An innovative partnership between PTF and OAFRESS (Organisation de l’Afrique Francophone pour le Renforcement des Systemes de Sante et de Vaccination – the Francophone African Organization Supporting Healthcare and Vaccination Systems).
June 13, 2024:
The effective delivery of vital healthcare services in many of the world’s poorest countries are so often undermined by the combination of lack of financial resources, waste, inefficient management and corruption. The work of the “Champions” demonstrates that serious obstacles can be overcome, that critical vaccination programs for children can be pursued, and that meaningful collaboration between government and civil society can be attained.
PTF Advisor Pietronella van den Oever says: “Over the last two-and-a-half years, a PTF team of advisors has worked with a group of “Champions” from 18 French-speaking African countries to advocate for childhood vaccination programs. The work by the Champions’ is highlighting the importance of vaccination for children in these countries and securing progress in vaccination rates of children in the target areas.”Pietronella added: “Crucially, the program is demonstrating the pivotal role of civil society in shaping health policies and securing resources for the well-being of communities.”
Many of these 18 Sub-Saharan African countries belong to the group of poorest and most fragile countries in the world, according to the World Bank’s classification. More than half rank in the lowest (more corrupt) quarter, and all of them rank below 43 (= lower half) according to the 2023 Transparency International (TI) Corruption Perception Index (CPI).
And yet, several of these countries are teaching an important lesson: Contrary to what might have been expected, the approaches to collaboration between government services and civil society organizations provide multiple examples of well-organized and effective partnerships as this report shows.
OAFRESS, based in Dakar, Senegal, is a central platform composed of representatives of 18 country platforms of non-governmental public health organisations (NGOs) from French-speaking countries in Africa. During the OAFRESS 2021 General Assembly meeting, the persistence of low childhood vaccination rates throughout the region was repeatedly brought up as a major global problem, in spite of the fact that significantly increased worldwide efforts to secure enough resources for vaccination in general were being deployed, in the wake of the COVID-19 pandemic.
The OAFRESS General Assembly concluded that it was not necessarily the physical means and technology that were in short supply in their constituent countries, but rather the link between efficient information and outreach to hard-to-reach, isolated population groups and resistance amongst certain poorly informed population groups against childhood – and all other – vaccinations. As a follow-up, 21 Advocacy “Champions” were recruited within the individual OAFRESS country platforms. Their objective was to perform multiple tasks that could help to surmount societal factors that stood in the way of ensuring that the maximum number of children were fully vaccinated.
In the fall of 2021, PTF was asked to partner with OAFRESS in implementing a new, experimental program of mentoring OAFRESS Advocacy Champions, to contribute to an increase of the proportion of children in their respective countries who are vaccinated according to WHO criteria and in line with the immunization schedule of their respective countries. Although Champions are generally not involved directly in the administration of vaccines, they provide a bridge between the government’s health services and isolated, poorly informed and vaccine resistant populations in their own countries and regions.
What have the Champions done so far?
The Champions – individually and as a group – have established a communication and information structure with the objectives of: 1) Informing target populations about the importance of having as many children as possible vaccinated to prevent serious childhood diseases, and epidemics, and strengthening their chances of surviving serious childhood diseases; 2) Making the immunization process more transparent and accessible to target communities, especially in remote areas of their countries; 3) Making the collaboration between the public health service and local health NGOs more transparent and accountable to local populations; 4) Advocating for the reservation of increased monetary resources within the national budgets of OAFRESS member countries; 5) Recording, analyzing, disseminating and multiplying results of the Champions’ advocacy work at the local, regional, national and international levels.
1. Systematic collaboration between Public Health Services and CSOs/NGOs
One first lesson learned from our experience so far is that a logical division of labor between government health services and NGOs has emerged in most OAFRESS countries. While public health services continue to administer the vaccines, OAFRESS advocacy Champions serve as a liaison between these vaccination services and the target group of hard-to-reach rural communities, families and children eligible for vaccinations. In many countries this division of labor has been codified in legally binding working documents between government services and NGOs. In addition, most countries are implementing regular multi-stakeholder working meetings to prepare outreach to hard-to-reach audiences and to monitor results and to experiment with optimal outreach strategies, using innovative stakeholder analysis and engagement strategies. Examples of these collaborative relationships were presented by a group of Champions during the OAFRESS ConneXion Conference in July 2022 in Niamey, Niger. Furthermore, on the occasion of the last week of April 2024 (International Vaccination Week) Champions from Burkina Faso and Côte d’Ivoire organized a very well attended international Zoom meeting (82 participants mostly from West Africa) to present their detailed case studies of collaboration between the public health service and local NGOs in their respective countries.
2. Champions are Making Public Health Services Accountable to Local Communities
The Champions, by being generally close to remote populations, are particularly well-placed to understand the social dynamics of communities and to strengthen good governance and transparency of public services for immunizing children. As a result, they are able to remove often encountered obstacles to vaccination.
2.1. Champions help to overcome a lack of clear information.
The Champions are generally working in their regions of origin. Hence they know the local context, the local language and culture and the community leaders, and are accepted as being “from here”. For that reason, they are often much better able to overcome societal obstacles, than a “stranger” – even someone from the same country – would be able to do.
2.2 Champions help to overcome vaccine resistance.
They are informed about the process of vaccination, and receive first-hand information from the public health service. Thus they are able to subtly convince the local community of the need, the date, the place and the location of the target group to get children vaccinated, and usually to overwin the vaccine resistance and reject fables about the dangers of vaccines that are circulating in the community.
2.3. Champions help to find solutions by bringing all partners together
Most importantly, in collaboration with all the different stakeholder groups, they are able to find solutions to identified shortcomings and to ensure that the target groups have “a voice” in the process, thus involving them in the smooth running of the vaccination process, thereby minimizing mismanagement and waste and ascertaining the health service’s accountability to the target population.
2.4. Advocates for allocating monetary resources for vaccination in the national budget
This year we witnessed an interesting phenomenon of South-South learning across the OAFRESS network, when Champions from various other OAFRESS countries, who received special training on the subject, conducted successful tours to advocate for setting aside additional financial resources for vaccination in their respective countries. Thus, thanks to the relentless dedication of the Champions and their initiatives across the entire network, the vaccination budgets in OAFRESS countries may be significantly increased.
