers and executive to state their views and suggestions within the framework of a collective research for solutions pertaining to immunization in Africa. The commitment of these different stakeholders is a force for the execution of the project.

At the end of 1 year of activities, PROMETRA International took advantage of the support of several stakeholders, in order to be on the track for a major breakthrough to understand traditional healers and indigenous religious leaders' comprehension of and attitude toward immunizations and to analyze the perceived and real access barriers to immunizations of the African populations. In fact, the outcome of our Year 01 research (KAP) project will provide valuable and critical information to add to the global conversation (and debate) on immunization programs and their benefit to children and families of Africa.
 
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