Trainers' Facilitation Guide

Interpersonal Communication for

Immunization Package

©UNICEF/Naftalin

Trainers' Facilitation Guide - For Global IPCI

 Contents
Acknowledgements............................................................................................................................iv
Photo Credits........................................................................................................................................iv
Abbreviations and Acronyms................................................................................................................v
Trainers' Facilitation Guide Overview.....................................................................................................vi
Glossary: Interpersonal Communication for Immunization Key Terms....................................................x
Overview...............................................................................................................................1
Training Schedule..................................................................................................................................4

MODULE 1
Principles Of Interpersonal
Communication
Beginning On Page 5

1.1 Opening Pg 6

1.2 Pretest Pg 8

1.3 Client-Centered Approach Pg 8

1.4 Interpersonal Communication and a Client-Centered Approach Pg 10

1.5 Interpersonal Pg 12
Communication Skills

1.6 Appreciating the Caregiver Pg 16

MODULE 2
Exploring Provider Perspectives And
Barriers And Problem Solving
Beginning On Page 18

2.1 Respect and Equity Pg 19

2.2 Provider Barriers Pg 20

2.3 Problem Solving Pg 21

i Trainers' Facilitation Guide - For Global IPCI

TABLE OF CONTENTS
MODULE 3
Immunization And Vaccines
Beginning On Page 25

3.1 Immunity Pg 26

3.2 Vaccines Pg 28

3.3 Vaccine-preventable Pg 30
Childhood Diseases

MODULE 4
Profiling Types Of Caregivers
Beginning On Page 32

4.1 Understanding Vaccine Hesitancy Pg 33

4.2 Profiling Caregivers Pg 35

4.3 Communicating with caregivers Pg 39

MODULE 5
Community Engagement
Beginning On Page 44

5.1 Conducting a needs assessment Pg 45

5.2 Barrier Analysis Pg 47

5.3 Conducting a Community Conversation Pg 50

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TABLE OF CONTENTS ii
MODULE 6
Addressing Negative Rumours,
Myths, And Misconceptions
Beginning On Page 54

6.1 What can be done about a negative rumor Pg 55

6.2 Communicating Potential Adverse Events Following immunization Pg 57

6.3 Risk Communication Pg 60

MODULE 7
Action Planning And
Workshop Closing
Beginning On Page 63

7.1 Collecting and using Pg 64

community feedback
7.2 Mobilization Pg 66
7.3 Apply your skills Pg 69
7.4 Post-test and workshop evaluation Pg 70
7.5 Commitments and Certificates Pg 71

RESOURCES..................................................................................................................................................73
APPENDIX A. PRETEST AND POST-TEST.................................................................................................74
APPENDIX B. BARRIERS REVIEW IMAGE................................................................................................77
APPENDIX C. BARRIERS AND FACILITATORS TO EFFECTIVE COMMUNICATION..............................78
APPENDIX D. JOB AID: COUNSELLING THE CAREGIVER......................................................................79
APPENDIX E. STEPS TO COMMUNITY MEETINGS.................................................................................81
APPENDIX F. SAMPLE COMMUNITY CONVERSATION AGENDA ............................................................82
APPENDIX G. JOB AID: TIPS FOR USING IMMUNIZATION SUPPORT MATERIALS EFFECTIVELY......83
APPENDIX H. WORKSHOP EVALUATION QUESTIONS..............................................................................84
APPENDIX I. RECOMMENDATIONS FOR FOLLOW-UP AND SUPERVISION AFTER IPC/I TRAINING......85
APPENDIX J. TRAINING SCHEDULE............................................................................................................88
APPENDIX K. IPC/I Self-Assessment Checklist............................................................................................93
APPENDIX L. CERTIFICATES........................................................................................................................98

iii Trainers' Facilitation Guide - For Global IPCI

TABLE OF CONTENTS
This Resource
This resource is available on the Internet at:
ipc.unicef.org
Copies of this document, as well as additional IPC materials on immunization, may be requested
from UNICEF and partners:
UNICEF
3 United Nations Plaza
New York, NY 10017
Tel:     +1-212-326-7551
Email: [email protected]
© 2019 UNICEF
UNICEF and partners welcome requests for permission to use, reproduce or translate IPC for
Immunization resources, in part or in full.
The content and the presentation of the material in this resource and the IPC package do not imply
the expression of any opinion whatsoever on the part of UNICEF and partners.
Suggested citation: United Nations Children’s Fund, ‘IPC for Immunization Package’, UNICEF, New
York, 2019.
For more information, or to provide feedback, please write to [email protected]

Trainers' Facilitation Guide - For Global IPCI

THIS RESOURCE iv
Acknowledgments
The Interpersonal Communication for Immunization (IPC/I) Package is the result of strenuous hard work and collaborative efforts of many
institutions and individuals, without whose help, guidance and support, this would not have been possible.
UNICEF wishes to recognize their contributions to this important initiative and expresses gratitude to all those who supported the development of
the package through their time and expertise.
Special thanks to the global advisory group and the frontline workers From various parts of the world who contributed to develop the package.

Global IPC Advisory Group Members

Molly Abbruzzese, BMGF

Hardeep Sandhu CDC
Susan Mackay, GAVI
Lisa Menning, WHO
Jhilmil Bahl, WHO
Mike Favin, The Manoff Group
Lora Shimp, John Snow Inc.
Bill Glass, CCP
Saad Omer, Emory University
Dr. Stephen Hodgins, University of Alberta, Canada
Nathan Pienkowski, Bull City Learning
Dr. Naveen Thacker, IPA
Benjamin Hickler, UNICEF
Ketan Chitnis, UNICEF
Tommi Laulajainen, UNICEF
Claudia Vivas, UNICEF

JHU Project Team

Sanjanthi Velu, Jvani Cabiness, Caitlin Loehr, Amrita Gill Bailey, Ron Hess, Guy Chalk, Michael Craven, and Bill Glass. Others who contributed
include Rupali Limaye, Anne Ballard, Mark Beisser, Missy Eusebio, and Carol Hooks.

Acknowledging and thanks to the CCP field offices and sister organizations in Nigeria, Pakistan, Uganda, Ethiopia, India and CHIP Pakistan for their
support during the formative research and pretesting stages of the package.

UNICEF Team

Attiya Qazi, Chikondi Khangamwa, Anisur Rehman, Rufus Eshuchi, Kennedy Ongwae, Ayesha Durrani, Robb Butler, Violeta Cojocaru, Jonathan
David Shadid, Johary Randimbivololona, Natalie Fol, Deepa Risal Pokharel, Helena Ballester Mario Mosquera, Svetlana Stefanet, Sergiu Tomsa,
Daniel Ngemera, Fazal Ather, Vincent Petit, Carolina Ramirez, Alona Volinsky, Hannah Sarah Dini, Benjamin Schreiber, Rafael Obregon, Diane
Summer, Robin Nandy, Luwei Pearson and Stefan Peterson.

Suleman Malik, Communication for Development Specialist, UNICEF Headquarters, New York, USA. UNICEF Team Lead

v Trainers' Facilitation Guide - For Global IPCI

ACKNOWLEDGMENTS
Foreword
In recent decades, child mortality has dropped dramatically. Vaccines have been a major contributor to
improvements in health by protecting children and adults against diseases that once maimed and killed. The
scourge of smallpox has been eradicated, the last mile of polio eradication is close, as is the elimination of maternal
and neonatal tetanus. Yet, despite the availability of vaccines, many countries face continuing constraints to
achieving universal vaccination. One of the key challenges is ensuring sustainable demand for vaccination at family
and community levels. The value that community members place on vaccination is a major contributor towards
good health. The Global Vaccine Action Plan (2011–2020) acknowledges the importance of community attitudes
and practices, as reflected in one of its six strategic results: “Individuals and communities understand the value of
vaccines and demand immunization as both their right and responsibility.”
Although most children do receive the recommended vaccinations, too many still miss out: almost 20 million
globally do not receive the full schedule of essential childhood vaccines. The reasons are complex. In some places,
health services are not easily accessible – and when accessible, may not be convenient to users – and/or reliable.
In some cases, health worker’s behaviors or attitudes may limit the uptake of vaccination services. Caregivers’ and
children’s experiences with immunization services may be unpleasant for various reasons and this can explain why
many children who receive the first dose of vaccines (e.g. BCG or DTP1), drop out. In other instances, children
miss recommended vaccinations because their parents or guardians have concerns or misunderstandings about
vaccines, lack information on the benefits of vaccines, or do not understand what they need to do to get their
children vaccinated and protected.
Frontline Workers (FLWs), including facility-based professionals, community health workers (CHWs) and community
volunteers (CVs), are a critical source of information about vaccination. Research shows that FLWs are the most
influential source of information about vaccines for caregivers and families of children. Because of their critical
role in providing essential information about vaccination services, FLWs must have effective interpersonal
communication (IPC) skills. They also need positive attitudes towards the people they serve and their work, an
understanding of the importance of communication, and an ability to operate in an environment that enables them
to communicate effectively to build trust and confidence. When equipped with the relevant skills and supported by
their supervisors, FLWs can be very effective in influencing attitudes and promoting uptake of vaccination services.
Across countries, FLWs engage communities in dialogue, mobilize community leaders and provide communities
with health services and knowledge about healthy practices. However, the limited IPC skills of FLWs remains a
challenge and requires focused efforts to enhance their capacity to communicate effectively with care givers and
community members that they serve, and a system that supports and values the practice of these important
competencies is vital.
UNICEF, together with Bill & Melinda Gates Foundation (BMGF), Centers for Disease Control and Prevention (CDC),
Emory University, GAVI, the Vaccine Alliance (GAVI), International Pediatric Association (IPA), John Snow Inc. (JSI),
the United States Agency for International Development’s flagship Maternal and Child Survival Program, World
Health Organization (WHO) and other partners, remain committed to closing the gap by facilitating a process of
empowerment through the development and roll out of a comprehensive ‘IPC for Immunization’ package.
UNICEF and partners are pleased to introduce this IPC for Immunization package and invite national and sub-
national programme managers, partners and FLWs to adapt it to their local context and use it to guide their work
with caregivers and communities. A range of resources are in the package, including participant’s and facilitator’s
manuals, an adaptation guide, a supportive supervision manual, FAQs, flash cards, videos, audio job aids, a mobile
application, and a monitoring and evaluation (M&E) framework. These resources are available both online (IPC.
UNICEF.Org) and offline in four global languages. It’s hoped that through this package and instructional-design
approaches, FLWs will improve their capacity to effectively communicate and successfully promote demand for
immunization and other health services; empathize with caregivers; address questions and concerns through
counselling; and clearly communicate key messages regarding the timing and importance of further vaccinations
and practical information on where and when they should be obtained.
UNICEF extends gratitude to partners, colleagues and the advisory group who contributed their time, expertise
and experience to the preparation of this package. Special thanks to Johns Hopkins University Center for
Communication Programs for helping to develop the package, to the UNICEF regional and country colleagues and
the FLWs for their support, valuable feedback and collaboration in developing the package. Through this partnerships
and support, UNICEF will continue to enhance the capacity of the immunization workforce, institutions, and teams
that will help communities to value, demand, trust and improved understanding to the right to
immunization services.

Trainers' Facilitation Guide - For Global IPCI

FOREWORD vi
Abbreviations And Acronyms

•• AEFI adverse event following immunization

•• FLW frontline workers

•• IEC information, education, and communication

•• IPC interpersonal communication

•• IPC/I interpersonal communication for immunization

vii Trainers' Facilitation Guide - For Global IPCI

ABBREVIATIONS AND ACRONYMS
Trainers' Facilitation Guide
Overview
Module 1 - Principles Of Interpersonal Communication

Activity Session Module

Sessions Key Concepts Activities
Timing Timing Timing

1.1 Opening Why interpersonal Set ground rules 5 min. 15 min. 4 hr.
communication
is important to
the immunization Learning 5 min.
program expectation

1.2 Pre-test Testing current

knowledge Pretest 20 min. 30 min.

1.3 Client- Good customer

centred service in health Client experience 15 min. 20 min.
approach service role play

1.4 Interpersonal Empathy

communication Persona exercise 45 min. 2 hr.
and a client-
centred Journey mapping 1 hr.
approach the caregiver
experience

1.5 Interpersonal Nonverbal

communication communication;
skills creating a welcoming Double ‘blind’ 10 min. 20 min.
environment; asking communication
questions sensitively

1.6 Appreciating Appreciating the Photo review 15 min.

the caregiver caregiver 45 min.
Role play 25 min.

Trainers' Facilitation Guide - For Global IPCI

TRAINERS' FACILITATION GUIDE OVERVIEW viii
Module 2 - Exploring Provider Perspective And Barriers And Problem Solving

Activity Session Module

Sessions Key Concepts Activities
Timing Timing Timing
2.1 Respect and Discrimination, Reflection on 20 min. 45 min. 1 hr,
equity diversity experience 45 min.

Dimensions of 15 min.
diversity

2.2 Provider Experiences of Agree-disagree 10 min. 15 min.

barriers frontline workers
impacting client
services

2.3 Problem Problem solving Problem solving 25 min. 45 min.

solving

Module 3 - Immunization And Vaccines

Activity Session Module

Sessions Key Concepts Activities
Timing Timing Timing

3.1 Immunity Active, passive, How vaccines 10 min. 45 min. 1 hr,

herd immunity work pop quiz 30 min.

3.2 Vaccines Types of vaccine Lecture 30 min. 30 min.

3.3 Vaccine- Vaccine- Guess that 20 min. 45 min.

preventable preventable vaccine-
childhood diseases preventable
diseases disease

ix Trainers' Facilitation Guide - For Global IPCI

TRAINERS' FACILITATION GUIDE OVERVIEW
Module 4 - Profiling Types Of Caregivers

Activity Session Module

Sessions Key Concepts Activities
Timing Timing Timing

4.1 Understanding Determinants of Examples from 15 min. 45 min. 1 hr,

vaccine vaccine hesitancy; the local context 30 min.
hesitancy identifying
parental concerns

4.2 Profiling Identifying parental Practice profiling 30 min. 1 hr.

caregivers concerns; types of
hesitant caregivers

4.3 Communicating What to Finding-the-right- 10 min. 40 min.

with caregivers communicate during message skits
an immunization visit

Module 5 - Community Engagement

Activity Session Module

Sessions Key Concepts Activities
Timing Timing Timing

5.1 Conducting Approaches for Lecture 45 min. 45 min. 2 hr,

a needs conducting a 15 min.
assessment needs assessment

5.2 Barrier Common Image review 15 min. 45 min.

analysis caregiver barriers

5.3 Conducting a Communicating Story and brainstorm 10 min.

community immunization 45 min.
conversation messages to the Planning a 10 min.
community community
conversation

Trainers' Facilitation Guide - For Global IPCI

TRAINERS' FACILITATION GUIDE OVERVIEW x
Module 6 - Addressing Negative Rumors, Myths, And Misconceptions

Activity Session Module

Sessions Key Concepts Activities
Timing Timing Timing

6.1 What can be Steps to Addressing rumors 15 min. 30 min. 2 hr.

done about a addressing a speed rounds
negative rumor negative rumor

6.2 Communicating Causes of adverse AEFI case study 20 min. 45 min.

potential events following
adverse events immunization
following (AEFI)
immunization

6.3 Vaccine safety; Practice 20 min. 45 min.

Risk essentials and with difficult
communication
techniques for risk conversations
communication

Module 7 - Action Planning And Workshop Closing

Activity Session Module

Sessions Key Concepts Activities
Timing Timing Timing

7.1 Collecting Why collect Prototyping a 1 hr. 1 hr, 4 hr,

and using community feedback system 15 min. 15 min.
community feedback and how
feedback

7.2 Mobilization Advocating with Communication 15 min. 30 min.

influencers campaign

7.3 Apply your Skills application Individual interactive 1 hr, 1 hr,

skills and practice immunization 30 min. 30 min.
education session

7.4 Post-test and Post-test, Post-test 20 min. 40 min.

workshop workshop
evaluation Workshop evaluation
evaluation

7.5 Commitments Issue certificates Post-training 15 min. 25 min.

and certificates commitments

Issue certificates 10 min.

xi Trainers' Facilitation Guide - For Global IPCI

TRAINERS' FACILITATION GUIDE OVERVIEW
Glossary - Interpersonal
Communication For Immunization
Key Terms
Advocacy
Refers to the ways of developing and implementing a strategy to enable you to gain the
support and commitment of policymakers, community members, and other stakeholders
and to successfully lobby for increasing immunization coverage.

Agency
Refers to the expression of choice, voice, and power. It is the ability to make and influence
decisions that inform one’s life, the capacity to assert one’s interests and meaningfully
participate in public and private decision making, and the capacity to influence behaviour or
a course of action.

Caregiver
Someone who provides unpaid assistance and support to the physical, psychological, or
developmental needs of a baby or child. They may be a parent or someone who acts as the
secondary support to a parent, or as a primary guardian.

Client-centred approach
Means that the client’s needs, concerns, and experiences are the core focus during
immunization communications and services.

Closed question
A query the caregiver answers with a simple ‘yes’ or ‘no’. A closed question does not allow
you to check to make sure the caregiver or client has understood the question or really
knows the answer.

Communication
The transmission of information or conveying thoughts or feelings from a source (sender) to
a destination (receiver). Both sender and receiver have a responsibility to interpret the words,
gestures, or symbols that are being exchanged and to provide feedback.

Community conversation
A process of discussion within a community group. This activity is used to identify issues that
are causing problems locally and to find collective solutions to these problems.

Community mobilization
A process of gaining the involvement of key stakeholders in the community for an action
towards a particular goal.

Counselling
A collaborative effort between a counsellor and client(s) that helps clients identify goals and
potential solutions to barriers and promotes behaviour change.

Trainers' Facilitation Guide - For Global IPCI

GLOSSARY
xii
Empathy
An emotional identification with someone. It is the capacity to project a person’s thoughts
and/or feelings despite not having those thoughts/feelings explicitly communicated.

Equity (in health)

Means that no one is denied the possibility of being healthy because they belong to a
particular group or have an economic or social disadvantage.

Feedback
An audience’s response to a communication or experience either orally or nonverbally.
Feedback enables a communicator to evaluate the effectiveness of their message. Giving an
audience a chance to provide feedback is crucial for maintaining open communication.

Focus group discussion

A discussion with clear guidelines about the topic that the discussion should centre on. The
ideal number of participants in a focus group is between six and 10. A facilitator keeps the
discussion focused on the agreed upon topic and makes sure that everyone’s views are
heard.

Frontline worker
A social worker or healthcare provider (facility- or community-based, professional or volunteer)
tasked with delivering interpersonal communication (IPC) and counselling, immunization, or
education and outreach to caregivers, clients, or community members.

Immunization
The process by which a person is made immune or resistant to an infectious disease, typically
by the administration of a vaccine.

Interpersonal communication
The process of exchanging information, ideas, thoughts, and feelings between a group of two
or more people using verbal and nonverbal messages. The exchange allows them to receive
an immediate response or feedback that can lead to mutual understanding, agreement, and
action. IPC can happen in a face-to-face/direct setting or in a mediated/indirect setting, such
as video, audio, short message service (SMS) message, telephone, or internet exchange.
IPC is related to and supports the following skills:

•• Communication: Conveying ideas effectively through verbal and nonverbal means

•• Empathy: Understanding individuals

•• Mentoring: Coaching one or more people

•• Problem solving: Resolving personal, group, and workplace challenges

•• Negotiation: Coming to an agreement with others when opinions differ

•• Teamwork: Working together with various people to achieve a single goal

xiii Trainers' Facilitation Guide - For Global IPCI

GLOSSARY
Key message
A statement representing the general tone and main points to guide communication about
vaccines or immunization.

Mobilization
An approach to engaging individuals, groups, or organizations to become their own agents
of change in order to make improvements in the health and well-being of their families and
communities.

Nonverbal communication
A method of transmitting information or conveying thoughts or feelings through actions such
as body language, gestures, facial expressions, or sounds that are not quite words. These
actions can strengthen or contradict what is expressed verbally.

Open-ended question
A question that encourages the caregiver to answer in their own way and share their concerns
with you.

Respect
A positive feeling or action shown towards someone or something considered important.
Respect conveys a sense of admiration for good or valuable qualities and honours someone
by exhibiting care, concern, or consideration for their needs or feelings.

Social and behaviour change communication

Developing and implementing a communication strategy to promote a positive change in
health-related behaviours in a community, informed by local values and priorities. This can
only be done by sustained work with individuals and communities to explain the issues and
implications involved and to support people as they try to understand them.

Sympathy
When you share the feelings of another. It is the act or capacity of entering into or sharing
the feelings or interests of another.

Vaccination
The act of introducing a vaccine into the body to produce immunity to a specific disease.

Vaccines
A product that stimulates a person’s immune system to produce immunity to a specific
disease and protect the person from that disease. A vaccine initiates the immunization
process. Vaccines are usually administered through needle injections, however, some are
administered by mouth or sprayed into the nose.

Trainers' Facilitation Guide - For Global IPCI

GLOSSARY xiv
Overview
Background
There are many reasons for children not being fully vaccinated. Parents and caregivers have many
reasons for delaying, refusing, or not fully completing childhood vaccination. Their reasons might
include individual religious, ethical, and medical considerations; the influence of antivaccination
information; fear of side effects or complications; undervaluing the benefits of vaccination;
inconvenience of services (as perceived by caregivers); unreliability of services (sessions cancelled,
vaccinator not available, stockouts of vaccine); poor communication by vaccinators regarding the
return date, side effects, and so forth. They may also make poor decisions on whether to vaccinate
or which vaccinations to give and fail to screen and referral of eligible children within health facilities.

Evidence shows that the quality of the interaction between frontline health workers (FLWs) and
caregivers is a key factor in ensuring completion of the vaccination schedule. FLWs are among the
most influential sources of information about immunization behaviour. The healthcare providers,
social workers, community health workers, and community-based volunteers at the frontline
of immunization programs provide a crucial bridge between the communities they serve and the
immunization services they provide.

FLWs who routinely engage in positive and meaningful interpersonal communication (IPC) with
caregivers and community members – such as asking relevant questions, encouraging participation,
demonstrating empathy, emphasising the importance of timely vaccination, listening attentively, and
responding to, showing respect for, and appreciating caregivers – are able to build trustful relationships
and increase the likelihood that children will receive the recommended vaccines on time.

About This Resource

The Trainers' Facilitation Guide and participant’s manual on interpersonal communication for
immunization (IPC/I) and its companion resources are designed to help FLWs acquire the knowledge,
skills, and attitudes needed to communicate effectively with caregivers and communities about
childhood immunization. The information and exercises these resources contain can be used for
preservice training, training workshops, day-to-day supervision, supportive supervision visits, on-the-
job training (including coaching, mentoring, and peer-to-peer mentoring), and self-study. The Trainers'
Facilitation Guide was developed for group training and is supported by the participant’s manual,
which can be used in group training settings or for self-study. The guide and manual were designed so
that country offices can adapt them according to local context and needs. The modules incorporate
several social and behaviour change theories and approaches. We recommend trainers familiarize
themselves with basic principles of social and behaviour change or communication for development
in preparation to deliver the training. A number of relevant resources and reference materials can be
found at thecompassforsbc.org.

Trainers' Facilitation Guide - For Global IPCI

OVERVIEW
1
Training Philosophy
Intended to be participatory, this training includes learning-by-doing activities with a focus on adult
learning methods that require participation through paired and small group exercises as well as large
group discussions, brainstorming, role play, and practice. The training follows four guiding principles:
clarity, engagement, reflection, and reinforcement.

Intended Audience
The intended audience is FLWs, broadly defined. An FLW is a social worker or healthcare provider
– facility- or community-based, professional or volunteer – who does or should deliver IPC and
counselling, immunization, or education and outreach to caregivers, clients, or community members.
An immunization program may be composed of several different types of FLWs whose key
characteristics (such as education levels, training, competencies, and compensation levels), skills,
roles, and jobs vary. Regardless of their differences, they all can play complementary roles in ensuring
that communities achieve full vaccine coverage.

The resources within the IPC/I package are geared towards FLWs who serve in a health promotion
and preventative care capacity. Their profiles vary by country and within individual countries. Those
with more formal education tend to work in health facilities, where they vaccinate. They may have
public health training of only a few months up to several years, in the case of registered nurses or
medical technicians. FLWs may be minimally literate community volunteers or educated salaried
employees. All FLWs are responsible for informing, counselling, and encouraging families to have
their children fully immunized.

Training Objectives
The resources within the IPC/I package seek to help immunization programs address the following
knowledge, attitudes, and practices among FLWs:

FLWs Will Gain Knowledge About:

•• The principles of effective IPC

•• How to effectively communicate with caregivers irrespective of their workload or the length of
the caregiver interaction

•• What steps are taken by regulatory authorities, vaccine manufacturers, and the health system to
ensure vaccine safety

•• How vaccines prevent disease

Flws Will Gain The Perspective That:

•• All caregivers and community members deserve respect, empathy, equitable service, and to
be heard regardless of religion, ethnicity, national origin, gender, education, or socioeconomic
status.

•• FLWs play a key role in enabling community health.

2 OVERVIEW
•• Vaccines are safe and prevent disease.

FLWs Will Have The Skills To:

•• Explain the benefits of various vaccines, remind caregivers about subsequent vaccination, and
describe possible side effects and actions caregivers can take to address them

•• Effectively communicate with caregivers and community members with various attitudes about
vaccines or the health system at large

•• Encourage caregivers to ask questions and provide caregivers with clear and appropriate
responses to these questions

•• Appropriately address rumours, concerns, or misconceptions

•• Plan and conduct community engagement and outreach activities

Layout/Content Of The Manual

The manual is divided into individual sessions, which include notes to help guide the trainer facilitate
each session, including the:

•• Objectives of the session

•• Time required for the session

•• Materials/preparation needed for the session

•• Training methods used

•• Session content

Preparation For The Training

To make the best use of this manual and conduct effective training, trainers should:

1. Read the manual carefully prior to use so they know the training agenda, objectives, methodology,
materials, and time allocated for sessions and breaks

2. Practice activities before conducting them, setting aside adequate time to plan and seek assistance
from co-facilitators or translators

3. Review each activity and gather or develop the necessary materials

4. Know the characteristics of the training practice participants and prepare to accommodate
different education levels, professional backgrounds, languages, cultural norms and customs, and
learning styles

5. Adhere to the suggested timing and try to conduct training sessions with fewer than 12 participants

Trainers' Facilitation Guide - For Global IPCI

OVERVIEW
3
 MODULE 1
Training Schedule
Sample schedules for a five-day training, three-day training, and one-day training are offered
in Appendix J.

Preservice Training
Integration of this training package into preservice training will likely require a formal process
that includes a stakeholder consultation to identify individuals or groups interested in
supporting implementation, decide which modules and sessions should be added to the IPC/I
curriculum, analyse the content of the program’s current IPC and IPC/I training resources,
plan to adapt and introduce new content and prepare instructors, and develop a monitoring,
evaluation, and learning plan.

In-Service Training
Prior to providing in-service training, assess participants’ training needs and modify the
content of the training package to meet those needs. Consider adapting the objectives,
sessions, steps, timing, activities, role play scenarios and character/place names, examples,
vocabulary, key takeaways, and any other elements to make the training more closely aligned
with the needs and policies of the immunization program, profile of the participants, and
barriers within the community. Enhance the content with local examples and country-level data
for better contextualization and modify the content according to the time available, focusing
on the modules that align with the identified learning needs. In some health systems, it may
be necessary to spread content over two or more mini-workshops of one to two days each
or reduce the content to fit in a single workshop of one to three days. If these changes are
necessary, make every effort to maintain the highly participatory, practice-oriented nature of
the workshop as outlined. You will likely achieve the best result by covering a limited number
of topics and sessions deeply.

On-The-Job Training
To use these modules for on-the-job training, focus on one or a few staff who you have
identified as having the same training needs. Through supportive supervision and other
needs assessments, focus the training on specific knowledge, attitudes, and skills. Allocate
time to cover each competency on a schedule that will allow the FLWs to learn, practice, and
independently apply the new skills or approaches.

4 TRAINING SCHEDULE
Principles Of
Interpersonal
Communication
Objectives

Identify the IPC techniques needed to

enhance interactions with caregivers
and clients

Analyse the barriers to IPC and

the factors that promote effective
interactions for increased
immunization demand

Learn how to respond to caregiver/

client concerns to support informed
decision making

Understand and be able to apply the

principles of empathetic and active
©UNICEF/Asselin
counselling with caregivers
Session 1.1 Opening
Introduction: Why Is Communication Important To The
Immunization Program?
The main task of IPC/I is to facilitate children receiving vaccinations as closely as possible to the
recommended schedule. Achieving this goal requires access to reliable services, treating people
respectfully, and clearly communicating essential practical information. Effective IPC fosters a
positive relationship of respect and trust between FLWs, families and communities. This practice
encourages and responds to caregivers’ questions and concerns, a task that is challenging when
caregivers, religious leaders, political leaders, or cultural leaders reject vaccinations or some aspect
of recommendations. Finally, it is used to inform communities and individuals about public health
concepts related to immunization.

When you communicate with caregivers about vaccine-preventable diseases, vaccines, and
immunization, it is important to understand their current attitudes, beliefs, and level of knowledge.
You should always try to make sure that your points are memorable, made clearly, and respond
directly to what the caregiver needs to understand or feel to accept vaccination. It is important to
respond to the needs and concerns of the community, appreciating local challenges and showing
respect for local customs and culture.

While completing the training exercises, it might be helpful to distinguish what kind of IPC is needed
to address the concerns of caregivers bringing a child for the first vaccination(s) compared to the
concerns of bringing a child for subsequent ones. Vaccine hesitancy and access issues most affect
the former, while the service experience and quality of communication by the vaccinator most affect
the latter.

Welcome Remarks
•• Welcome participants

•• Thank everyone for their participation and enthusiasm

•• Use the “Why communication is important to the immunization program?” section above as
speaking points to explain the workshop purpose

•• Provide some background on the current status of the immunization program

Activity: Set Ground Rules

•• Ask participants to develop a set of ground rules to govern the workshop.

•• This can be done “popcorn-style” to get everyone to participate. Toss a ball to one
participant. When they catch the ball, they have to name one ground rule and then toss
the ball to another participant. Each person should catch the ball once and each person
should come up with one rule.

•• Write the rules on a whiteboard, chalkboard, or flip chart paper.

6 MODULE 1 - PRINCIPLES OF INTERPERSONAL COMMUNICATION

Training Goals and Objectives

•• To describe the training objectives outlined in the Overview section

•• To develop and enhance the IPC skills of FLWs to provider quality care services

Activity: Learning Expectations

This activity will explore the barriers that affect the interactions with
caregivers/clients.

1. Give each participant a full sheet of paper and a drawing or writing

utensil (marker or pen).

2. Each participant should be given a few minutes to draw a picture

illustrating a personal or professional challenge they face that they feel
prevents them from ensuring that every caregiver has a high-quality
immunization experience.

3. Each person should share their name, describe the meaning behind
their illustration, and share one thing this workshop will help them to
do better.

Note to Facilitator: Reiterate how the workshop objectives will help to address the
challenges they face with caregivers, supervisors, and community members. Mention
that the FLWs themselves are likely to get more satisfaction from their work if they
improve their IPC.

IPC/I Video: FLWs Can Make a Difference

Despite the many barriers faced by FLWs, they are integral in preventing children
from dying of vaccine-preventable illnesses. See the video ‘FLWs Can Make a
Difference’, which shows the inspiring work of FLWs around the world.

This video establishes the importance of the role of FLWs in behaviour change for
immunization. It highlights the key role FLWs play as trusted and influential actors in
motivating vaccination uptake and increasing demand for immunization.

Reflection Questions
•• What motivated you to be an FLW?
•• What is one of your most memorable positive experiences with
a caregiver?
•• What is the most rewarding part of your work?

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Session 1.2 Pretest
Pretest
1. Distribute a copy of the pretest to each participant (see Appendix A).

2. Instruct participants to write their name (or a unique identifier at the top; if they use an
identifier, they should use the same one for the post-test).

3. Allow 20 minutes to complete the test.

4. Collect each test.

Session 1.3 Client-Centred Approach

Introduction: Interpersonal Communication And A
Client-Centred Approach
Interpersonal skills are those pertaining to relationships with people and encompass many different
important skills. The purpose of this session is to introduce how IPC can support a client-centred
health services experience.

Activity: Client Experience Role Play

Ask two participants to role play, one acting as a caregiver and the other acting as a
receptionist who welcomes visitors the health facility.

A mother arrives late to the health facility with a newborn and a small child. The mother
is flustered from her long journey and not sure whether to enter the facility. Before
she reaches the entrance to the clinic, the receptionist asks if she has come for a
vaccination. She answers ‘yes’, and he asks whether she has brought the immunization
card. She answers ‘no’. He tells her the nurse is very busy, and she should come back
the next morning with her child’s immunization record.

Group Discussion

•• How would you feel if you were the caregiver?

•• What are some reasons the receptionist may have treated the caregiver this way?

•• What could the receptionist have done differently?

•• How would you interact with a caregiver who had an experience such as this?

•• What would you (as the FLW) say to the receptionist to improve their behaviour?

8 MODULE 1 - PRINCIPLES OF INTERPERSONAL COMMUNICATION

Definition of a client-centred approach

A client-centred approach to immunization service means that the clients’ needs, concerns, and
experiences are the core focus of communication and services.

A client-centred approach is important because it:

•• Improves the caregiver and client’s attitude towards FLWs

•• Improves the reputation of staff at the facility and community levels
•• Provides the caregiver and client with positive, memorable experiences
•• Satisfies the needs and expectations of the caregiver/client
•• Increases the number of caregivers/clients who continue to bring children for recommended
immunizations (reducing dropout)
•• Increases the number of caregivers/clients demanding immunization

Reflection Questions
•• How would you define a client-cantered approach?

•• How can you demonstrate to caregivers/clients that they matter most? How can you
improve on this?

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Session 1.4 Interpersonal Communication And
A Client-Centred Approach
IPC is vitally important to delivering a client-centred approach and supporting the behaviour change
process. In particular, it is very good for:

•• Informing individuals and target audiences about the value of the proposed behaviour change by
explaining and responding to questions and doubts about immunization

•• Addressing rumours about adverse effects of immunization

•• Addressing any personal issues the caregivers may express

•• Through advocacy efforts, helping to mobilize resources from the community to enhance the
immunization program

•• Building consensus, for example, to bring all eligible children for immunization

•• Explaining to caregivers about the immunization status of the child

•• Telling the caregivers about the next immunization(s) the child will need

Empathy
Before focusing on the principles of effective IPC in detail, it is important to try to understand
how caregivers and clients experience immunization services. The more we can understand their
experiences, the better we can empathize with the different types of caregivers and clients we
encounter. Empathy gives us a sense of understanding and compassion for another person, based
on our ability to imagine what an experience might be like for them.

Showing empathy is one of the most important communication skills for FLWs because it helps
us to treat people with respect and kindness, regardless of their background, social position, or
attitude. Showing empathy makes caregivers more likely to express themselves, allowing you to
learn more about the caregiver, child, and issues or concerns that need to be addressed. When
you show caregivers empathy, you are more likely to have positive interactions and they will feel
more comfortable discussing vaccination concerns with you and following your guidance. It may be
challenging to act empathetically under stressful working conditions, but it is important to try.

Activity: Journey Mapping the Caregiver Experience

The mapping exercise is intended to build empathy by helping participants imagine the
experience of caregivers from the time they decide to bring their child to get a vaccination
to the receipt of the vaccination.

Part 1: Understanding the Caregiver

1. Divide the participants into groups, with four participants per group.
2. Give each group two large pieces of flip chart paper, a marker, and s

10 MODULE 1 - PRINCIPLES OF INTERPERSONAL COMMUNICATION

 3. Assign each group one of the following caregiver personas/characters:

a. A young (19 years old), married mother

b. An old grandmother unable to read or write
c. A recently widowed father
d. An educated, married couple

4. Allow each group 30 minutes to create the caregiver’s character. They can choose to imagine
any backstory or personal history associated with the persona they have been assigned.
5. Draw an image of the caregiver and their family. Be prepared to discuss the points below.

Each group should be prepared to describe the following about their character:

•• Thinking and feeling: What are their worries and aspirations for themselves and their children?

•• Seeing: What does the person look like, what do they wear, what is their profession? What does
their community, health facility, and environment look like? What resources does it offer?

•• Saying: What is their public attitude towards childhood immunization? Towards the health
system in general?

•• Hearing: What are their peers, family members, and other influential people in their lives saying
about immunization?

Note to Facilitator:

If feasible, consider inviting some caregivers from the community to observe the session and
participate in the reflection questions. At the end of the role play, ask the caregivers how realistic the
portrayals were and what changes or additions they believe should be included.

Part II: Mapping the Persona’s Experience through the Health System

Now you will ‘map’ the journey of your character’s experience using immunization services. Allow 30
to 45 minutes for the mapping. It may help to organize this as a chart with Step 1 on the horizontal
axis and Step 2 on the vertical axis. Allow each group 10 to 15 minutes to present their persona and
journey map.

Note to Facilitator:

There are a number of different ways to conduct a journey mapping exercise. The objective is
to systematically think through a caregiver’s experience as they interact with health services.
Understanding this then helps the FLW build empathy and develop solutions address any pain points.
To familiarize yourself with journey mapping see this resource from IDEO.

Step 1: In the same groups, with the same caregiver character in mind, list the steps involved
in receiving a vaccination for their child. Include: (1) the journey to reach the health facility; (2)
what happens once they arrive at the facility; and (3) what happens when their child receives the
vaccination. Be as detailed as possible.

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 Step 2: Now, the groups will answer the following questions about the journey:

•• Questions: What questions might the caregiver have as they move through the journey?

•• Pain points: What are the problems, frustrations and annoyances, or potential barriers
that may create a negative experience?

•• Happy moments: What are the positive, enjoyable things that could improve the
experience?

•• Opportunities: What can you implement or do as an FLW to address any of the pain
points identified?

Reflection Questions

•• Considering the entire caregiver/client journey, what might be the most difficult part of
the immunization services experience?

•• Given the challenges a caregiver might experience, what might motivate them to bring
their children to complete the immunization schedule on time?

•• What might a caregiver want to change about immunization services?

•• How would you expect caregivers to behave when they arrive at the facility, given the
pain points they have experienced?

Session 1.5 Interpersonal

Communication Skills
Activity: Double ‘Blind’ Communication
Through this activity, participants observe the importance of
nonverbal communication.

1. Divide the participants into pairs. They should work with

someone they do not know well, if possible.
2. Each pair sits in chairs, one person directly behind the
other, facing in the same direction – meaning that the
second person should be staring at the back of the
other person’s chair.
3. Instruct the pairs that the person in front should not turn around and the person
behind them should not move towards the front of the other person.
4. Ask them to have a two-minute conversation about why they each became
an FLW.
5. When finished, bring the participants together in the large group and discuss
the exercise.

12 MODULE 1 - PRINCIPLES OF INTERPERSONAL COMMUNICATION

 Reflection Questions
1. How did it feel to have a conversation without being able to look at the other person?

2. What was missing from the interaction?

3. What important attitudes does a caregiver/client express through their facial expression,
eye contact (or lack of), posture, gestures, and so forth?

4. What kind of nonverbal communication supports positive interactions with caregivers?

Note to Facilitator:

Before reviewing the list of IPC skills below with the participants, invite participants to mention and
describe skills they already know.

Interpersonal communication skills

Below are IPC practices important for immunization communication. These skills require practice and
awareness until they become habit.

•• Welcome the client warmly.

•• Empathize with the caregiver by demonstrating that you understand their questions, concerns,
and how they feel.

•• Keep messages simple and clear.

•• Speak in simple terms, using local and easy-to-understand language; give examples that the
caregiver is likely to understand.

•• Check for understanding. After explaining something, ask questions to find out whether you are
understood.

•• Motivate by praising the caregiver for bringing the child for immunization and encouraging them
to return for the next dose.

•• Listen actively. Active listening is very different from just hearing. It means listening to another
person during a conversation in a way that shows your understanding and interest. This method
encourages the other person to be more involved in the conversation.

•• Use appropriate visual aids, such as posters, flip charts, counselling cards, and pamphlets, if
available, to support the conversation. Any images you use should be relevant to the message
you want to convey and appropriate to the local customs.

•• Summarize what has been discussed at the end of the conversation. You should check and
confirm understanding and request the caregiver’s commitment to bring the child back for the
next vaccination(s) when scheduled, discuss a concern with her husband, and so forth.

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You can demonstrate care and respect for caregivers and clients through the following actions:

•• Being polite

•• Being pleasant

•• Encouraging caregivers to express their ideas by asking open-ended questions and pausing to
allow them to respond

•• Showing your appreciation for the caregivers’ knowledge and questions

•• Avoiding interrupting caregivers when they speak

•• Showing compassion if they share an issue or concern

•• Using appropriate body language, including pleasant facial expressions, appropriate eye contact,
and appropriate distance between you and the caregiver.

Note to Facilitator:

•• After reviewing these skills, display them so participants can reference them throughout
the training.

Asking Questions Sensitively

Asking questions sensitively means that, when you assess how much they understood and accepted
what you have discussed, you are careful to not imply that the caregiver should have doubts about
immunization. Ask them questions that enable you to assess their attitudes about and the likelihood
of continuing to seek the recommended vaccinations, as scheduled.

Asking about a caregiver’s worries about immunization is an example of an open question, that is,
it is a question that encourages the caregiver or client to answer in their own way and share their
concerns with you. You should avoid asking closed questions that the caregiver or client can answer
with a simple ‘yes’ or ‘no’. A closed question does not allow you to make sure that the client has really
understood the question or knows the answer. When asking questions, always give the client time to
think and answer. Let the client answer freely and do not interrupt while they are speaking.

An example of a closed question is: “Can we look together at your child’s immunization record to see
which immunizations your child has been given and at what ages?”

Change this to an open question on the same topic by asking: ‘Which immunizations has your child
been given, and at what age was your child when they got them?’

14 MODULE 1 - PRINCIPLES OF INTERPERSONAL COMMUNICATION

 Key Takeaways
•• By putting yourself in your client’s position, you can understand and appreciate their challenges,
fears, problems, and barriers better and empathize with their situation.

•• By using simple and genuine ways of demonstrating care and respect for the caregiver, you can
increase the uptake of immunization.

•• By adopting a client-centred approach (focusing on the specific needs of the client), you can
address their questions and concerns effectively.

IPC/I Self-Assessment Tool (see appendix K)

Complete the IPC/I Self-Assessment tool to evaluate whether you are currently practicing effective
IPC. This tool is meant for participant’s personal use; however, they are encouraged to share it with a
supervisor following the training.

IPC/I Video: Welcoming and Reflection Questions

communicating effectively
•• How was the caregiver’s
For an illustration of client-centred experience similar and different
care, see the video ‘Welcoming and from caregivers you have
communicating effectively’. encountered?
•• What are some of the skills the
This video focuses on a whole-site FLWs practiced to make sure the
approach to creating a patient- caregiver had a
friendly environment. It aims to equip positive experience?
everyone in the facility – from security •• Do you think this caregiver is
to the administration, cleaners, and likely to return to the facility?
clinicians – with information on how Why or why not?
to foster a positive immunization
experience for the caregiver/client
and the importance of doing so.

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MODULE 1 - PRINCIPLES OF INTERPERSONAL COMMUNICATION 15
Session 1.6 Appreciating The Caregiver
Activity: Practice Appreciating the Caregiver – Photo Review
1. Project or distribute copies of the photo (next page) of a caregiver (in red) and an FLW
(in yellow).
2. Allow participants five minutes to study the image and write down the positive things
the photo is displaying. What is the caregiver doing well? What can we assume from
the photo about her attitude towards vaccines? What is her behaviour towards the
FLW? How is she caring for her child?
3. In plenary, ask participants to share the reasons why they appreciated the caregiver.*

Note to Facilitator:

Before the session, please prepare at least 10 reasons to appreciate the caregiver.
These may include, the fact that the caregiver brought the child in for immunization,
the child is appropriately clothed, the caregiver appears to have a positive relationship
with the
FLW, etc.

Activity: Practice Appreciating the Caregiver – Role Play

©UNICEF/Sokol

1. Divide the participants into pairs.

2. Assign each pair one of the following scenarios to role play. One participant should
role play as the caregiver and the other as the FLW. The FLW should find at least one
or two ways to appreciate the caregiver.

3. Select two or three pairs to act out their role play scenario for the larger group.

4. Ask the participants to share situations in which they might find it difficult to
appreciate or praise a caregiver.

5. Allow other participants to give suggestions on how to appreciate caregivers in

those situations.

16 MODULE 1 - PRINCIPLES OF INTERPERSONAL COMMUNICATION

Appreciating the caregiver role play scenarios

A father brings his newborn in for her first A very shy mother brings her child for
immunizations since birth. immunization. She answers all the FLW’s
questions with one-word answers and
seems afraid (or not interested) in asking any
questions.

An experienced mother has brought her A mother brings her child for his second round
child for every immunization session, so of immunizations one month late.
he is now fully vaccinated.

The young mother arrived just after the last A wife explains to her husband that she
child had been immunized and taken away by wants to vaccinate the child, but he refuses
his father. You are tired and ready for lunch. to allow it.
She explains that her transport broke down,
but she still wants her baby immunized.

During the group discussion, a father After listening to the FLW explain the
asks why he should allow an FLW to importance of vaccination during a home visit,
vaccinate his child when other children the caregiver still refuses.
have gotten a fever after vaccination.

A mother brings her child for A young father brings his child in for
immunization but overwhelms you immunization. He says he cannot wait for the
with questions. group discussion to finish because he must go
to work.

Reflection Questions
•• Why is it important to appreciate a caregiver during an immunization visit?
•• How can appreciating caregivers motivate them to return for the next visit?
•• What are the positive and reaffirming statements a caregiver might like to hear?

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Exploring Provider
Perspectives And
Barriers And Problem
Solving
Objectives

To examine how providers’

attitudes and barriers impact the
healthcare experience and access to
immunization

To encourage FLWs to try strategic ©UNICEF/Knowles-Coursin

problem solving to overcome barriers
Session 2.1 Respect And Equity
It is the responsibility of everyone within the healthcare system to treat people with respect,
regardless of any aspect of their identity. It is important for FLWs to demonstrate the following
to all caregivers: empathy, interest, tolerance for values and beliefs, unbiased attitudes, patience,
gentleness, friendliness, and willingness to support them.

Activity: Reflection on Experiences

1. Distribute a piece of paper and writing utensil (marker or pen).

2. Instruct participants that this activity will be silent.

3. On the piece of paper, participants will record an incident when they felt they were
treated unfairly.
a. They can record the incident in writing or as an image.
b. Give them 10 minutes to record the memory.
c. Next, in pairs, participants will share this memory with one another. Make sure partners
ask one another:
i. Why this incident stands out?
ii. How it made them feel?
iii. Why do they feel they were being treated unfairly?
Each person should listen carefully to their partner as they may be asked to relate the
story back to the group.
d. Request a few volunteers to share the stories that they heard. Volunteers should ask
for their partner’s permission before sharing their story with the larger group.

Activity: Dimensions of Diversity

1. In the large group, ask participants to brainstorm reasons that people might be treated
differently or unfairly; examples include race, ethnicity, nationality, gender, disability,
age, education, income, and religion.
2. The participants should return to their pairs. Each pair should discuss the ways in which
a particular dimension of diversity might positively and negatively affect the healthcare
experience of and access to immunization. Assign each pair one of the ‘dimensions of
diversity’ below:

Dimensions of Diversity:

Internal dimensions: age, gender, race, ethnicity, physical ability, and sexual orientation

External dimensions: geographic location, marital status, parental status, appearance, work
experience, educational background, religion and spirituality, income, and personal habits

3. Next, they should discuss how they, as an FLW, can help to address and lessen any
negative healthcare experiences that are rooted in a caregiver/client’s identity.
4. Depending on the amount of time remaining, select a few pairs to share what
they discussed.

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MODULE 2 - EXPLORING PROVIDER PERSPECTIVES AND BARRIERS AND PROBLEM SOLVING 19
 Reflection Questions

•• How might your own biases affect your interactions with caregivers/clients?

•• What can you do to ensure you treat all caregivers/client equitably, regardless of
their identity?

•• How can your personal beliefs help you become a more empathetic service provider?

Session 2.2 Provider Barriers

Multiple factors have been linked to the underutilization of services. One commonly noted factor is
that a provider’s barriers may translate to access barriers for their clients. Service providers are among
the most influential sources of information in community settings and serve as crucial facilitators
in reducing client barriers to services. However, FLWs have their own experiences, perspectives,
and biases that can challenge their ability to adequately deliver immunization services. They may be
faced with a number of personal and professional barriers that contribute to poor quality or
insufficient service. A provider’s personal opinions and biases, attitudes and behaviours, capacity
and skills, and working conditions may all impact their ability or motivation to deliver quality
services. It is important for FLWs to understand their barriers, so they can work with their
supervisors, the health system, and interested citizens to address how those barriers and
perspectives negatively impact interactions with caregivers and clients.

Note to facilitator:

Before the session, please prepare a few discussion points or key messages to conclude the activity.
You may consider giving the participants to stand between agree or disagree in a “middle ground”.

Activity: Agree-Disagree
Place a sign that reads ‘Agree’ on one side of the room. Place another sign that reads
‘Disagree’ on the other side of the room. As you read aloud the following statements, ask
participants to stand next to the ‘Agree’ sign if they agree and next to the ‘Disagree’ sign if
they disagree with the statement. After the participants are comfortably settled next to the
sign of their choice, have one person from each side provide an example of a time when
they felt this way. You may choose to add more issues related to how the health system
treats FLWs. This set of statements is a good place to start:

(Continued on next page)

AGREE DISAGREE

20 MODULE 2 - EXPLORING PROVIDER PERSPECTIVES AND BARRIERS AND PROBLEM SOLVING

•• On most days, I enjoy my job.

•• I feel motivated to do whatever it takes to protect the health of the community I serve.

•• I feel respected and supported.

•• Seeing a child complete their immunization schedule gives me personal satisfaction.

•• I am always patient, respectful, and kind when dealing with caregivers.

•• Sometimes my facility runs out of vaccines and I have to turn caregivers away.

•• I often find it difficult to provide good IPC because I need to rush due to so many caregivers and
children waiting for vaccination.

•• Some caregivers do not deserve to be treated with kindness.

•• I sometimes get angry at caregivers who forget their child’s immunization card or come late for
vaccinations.

•• I feel confident confronting a coworker who is treating caregivers/clients poorly.

•• I feel like I have the training and information I need to respond to caregivers’ questions on
immunization, vaccines, and vaccine-preventable diseases.

•• I receive support from my supervisors that enables me to improve my performance.

•• I have opportunities to expand my skills and move to more responsible and better compensated
positions in the health system.

Session 2.3 Problem Solving

FLWs cannot solve all of their problems alone. For example, the common problem of overcrowded
vaccination sessions can be addressed by, for example, expanding vaccination hours or days,
working with community leaders to encourage caregivers to bring children during less crowded
times (usually afternoons), and setting up a counselling table at the facility exit. More essential
information could be given during community health talks, so less time is needed for individual
sessions.

Open this session by asking the participants who are their supervisors and what type of support
they currently receive.

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MODULE 2 - EXPLORING PROVIDER PERSPECTIVES AND BARRIERS AND PROBLEM SOLVING 21
Problem solving is a constructive process focused on how to adapt, be flexible, and effectively deal
with an immediate or long-term problem or obstacle. The steps are as follows:

Step 1 Identify the problem.

Step 2 Brainstorm possible strategies to address it

Step 3 Engage others to generate possible solutions

Step 4 Examine the advantages and disadvantages of each

Determine which strategy might be the most effective

Step 5 and select the best solution

Step 6 Develop a plan of how to carry out the solution

Step 7 Take action using the plan

Step 8 Evaluate how well the solution addressed the problem

Activity: Problem Solving

Now that participants have shared the types of barriers they experience in their work,
they should brainstorm solutions for dealing with these barriers. Divide the participants
into groups of four people each. Allow each group to select one of the barriers mentioned
in the agree–disagree exercise (e.g., time constraints, low motivation, difficult caregivers,
lack of support, or low technical knowledge). Give them 15 to 20 minutes to brainstorm a
skit (short play) that demonstrates the challenge and a communication-based solution for
addressing it.

22 MODULE 2 - EXPLORING PROVIDER PERSPECTIVES AND BARRIERS AND PROBLEM SOLVING

 Reflection Questions
•• What were the similarities and differences in the solutions and approaches the groups
proposed?

•• How does this eight-step process differ from how you normally approach solving
problems?

•• How do you see yourself using the problem-solving process in your workplace? Your
community? Your household?

•• How can this process be applied to resolving challenges for caregivers?

IPC/I Video: Supportive supervision and problem solving

The problem-solving process does not need to be an independent exercise. Look to supervisors
and other FLWs for additional support to address the challenges you and your clients face. See the
video ‘Supportive Supervision and Problem Solving’ for an illustration of how supervisors can help to
support problem solving.

This video illustrates the process of guiding and coaching FLWs to promote compliance with
standards of practice and assure the delivery of quality health services. It focuses on strengthening
communication, identifying and solving problems, facilitating teamwork, and providing leadership and
support to empower healthcare providers to monitor and improve their own performance.

Reflection Questions

•• What kinds of issues can a supervisor help you address?

•• What kind of issues can a fellow coworker help you address?

•• What can you do to strengthen the relationship with your supervisor?

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MODULE 2 - EXPLORING PROVIDER PERSPECTIVES AND BARRIERS AND PROBLEM SOLVING 23
 MODULE 3
Key Takeaways
•• Problem solving is a practical and helpful process that focuses on brainstorming and evaluating
possible solutions then taking action.

•• Learn to seek help from supervisors, coworkers, and others to address problems and barriers at
work that will ultimately impact caregivers and uptake of immunization.

•• Realize that biases and attitudes of FLWs play a crucial role in the counselling experience.

24 MODULE 2 - EXPLORING PROVIDER PERSPECTIVES AND BARRIERS AND PROBLEM SOLVING

Immunization
And Vaccines
Objectives

Understand the mechanisms of

immunity and the immunization
schedule

Describe the cause of infections

Explain how the body develops

immunity

Know the various types of vaccines ©UNICEF/Sewunet

Note to Facilitator:

Before conducting this session, probe into what participants already known about immunization and
vaccines and focus on what is not known or well-understood.

Session 3.1 Immunity

Immunity is the ability of the human body to tolerate the presence of materials indigenous to the body
and resist materials foreign to the body. This discriminatory ability provides protection from infectious
disease, since most microbes are identified as foreign by the immune system. Immunity is generally
specific to a particular organism or group of closely related organisms and is usually indicated by
the presence of an antibody to that organism. There are two basic ways to acquire immunity against
infections – active immunity and passive immunity.

Active Immunity
Active immunity is acquired when a person’s own immune system is stimulated to produce antigen-
specific antibodies and immune cells. This type of immunity often lasts for many years and, in some
cases, may be lifelong. Active immunity can be divided into natural and artificial active immunity.

Natural active immunity: This type of immunity is acquired after an individual has survived an infection
with the disease-causing form of the organism.

Artificial active immunity: T his type of immunity is acquired through vaccine administration.

Passive Immunity
Passive immunity occurs when antibodies are transferred from one person and/or animal to another.
Passive immunity disappears over time, usually within weeks or months. It is divided into natural
passive immunity and artificial passive immunity.

Natural passive immunity: Passively acquired antibodies are responsible for the protection of newborns
and young infants against certain diseases. The transfer of antibodies from mother to fetus across the
placenta during the last two to three months of pregnancy provides the newborn with a portion of the
mother’s immunological experience.

Artificial passive immunity: ‘Borrowed’ antibodies can protect a person temporarily. These borrowed
and prepared antibodies are from the serum (antiserum) of a person or animal that has been exposed
to an antigen and has produced antibodies that are then purified and directly injected to the person at
the site of infection to immediately counteract the offending antigen. Sources of passive artificial
immunity include blood and blood products, immune or *hyperimmune globulin, and animal
antitoxins.

* Hyperimmune globulin is prepared from the plasma of donors with high titers of antibody against
a specific antigen. Some agents against which hyperimmune globulins are available include hepatitis
B, rabies, tetanus toxin, and varicella-zoster.

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MODULE 3 - IMMUNIZATION AND VACCINES

Herd Immunity
This is the protective effect given to the few unimmunized individuals in a community that has a high
proportion of its population immunized. Herd immunity usually is strongest when a high percentage of
individuals are immunized and evenly distributed in a given area. A community becomes susceptible
to the disease if a large number of nonimmune people – either by birth or immigration – enter the
area. There are two ways of developing herd immunity:

• High natural infection rate in the community

• Artificial immunization

Activity: How Vaccines Work - Pop Quiz

Ask the following questions aloud. Read each answer choice. Ask participants to raise their
hand based on the answer choice they think is correct. Whoever raised their hand to the
correct answer can be provided a small treat (such a piece of chocolate). Be sure to share
the correct answer (highlighted) and explain why it is true.

Question 1. Which of the following is true about the immune system?

A. The immune system is an infection that harms the body.

B. Skin and mucous membranes are not part of the immune system.

C. The immune system does not help the body fight disease.

D. Vaccines help the immune system fight disease

Question 2. Which of the following is true about vaccines?

A. Giving an infant multiple vaccines can overwhelm its immune system.

B. Vaccines are made from adjuvant, stabilizers, and preservatives.

C. Natural immunity works better than vaccines.

D. Ingredients in vaccines are harmful.

Question 3. Which of the following diseases mainly affects children under five years of age and
remains endemic in only two countries?

A. Rubella

B. Polio

C. Measles

D. Tetanus

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27
Question 4. Which of the following is NOT a vaccine-preventable disease?

A. Cervical cancer

B. Polio

C. Hepatitis B

D. Asthma

Question 5. How many infants worldwide are still missing out on basic vaccines?

A. 1.4 million

B. 5.9 million

C. 6.8 million

D. 18.7 million

IPC/I Audio Job Aid: Can vaccines help to eradicate or eliminate certain diseases?

This audio job aid provides an overview of how a disease can be eradicated and the role that vaccines
play in increasing immunity, with the aim of ultimately eradicating diseases. The audio job aid
also explains why some diseases, particularly those with environmental reservoirs, may never be
eradicated, pointing to the importance of widespread vaccination against those diseases.

Reflection Questions
• What are some of the challenges in achieving high levels of population immunity for all
diseases?
• How would you simply explain the importance of population immunity to a caregiver?
• What IPC skills were used in the audio?

Session 3.2 Vaccines

Vaccines are produced and distributed with the principal goal of preventing and protecting
against serious diseases. The efficacy of vaccines has been shown all over the world. Many
diseases that were once common, such as polio, measles, mumps, and tetanus, are now rare
and under control.

Vaccines are proven safe and effective. They are held to high safety standards and carefully monitored
from the start of the development process to the time they reach the child. A quality assurance system
is in place to ensure that vaccines are as safe as possible and are closely monitored throughout the
immunization production and delivery system. The vaccine safety system starts from quality control
at the level of the manufacturer and continues through the supply chain and cold chain to the delivery
point where the vaccines are administered. Manufacturers make sure to they maintain a high level
of quality control throughout the manufacturing and transportation of the vaccines to the health
facilities. In [country], there is a quality assurance system in place to ensure that vaccines are as safe
as possible and are closely monitored throughout the immunization delivery system.

28 MODULE 3 - IMMUNIZATION AND VACCINES

Quality and Safety

The World Health Organization works closely with national experts and authorities to ensure and
support the quality, safety, and effectiveness of all vaccines. They, along with partner countries and
coordinating bodies, establish a set of safety standards to ensure vaccine safety, including:

• Conducting a thorough review of the evidence on the efficacy and safety of the vaccine

• Establishing quality standards for specific vaccines

• Testing every batch for potency (to ensure it works effectively to protect against the specific
disease), purity (to ensure that certain ingredients used during production have been removed),
and sterility (to ensure that it does not contain any outside germs).

• Establishing a vaccine monitoring system for detecting and investigating AEFIs

Types of Vaccines
There are three types of vaccine: live attenuated, inactivated (either
whole cell or cell fractions), and recombinant (genetically engineered)
vaccines. In communities that are sceptical about the make-up of
vaccines, effective communication may need to focus on providing
assurances about vaccine safety and side effects.

Live Attenuated Vaccines

Live attenuated vaccines are derived from disease-causing viruses or bacteria that have been
weakened under laboratory conditions. Examples of live attenuated vaccines include:

•• Viral: Oral polio vaccine (OPV), measles, and yellow fever

•• Bacteria: Bacillus Calmette-Guerin (BCG), oral typhoid (Salmonella typhi), and oral cholera

Inactivated Vaccines

Inactivated vaccines are produced by growing viruses or bacteria and then inactivating them with
heat or chemicals. Because they are not alive, they cannot grow in a vaccinated individual and,
therefore, cannot cause the disease. Multiple doses are required for full protection. Booster doses
are needed to maintain immunity because protection by these vaccines diminishes over time.
Examples of inactivated vaccines include:

•• Viral: Injectable polio vaccine (IPV) (Salk), hepatitis A, influenza, and rabies

•• Bacterial: Whole-cell pertussis, inactivated cholera, and anthrax

Recombinant Vaccines

Recombinant vaccines are produced by inserting genetic material from a disease-causing organism
into a cell, which replicates the proteins of the disease-causing organism. The proteins are then

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MODULE 3 - IMMUNIZATION AND VACCINES 29
purified and used as vaccine. Examples of recombinant vaccines include:

• Hepatitis B and human papillomavirus (HPV)

IPC/I Audio Job Aid: The importance of immunizations and new vaccines
This audio job aid reviews key reasons why it is important that all children are fully vaccinated,
including the benefits to the individual child, family, and community. The audio job aid also explains
why it is beneficial that new vaccines are being developed and introduced to protect us from even
more diseases.

Reflection Questions

•• How would you use IPC skills to convince a caregiver that their child should follow the
recommended vaccination schedule so they can be fully vaccinated?

•• Why do you think a caregiver may be hesitant to have their child receive a newly introduced
vaccine? What could you say to convince them to allow their child to receive the vaccine?

Session 3.3 Vaccine-Preventable YES

Childhood Diseases NO
Activity: Guess that Vaccine-Preventable Disease
Instructions
Note to facilitator: You will need to prepare a PowerPoint presentation/slide deck ahead of time
for this activity with 16 slides. On each slide include You can use the IPC/I Reference Cards as a
reference. The slides should present key facts about each vaccine-preventable disease featured in the
Reference Cards, one disease per slide. If you do not have access to a projector, copy a few key facts
about each vaccine-preventable disease onto flip chart paper. Use one piece of paper per vaccine-
preventable disease.

1. Invite a volunteer to stand in the front of the room and face the rest of the participants.

2. Display either one of the vaccine slides or flip chart paper, so that it can be seen by the
workshop participants but not the volunteer.

3. The task of the volunteer is to identify what vaccine-preventable disease is on the slide using
only ‘yes’ or ‘no’ questions.

4. When the volunteer asks a question, the audience can only answer with a ‘yes’ or ‘no’,
providing no additional information.

5. The volunteer may ask up to 15 ‘yes’ or ‘no’ questions.

6. They can only guess the disease once. The game is over once they either reach 15 questions
or guess the disease correctly.

7. Alternate volunteers, using a different slide for each volunteer as time allows.

30 MODULE 3 - IMMUNIZATION AND VACCINES

IPC/I Quick Reference Cards

See the IPC/I Quick Reference Card Deck for more information on immunization and vaccines.

The cards are split into four decks: (1) general IPC/I guidance, (2) key immunization messages and
FAQs, (3) common vaccine-preventable diseases, and (4) review questions. For Decks 1 and 2, each
card has focus questions related to the topic of the card that are explicitly answered. Deck 3 answers
key questions about a specific vaccine-preventable disease and its corresponding vaccine. Deck 4
provides review questions and answers.

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MODULE 3 - IMMUNIZATION AND VACCINES 31
Profiling Types
Of Caregivers
Objectives

Discuss parental concerns and

categories of hesitant parents

Review specific case examples to

illustrate types of concerns that

caregivers have

Discuss how to address specific and

general concerns of caregivers

©UNICEF/Krishan
Session 4.1 Understanding Vaccine Hesitancy
Vaccine hesitancy refers to people’s negative attitudes and perceptions (primarily fears and lack of trust)
of vaccination. These perceptions may lead people to accept all vaccinations (but with concerns), no
vaccinations, some vaccinations, the recommended schedule, or an alternative schedule. Addressing
vaccine hesitancy is not a simple task as a multitude of factors can potentially influence a person’s
decision to seek out or accept vaccination for themselves or their child. The specific factors leading
to hesitancy need to be identified so that the most appropriate communication can be applied. The
information needed to address hesitancy will differ by subgroup, context, setting, vaccine, and amount
time available for a discussion.

Understanding The Situation

There are many reasons why a caregiver might hesitate to have their child receive some or all
vaccinations. Caregivers make decisions based on their knowledge and available information; their
own experiences with the diseases and vaccinations; and what they hear from the media, family,
friends, and service providers. What makes discussion about vaccination complicated, is that a
caregiver’s decisions and attitudes may vary depending on the type of vaccine or their experience
with health services.

It is important to remember that immunization is a process that includes many points of contact
with the health system and providers. Once a caregiver brings a child for their first vaccinations,
the service experience becomes at least as important as the caregiver’s perceptions when they
came to that first visit. The service experience includes caregivers’ perceptions of how long and how
comfortably they waited, how well they felt they were treated, whether their child received all of the
vaccinations due (or did not because of stockouts), whether the FLW clearly communicated essential
practical information such as the return date, and whether the child developed worrying side effects
that the FLW did not prepare the family for. Second, few caregivers totally reject any vaccination
(some do, of course). Rather, most have specific concerns, such as injection pain or side effects,
perceived dangers of a child getting too many vaccinations at too young an age or in the same visit,
and concern over certain ingredients in vaccines. Some caregivers may be members of a religious
group whose leadership rejects vaccination. All of these concerns need to be discussed.

The table that follows outlines common determinants that contribute to attitudes and beliefs
towards vaccines.

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33
Table 1. Working Group Determinants of Vaccine Hesitancy Matrix

CONTEXTUAL INFLUENCES a. Communication and media environment

Influences arising due to historic, b. Influential leaders, immunization program gatekeepers
sociocultural, environmental, and antivaccination or provaccination lobbies
health system/institutional, or c. Historical influences
economic or political factors d. Religion, culture, gender, and socioeconomic factors
e. Politics/policies
f. Geographic barriers
g. Perception of the pharmaceutical industry

INDIVIDUAL AND GROUP a. Personal, family, and community members’ experience

INFLUENCES with vaccination, including pain
Influences arising from b. Beliefs and attitudes about health and prevention
personal perceptions of the c. Knowledge and awareness
vaccine or the social/peer d. Health system and providers – trust and personal
environment experience
e. Risk/benefit (perceived and learned)
f. Immunization as a social norm vs. not needed/harmful

VACCINE/VACCINATION- a. Risk/benefit (epidemiological and scientific evidence)

SPECIFIC ISSUES b. Introduction of a new vaccine, formulation, or
Directly related to vaccine or recommendation for an existing vaccine
vaccination c. Mode of administration
d. Design of vaccination program/mode of delivery (e.g.,
routine program or mass vaccination campaign)
e. Reliability and source of vaccine supply or vaccination
equipment
f. Vaccination schedule
g. Costs
h. The strength of the recommendation, knowledge base, or
attitude of healthcare professionals

Source: SAGE working group, 2014.

Activity: Examples from the local context

During this exercise, participants will independently reflect on interactions with caregivers
that demonstrated any of the reasons for hesitancy. They can either write out or illustrate
their three examples.

1. After presenting the table above, instruct the participants to brainstorm three examples of
interactions with caregivers, one from each row, that demonstrated these concerns.

a. What did the caregiver say? Be specific.

b. How did you determine whether their concern was a contextual influence, individual/group
influence, or vaccine-specific issue? What was the question they asked or comment they
made?

c. How did you respond to the caregiver?

2. Select a few participants to share their examples with the larger group.

34 MODULE 4 - PROFILING TYPES OF CAREGIVERS

Session 4.2 Profiling Caregivers
Identifying parental concerns
The profiling tools below can help you determine whether a caregiver might be hesitant to vaccinate
their child. If caregivers answer ‘yes’ to any of these questions, then they may be hesitant to accept
some or all vaccinations. The extended tool can be used during longer caregiver interactions, while the
modified tool can be used during brief interactions. The questions do not need to be read directly to
the caregiver, the information can be interpreted through conversation. This tool may be useful where
vaccine hesitancy is a known problem that blocks higher coverage; however, it is not recommended
in countries or regions where vaccine hesitancy is not a major factor limiting coverage.

Extended Profiling Tool

Have you ever intentionally delayed having your child get a vaccine for
1. Yes / No
reasons other than illness or allergy?
Do you have any cultural, religious, or personal belief
2. Yes / No
regarding immunization?
Have you ever decided not to have your child get a vaccine for reasons
3. Yes / No
other than illness or allergy?
Are you certain that following the recommended vaccine schedule is
4. Yes / No
a good idea for your child?
Has your child or any child you know become seriously ill or injured after
5. Yes / No
an immunization?
Are you concerned that your child might get a serious side effect from
6. Yes / No
a vaccine?

7. Are you concerned that any of the vaccines might not be safe? Yes / No

8. Do you feel that children get more vaccines than is good for them? Yes / No

Do you feel that it is better for children to get fewer vaccines at the
9. Yes / No
same time?
Do you feel that many of the illnesses that vaccines prevent are severe
10. Yes / No
or deadly?

11. Are you concerned that a vaccine might not prevent the disease? Yes / No

Do you feel that it is best for a child to develop immunity by getting sick
12. Yes / No
(natural immunity) rather than to get a vaccine?
Do you feel that you have all the information you need to immunize
13. Yes / No
your child?

14. Do you trust the information you receive about vaccines? Yes / No

15. Overall, are you confident about immunization for your child? Yes / No
Modified from the Parent Attitudes about Childhood Vaccines Survey Tool,
University of Washington School of Medicine Seattle, WA, USA

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Modified Profiling Tool

1. Do you feel that children get more vaccines than is good for them? Yes / No

Do you feel that it is better for children to get fewer vaccines at the same
2. Yes / No
time?
Do you feel that it is best for a child to develop immunity by getting sick
3. Yes / No
(natural immunity) rather than to get a vaccine?
Do you feel that you have all the information you need to immunize
4. Yes / No
your child?

5. Do you trust the information you receive about vaccines? Yes / No

6. Are you confident about immunization for your child? Yes / No

Some Types Of Hesitant Caregivers

Uninformed But Want More Information
These caregivers are uninformed about vaccination and are turning to you, because of your
expertise as a healthcare professional, and they want you to assure them that vaccines are
safe and effective.
•• Listen to their concerns.
•• Answer their questions.
•• Explain basic facts in easily understood terms.
•• Share experiences that demonstrate
the benefits of vaccines.
•• It may be helpful to tell them about how your
child(ren) are fully vaccinated and that vaccination
is something you strongly recommend.

Misinformed But Open To Correction

These caregivers have inaccurate information about vaccines and the diseases they prevent.
They may believe misinformation, myths, or rumours about immunization.

•• Listen to their beliefs.

•• Provide them with relevant information or
experiences to disprove myths and misinformation.
•• Discuss the strong benefits of vaccines.

In addition: Discover the sources of misinformation because they

may be ongoing and can negatively affect current efforts.

36 MODULE 4 - PROFILING TYPES OF CAREGIVERS

 Well-Informed And Open-Minded
These caregivers are aware of arguments for and against vaccination. They will have many
questions and concerns that they want resolved.
•• Help them to assess the merits of each argument
by placing them in a proper context.
•• Discuss each concern and be prepared to have validated
evidence to counter any antivaccination points.
•• Discuss the strong benefits of vaccines.
•• Point them to appropriate fact-based resources
from well-respected sources.
•• Offer to follow up with them to dispel
any further worry or doubt.
In addition: Encourage them to be advocates and spokespersons
in the community

Informed And Refusing

These caregivers, whether well-informed, uninformed, or misinformed, are convinced that
they do not want their child(ren) to be vaccinated.
•• Ask the caregiver to describe their concerns about vaccines.
•• Ask the caregiver what it is about vaccines that makes them
concerned.
•• Acknowledge their concerns.
•• Address any misinformation with evidence and experiences.
•• Discuss the strong benefits of vaccines.
•• Point them to appropriate fact-based resources from well-
respected sources.

In addition: Identify their influencers and work with them as allies.

Anti-Vaccine Champion
These caregivers not only refuse to vaccinate their child(ren) but try to convert others
to their position.
•• Establish trust with these caregivers by listening to
their perspective.
•• While it is important to respect their opinion, it is
necessary to explain the importance of vaccines for
the overall health of their child.
•• Correct any antivaccine myths and misinformation.
•• Refocus the conversation onto the positive effects of
vaccines.
•• Explain the risks and responsibilities of not
vaccinating their child.
•• In addition: Commit to continuing the dialogue
about vaccines.
Some members of this group will never be convinced, but the FLW nevertheless needs to try.

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Note to Facilitator:

For the activity below, you may need to limit the number of questions per group (e.g. half of the first
profiling tool could be asked by one group).

Activity: Practice Profiling

During this exercise, participants will practice using the expanded or modified profiling
tool to identify a caregiver’s level of knowledge and comfort with vaccination.

1. Review the profiling tool and types of hesitant caregivers in the large group.
2. Divide the participants into pairs: one person will play a caregiver and the other will play
an FLW.
3. The participant playing the caregiver should select one of the types of hesitant caregivers
to role play. They should NOT tell their partner which type of caregiver they are role playing.
4. Relying on the questions from the expanded or modified profiling tool, the FLW should
guess the type of caregiver they are interacting with and respond to them accordingly.
5. Give the group two minutes to act out this immunization session. Try to make the dialogue
as natural as possible.
6. At the end of the two minutes, the FLW should check with the caregiver to see whether
they guessed correctly.
7. Now the partners should switch places in the role play and repeat the exercise.
8. Select a few participants to share their reflections on the activity. What was difficult? Is
this how we typically assess and counsel caregivers?

Reflection Questions
•• What are other ways to assess a caregiver’s level of comfort with vaccination? Are
there nonverbal cues?

•• What are some other useful ways to categorize types of caregivers that will help
us determine how to communicate with that caregiver type during discussion and
counselling sessions?

IPC/I Audio Job Aid: What to do if a caregiver refuses immunization

This audio job aid outlines some key reminders to give caregivers who refuse to immunize their
child, including the risks involved and the additional responsibilities they have to protect their
children and to protect others.

Reflection Questions
•• What type of hesitant caregiver is the one in the audio job aid?
•• Do you think that the key points presented in the audio job aid would be convincing to a hesitant
caregiver?
•• How would you use IPC skills to achieve a balance between communicating the danger of not
immunizing a child but not scaring a caregiver or making them feel like they do not have a choice
about immunizing their child?

38 MODULE 4 - PROFILING TYPES OF CAREGIVERS

Session 4.3 Communicating With Caregivers
Communicating effectively about vaccines with caregivers and communities is a key issue for the
public health community to address. In addition to national campaigns, FLWs play a very important
role in this communication. Building trust with caregivers is perhaps one of the most important
things an FLW can do to promote vaccination. There are many approaches to communicating with
caregivers. An atmosphere of caring, two-way dialogue and clear messages that address information
gaps and concerns supports trust between caregivers and FLWs. Although many factors influence
the decision to vaccinate, some studies have shown that the outcome of an immunization session
can differ based on how a provider begins a conversation with a caregiver.

The Presumptive Approach

The presumptive approach assumes parents are fine with the vaccines that the FLW recommends.
Using this approach, the FLW tells the caregiver which vaccine(s) the child will be given that day and
states the reason for the vaccine and the potential side effects. If the caregiver consents to vaccination
and has no objections or questions, then the vaccinator proceeds with vaccination. If the caregiver
objects or has questions or concerns, then those questions and concerns are answered by using
medical evidence or stories to convey the safety, effectiveness, and necessity of the recommended
vaccine(s).

The Participatory Approach

The participatory approach focuses on addressing concerns and helping caregivers understand the
importance and necessity of vaccines. Using this approach, the FLW asks the caregiver about their
vaccination preferences and emphasizes the importance of shared decision making. However, some
within the research and medical community feel that shared decision making is not appropriate
for vaccination.

Regardless of the approach you use, have some tested and proven effective key messages on hand
when you talk with the caregiver(s). A key message is a statement containing the main points of
information you want to communicate to caregivers to address their concerns and promote the
benefits of vaccines. A well-designed key message is simple, memorable, easily understood, culturally
appropriate, and meaningful to the caregiver.

Sample Key Messages

•• Vaccination is the most effective way to protect your child from life-threatening illnesses.

•• Communities with towns that have lower vaccination rates have higher rates of
life-threatening diseases.

•• I am a parent, too, and I vaccinated my children. I also received vaccinations myself.

It is important to carefully consider which of the above communication approaches and messages
are most successful with caregivers in your community. For example, some caregivers may respond
effectively to the presumptive approach; some might need to hear negatively-framed messages to be
moved while others may prefer stories over scientific data.

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Communicating With Caregivers
Regardless of the type of caregivers you meet, it is important to remember that they want their child
to be healthy, they would like to be heard and respected by the provider, and they want credible
information and the power to make an informed decision. Following these four practices will help you
communicate with parents:

•• Take time to listen

- Let the parent finish speaking.

- Resist the urge to multitask during conversation.

•• Solicit and welcome questions

- Ask for questions.

- Convey that you have time to answer them.

- Give concise answers to allow time for more questions.

•• Acknowledge risks and benefits

- While severe side effects do happen, they are extremely rare.

- Non-vaccination is much more risky.

•• Have both science and stories available

- Parents will appreciate experiences you can share.

•• Identify a safe and private space to discuss concerns

- It is important to have these conversations in private so the caregivers feel safe and
you reduce the risk of influencing other caregivers.

40 MODULE 4 - PROFILING TYPES OF CAREGIVERS

What To Communicate During An Immunization Visit
The following issues may need to be covered, depending on individual needs and understanding:

•• Why vaccination is important for children’s health

•• Your child needs some vaccinations more than once to gain maximum protection from the
specific disease.

•• The number and timing of doses

•• The importance of completing the series

•• The importance of being aware of and complying with the due date(s) to return for the next
dose(s)

•• Potential discomforts after vaccination and what to do if they occur

•• Explanation and reassurance in response to inaccurate information

•• Importance of immunization cards and the need to keep them in a safe place and always bring
them when bringing a child to health services

•• Immunization session locations and times, especially for the next visit

•• Which diseases are vaccine-preventable

•• Vaccines schedules and the diseases vaccines prevent

In most circumstances, it will be more feasible to discuss the last two topics with groups of caregivers,
rather than individually.

Reminders
There are many ways to remind caregivers when the next vaccination(s) is due, most involving IPC.
Studies in the last few years have found that use of reminders can reduce dropout and improve
timeliness. Some methods:

•• Ensure the vaccinators write the date of the next vaccination(s) on the home-based record. This may
require supervision and monitoring to reinforce instructions.
•• The health facility can maintain a tickler system (manual or electronic) and remind the caregivers of
upcoming vaccination dates by: SMSs, phone calls, or giving the list to a community-based person
or group to make home visits to remind
•• Assist communities to establish a method of monitoring each local child’s vaccinations, and remind
caregivers’ in home visits of upcoming or missed vaccinations.
•• Where there is a community vaccination focal person, as recommended in the RED/REC strategies,
these persons can remind caregivers.

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IPC/I Audio Job Aid: Sticking to the immunization schedule (including even when a child is sick)

This audio job aid describes how the immunization schedule has been developed and why it
is important for it to be followed. The audio job aid also states that it is safe to bring a child for
immunization even when they are mildly unwell and explains what to do if a child misses a
scheduled immunization.

Reflection Questions

•• What are some techniques you use to remind caregivers of the immunization
schedule and ensure that they bring their children on time?

•• What would you say to a caregiver who has

stopped bringing their child for their scheduled
immunizations and how would you help them get
back on schedule?

IPC/I Video: Welcoming and communicating

effectively
For an illustration of client-centred care, see the video ‘Welcoming
and communicating effectively’.

The video illustrates how to acknowledge caregiver and client

perspectives and concerns. It focuses on helping caregivers
understand their feelings about immunization and then addresses their specific personal concerns
and barriers.

Reflection Questions

•• What are some ways that the FLW encouraged the caregiver to freely voice their
questions and concerns about vaccinating their children?

•• Other than what you saw in the video, what are some of verbal and nonverbal IPC
skills you have adopted to make caregivers feel welcome and heard?

Facilitator’s Note:

Rather the conducting the activity below as skits, you may instead opt to divide participants into
discussion pairs. These pairs should then develop key messages to be used in dialogue with each of
the four categories of caregiver outlined in the profiling section.

Activity: Finding-the-Right-Message Skits

1. Divide the participants into small teams of four to six people.

2. Assign each team one of the four types of caregivers (uninformed but want more

42 MODULE 4 - PROFILING TYPES OF CAREGIVERS

 information; misinformed but open to correction; convinced and refusing; or antivaccine
champion).

3. Allow the teams 15 minutes to prepare a skit illustrating what the caregiver believes
about vaccines and an FLW communicating with that caregiver. The skit can show a
facility-based interaction, home visit, community encounter, or a combination.

4. The skit should be no longer that five minutes and involve all members of the team in
some way.

5. After each presentation, ask the audience to brainstorm as a group the key messages
(no fewer than five) that would support an effective communication with that type of
caregiver.

6. Write the key messages on flip chart paper and encourage the participants to note the
audience-specific messages.

Reflection Questions

•• What types of caregivers do we most often encounter in our work?

•• How can we best prepare to effectively communicate with them?

IPC/I Frequently Asked Questions

See the ‘Frequently Asked Questions’

resource for detailed guidance on how
to respond to questions you are likely
to encounter while interacting with
caregivers. The resource provides key
messages and supporting messages.
This tool can be adapted to provide the
most contextually relevant responses to
common questions.
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 Community
Engagement
Objectives

Describe reasons why engaging

communities in immunization

dialogues is important

Outline the steps to organize a

community conversation or meeting

Develop appropriate content for a

community meeting

44
Engaging the community in immunization issues can help to create awareness of services, stimulate
demand for services, help motivate those who may be hesitant, and encourage community
participation to reach difficult-to-reach or neglected (those who are left out of services) populations.
Meeting with the community also provides an important opportunity to get people’s feedback and
suggestions on improving health services.

Strategies to engage the community:

•• Build alliances with community leaders.

•• Use existing community structures for communication about immunizations and identify
partners to collaborate with.
•• Hold regular community meetings, share progress, and use community feedback to improve
activities.
•• Leverage community events/activities to literally ‘meet people where they are’.
•• Arrange for selected community representatives to participate in microplanning (including
outreach planning), development of communication campaigns, and data review meetings.

Note to Facilitator:

Throughout this section it is important to discuss how participants practice community

engagement. They may be very familiar with the approaches outlined below; therefore, you made
decide to spend the session discussing community engagement challenges and effective way to
address them.

This section may also used to address defaulter tracing strategies, including management of the
immunization register.

Session 5.1 Conducting A Needs Assessment

Approaches For Conducting A Needs Assessment
First, it is important to talk to people to learn about attitudes to immunization in the community, in
particular whether there is opposition to it. If there is some resistance to immunization, you need to
ask why this has occurred. Discussion with members of women’s groups and youth groups in your
community may help you to find answers. In some cases, you may also want to speak to community
leaders (traditional, elected, or religious) who are influential and can be allies or impediments,
depending on how they are involved in these processes. You may be able to identify specific behaviours
or attitudes that are creating a barrier to immunization in the community.

Consider organizing a committee to assess why people do not come to be vaccinated or do not
complete their vaccinations. This would help to:

•• Improve relations between you as an FLW and the community

•• Promote participatory decision making to improve community involvement in the Expanded
Programme on Immunization
•• Support the community to develop strategies for identifying and tracing immunization defaulters
•• Improve the quality of the immunization service
•• Encourage the community to identify and report outbreaks of communicable diseases

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MODULE 5 - COMMUNITY ENGAGEMENT 45
 Focus Group Discussions

One of the most effective ways to quickly get a range of opinions is to arrange small focus groups,
that have clear guidelines from you about the topic that the discussion should centre on. The ideal
number of participants in a focus group is between six and 10. A facilitator keeps the discussion
focused on the agreed topic (in this case, immunization) and makes sure that everyone’s views
are heard. You could select particular participants, such as caregivers you think may not bring their
children for immunization. In group interviews, if one participant starts sharing, others are more likely
to join in with honest opinions and stories.

Sample questions to explore in the assessment:

•• Why are children not being brought for immunization?

•• Has there been an adverse incident in the past that has worried parents?

•• Is there an opinion leader in the community who is opposed to immunization and has persuaded
others to resist it?

•• What, if anything, do they think they (or other community members) need to do to raise the
communities’ use of immunization services or to otherwise improve or support those services?

One-on-One Meetings with Caregivers

You may also talk to caregivers one-to-one when they visit the facility or health post to learn about their
good and bad experiences with the immunization services provided. However, if you ask caregivers
about their service experience while they are still in the health facility, you are less likely to receive
honest answers about how they felt, as they are unlikely to say anything negative even if they had a
miserable experience. Try to reach caregivers in the community who, for one reason or another, do
not visit the facility or health post. However, interview the caregivers who do visit the facility first,
since they are readily accessible and are often willing to talk about their experience of the services.
They may also suggest ways of reaching those who do not use facilities.

There are many things you might want to learn from caregivers, for example:

•• How close their child is to getting vaccinated on schedule

•• Any barriers to accessing existing services

•• If the times and locations of immunization sessions are appropriate for them

•• What they think about the quality of the service provided

•• How they think the service could be improved

•• What they already know about immunization

•• What concerns they may have about immunization

•• Their traditional beliefs about disease or immunization

46 MODULE 5 - COMMUNITY ENGAGEMENT

 Meeting with Nongovernmental Organizations and Other Partners

Try to meet with any other partners or institutions that you think might be able to help improve the
immunization service. Who these are will depend on your community, but may include traditional birth
attendants, traditional healers, private health practitioners, volunteer groups, and representatives of
nongovernmental organizations that focus on health, particularly the health of children.

Meetings with Special Groups

In your community, you may be aware of special groups that have been largely unreached by
immunization services or have chosen not to participate in them. You should try to include these
people or groups in your meetings and planning process from the start. Some examples of special
groups include:

•• Pastoralist groups

•• Migrant populations

•• Ethnic or other minority groups

•• Groups in geographically remote areas who may find it difficult to reach the site of the
immunization services

•• People who are injured, sick, or disabled who may find it difficult to get to where immunizations
are taking place

•• Religious or traditional sects

•• Refugees

•• Homeless families

Session 5.2 Barrier Analysis

We need to use empathy when we learn the reasons a child is behind on vaccinations. In many
cases, a caregiver may have sought vaccinations that the health facility could not provide due to,
for example, stockouts, vaccinator absent, or the session ended before it was supposed to. The
reason for falling behind needs to be clarified since it could be related to the family – such as the
husband being angry at side effects and refused further vaccinations – or the service experience. A
system should be in place for health facility staff to identify these children, whose families should
be visited at home to understand the issue, and to try to resolve any impediments to continuing the
vaccination schedule.

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MODULE 5 - COMMUNITY ENGAGEMENT 47
 Activity: Barriers Image Review
1. Divide participants into small groups

2. Distribute or display the image (see appendix B)

3. Assign each group one of the characters in the image

4. Next, ask each group to develop a profile or description of that individual. The profile
should include:

a. What are this person’s thoughts, feelings, or beliefs about vaccination?

b. Why does person think/feel/believe those things about vaccination?

c. What has been their experience with vaccination?

5. What barriers might they experience in trying to vaccinate a child or support vaccination?

6. Each group will then share the character profiles and barriers to the larger group.

Reflection Questions

•• Which barriers were similar across the characters, which were different?

•• Imagine that all of these characters live in the same community. How do their
thoughts/feelings/beliefs in regard to communication affect each other?

•• Who in the photo appears to have the most agency/power?

•• How might a woman’s barriers differ from her husband’s?

•• Who has the right to make the ultimate decisions about a child’s health?

48 MODULE 5 - COMMUNITY ENGAGEMENT

Barrier Analysis
If you can identify specific barriers to immunization, you will need to decide which barriers might be
targeted in order to find a solution. Which barriers could be removed? How might their removal help
to increase immunization coverage and decrease dropout rates?

Common reasons reported by caregivers to explain why their children were not fully
immunized include:

•• Caregiver was unaware of the need for immunization

•• Caregiver feared adverse effects following immunization
•• Caregiver was unaware of need to return for next dose
•• Vaccine was not available
•• Vaccinator was absent
•• Family was having problems and/or the caregiver was ill
•• Place and time of immunization was unknown
•• Immunization site was too far away
•• Time of session was not convenient due to caregivers’ other responsibilities
•• Caregiver was unhappy about how they were treated in the health facility
•• Essential information, such as the return date, was not provided to caregiver by vaccinator

Reflection Questions

•• Which of the reasons listed do you think could be best addressed by

improved communication?

•• How might you hope to address these barriers for an effective immunization service?

Key Takeaways
•• Barriers to seeking immunization service include issues that can be resolved by
better communication. These barriers include lack of knowledge about the need
for immunization, the need to return for further doses, or the time and location of
immunization sessions.

•• Fear of adverse reactions is another barrier that good communication can overcome.

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MODULE 5 - COMMUNITY ENGAGEMENT 49
IPC/I Audio Job Aid: Barriers to vaccines – cost, time, and spousal refusal

This audio job aid addresses some of the most common barriers faced by caregivers in immunizing
their children and provides examples of how an FLW might respond to a caregiver facing
these barriers.

Reflection Questions
•• In addition to what you heard in the audio job aid, what other suggestions or
arguments would you give to a caregiver facing these common barriers?

•• What is another common barrier faced by caregivers and how would you help a
caregiver overcome this barrier?

Session 5.3 Conducting A Community Conversation

Activity: Story and Brainstorm
Ask a volunteer to read the following:

A health worker glances at the calendar and realises they have

scheduled a community outreach meeting for the following day.
The next day, they arrive at the venue and find no one there.

Ask participants:

•• What are the possible reasons no one showed up to attend the immunization
meeting?

•• How could this have been avoided?

Discussing Immunization With Communities

Our job is to identify and arrange communication opportunities to exchange information with
community members. During these opportunities, FLWs can share technical information about
vaccinations, the importance of vaccination, and practical information about using health services.
Meanwhile, community members can teach FLWs how they feel about services, how services
can become more convenient and friendlier, how services can reach families who are not currently
being reached, and how they can mobilize their neighbours more effectively.

50 MODULE 5 - COMMUNITY ENGAGEMENT

Many approaches or activities can be used to exchange information between health services and
communities about immunization. Which one you choose will depend on the specific community
audience you want to engage and the most appropriate way to reach them. Communication
approaches might include a community conversation, community mobilization, or advocacy
campaign. You will need to plan what you want to do, when you hope to do it, how many people
you will need to help you, and who these people might be.

Your interactions may take place in community meetings, religious places, market places, and so
forth. You may need to use written materials, such as posters and leaflets, to communicate
your messages.

Dramatic television shows, plays, and local community radio broadcasts may also help your
communication messages to be heard and understood.

Community Conversation
Community conversations are successful when everyone is given the opportunity to be heard.
Because many will not participate fully in a meeting unless they feel at ease and believe their
opinions will be heard, to organize a successful community conversation, you should consider the
following points:

•• Decide on the purpose of the conversation and advertise it widely.

•• Decide who should attend or be invited based on your intended audience.

•• Prepare an agenda for the meeting.

•• Decide on the date and time and make sure that everyone you want to attend is informed about
the meeting’s time and location.

•• Choose a meeting place that allows everyone to hear one another’s views.

•• Facilitate the conversation in an open and non-judgmental way, so everyone feels included
and respected.

When to Arrange a Community Conversation

There are many situations where you might decide to arrange a community conversation about your
immunization program, for example:

•• If you have large numbers of families who do not bring their children for immunization

•• If you have a high dropout rate

•• If any children have had serious adverse reactions after immunization

•• If you believe there are negative rumours circulating in the community about immunization

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MODULE 5 - COMMUNITY ENGAGEMENT 51
Who to Involve in a Community Conversation

The appropriate people to invite will depend on the context and situation:

•• If you have large numbers of families who do not bring their children for immunization, you
could invite representatives of those families and any neighbours who do bring their children
for immunization.

•• If you have a high dropout rate from the immunization program in areas of your community, you
could invite parents from families whose children started their vaccinations but did not
complete them.

•• If children have had serious adverse reactions after immunization, you might invite the parents
of those particular children, along with other parents whose children were not
adversely affected.

•• If you believe there are negative rumours circulating in the community about immunization,
you might invite those you believe are being influenced by the rumours, along with community
leaders and other influential people in your local community who support immunization.

Assessment, Monitoring, And Evaluation

You will need to find ways to assess whether your strategy or activity is working. Here are ways you
might try to evaluate the effectiveness of your activities:

•• You could record how many people attended the meeting or community conversation and who
they were.

•• You could see if these people brought their children for immunization or brought them more
regularly than before.

•• If someone who is not known to you brings their children for immunization for the first time,
you could ask how they knew that immunization services were available. This could help you
establish whether those who were present at the meeting or community conversation
informed others.

Activity: Planning a Community Conversation

4 2
*You will need the “Steps to Community Meetings” worksheet (Appendix E).
3 1
1. Divide the participants into teams with four participants in each group.
2. Distribute one ‘Steps to Community Meetings’ handout to each group. The handout should be
pre-cut into tiles along the dotted lines.
3. Instruct each group to organize the tiles in the proper order.
4. The group that organizes the cards in the correct order the quickest wins a prize or recognition.
5. Read the correct answer to the entire training group and ask if they have any questions.
6. Ask the group to share any tips they have for hosting effective community conversations.

52 MODULE 5 - COMMUNITY ENGAGEMENT

A sample community conversation agenda can be found in Appendix F.

Reflection Question
•• How could you evaluate whether your message was understood and whether it has
made a difference to people’s behaviour?

Key Takeaway
•• Carefully plan community meeting to address the specific attitudinal, informational, or
behavioural barrier the community is facing.

IPC/I Video: Engaging communities and community leaders in dialogue

The video takes you through the process of identifying and engaging community leaders to increase
vaccine acceptance.

Reflection Questions
•• How can engaging community leaders help to strengthen immunization
communication?

•• Who should be involved in educating and mobilizing community members?

IPC/I Video: Engaging communities and

community leaders in dialogue
The video takes you through the process of
identifying and engaging community leaders
to increase vaccine acceptance.

Reflection Questions
•• How can engaging community leaders
help to strengthen immunization
communication?
•• Who should be involved in educating
and mobilizing community members?
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 Addressing
Negative Rumours,
Myths, And
Misconceptions

©UNICEF/Noorani

54
Rumours about bad consequences of immunization may circulate in communities and, increasingly,
on the internet. If such negative rumours are not dealt with appropriately, they can have a serious
effect on demand for immunization services. Any negative rumours about immunization that you hear
circulating should be communicated to your supervisor as soon as possible. The following suggested
actions cannot be carried out by you alone. Immediate reporting is important, and advice should be
sought before you take action.

Before you conduct these activities, it is important to invest in building trust within the community.
To gain trust from the community, it is critical to maintain caregiver and client confidentiality; act in a
responsible manner during interactions with the community, possess good knowledge on the health
topics you deliver and be available when the community needs you.

Communicate and demonstrate that you are acting in their child’s best interests and are committed
to their health.

Session 6.1 What Can Be Done About A

Negative Rumor
What can you do about negative rumours?
1. First, try to find out what the rumour is, who started the rumour, and who is spreading the
rumour now. Try to establish whether there is any reason for the rumour – there might be a
political or religious reason, or the rumour may have simply arisen from a lack of information
or incorrect information about the immunization program.

2. Once you have gathered this information, arrange a meeting with opinion leaders, such as local
government officials, traditional and religious leaders, community leaders, and other health
workers. In the meeting, begin by providing information about the immunization program and
the diseases it can prevent. Try to ensure that the individuals present are free to ask questions
and express concerns. Discuss and reach agreement on the ways they can collectively use to
correct negative rumours and incorrect information about the immunization service.

3. Identify the correct information about vaccines and how to deal with the rumour.

4. Disseminate the correct information about immunization to the public. This can be done
through communication materials, regional or national campaigns, radio programming,
community education and so forth.

Strategies that can be used to reach people who are hard to convince, including the following:
•• Identify the groups that are involved in perpetuating the rumours/misinformation.
•• Engage key informants to find out the nature and reasons for rumours/misinformation.
•• Visit influential people/leaders for one-on-one discussions.
•• If relevant, meet with media representatives, such as radio and television or
internet contributors.
•• Hold discussions with leaders and community members to address the
rumours/misconceptions.
•• Seek endorsement statements from credible authorities, such as members of government,
church leaders, and medical professionals.
•• Invite respected/trusted authorities to participate and discuss the issues with
community members.
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MODULE 6 - ADDRESSING NEGATIVE RUMOURS, MYTHS, AND MISCONCEPTIONS 55
IPC/I Video: Addressing rumours or myths and health workers’ role in vaccine
safety events

Rumours can be fuelled by inadequate/inaccurate knowledge, mistrust of the government, past

experiences of poor treatment by health workers, or other personal, social, or political reasons.
The video illustrates strategies to address rumours, myths, and misconceptions, particularly about
vaccine safety.

Reflection Questions
•• What are some specific strategies that the protagonists in the video employed to
address rumours, myths, and misconceptions in the community?
•• Thinking back about your own experience or the experience of someone you know,
was there a time when a successful strategy was used to stop a rumour or myth? If
so, how was it done?

Activity: Addressing Rumours Speed Rounds

1. In the large group, brainstorm a list of rumours/myths/

misconceptions.
2. Record these ideas so that everyone in the training can
see them.
3. Assign half of the participants to play caregivers and the
other half to play FLWs in a facility setting.
4. Assign each of the caregivers one of the rumours/
myths/misconceptions. They will role play a caregiver who believes the rumour/myth/
misconception to be true.
5. Match one FLW with one caregiver. The caregiver will maintain the same character for
the first half of this activity.
6. The FLW will have 60 seconds to practice responding to and effectively addressing
the caregiver’s beliefs.
7. They should pretend that this is a real visit with a caregiver and use the skills they
have learned throughout the day.
8. The FLW should rotate after 60 seconds and conduct another mock visit with another
caregiver character.
9. Each FLW should practice with at least five different caregiver characters.
10. Now repeat Steps 3 through 9. The participants who played caregivers in the first
round will now play FLWs and vice versa.
11. After the activity, bring the group back together in plenary to develop messages that
respond to each of the rumours (scenarios) that were brainstormed and role-played
in step 1.

56 MODULE 6 - ADDRESSING NEGATIVE RUMOURS, MYTHS, AND MISCONCEPTIONS

Note to Facilitator:

Encourage participants to record the responses to rumours so that they can reference them later
when conducting IPC with caregivers.

Reflection Questions

• What was challenging about this exercise?

• How effectively did you remember to address each of the points within the ‘What
to communicate during an immunization visit’ list?

• Do you feel you adequately addressed the caregiver’s beliefs? If not, what other
strategies could you have tried?

Session 6.2 Communicating Potential Adverse Events

Following Immunization
An adverse event following immunization (AEFI) is any unexpected medical occurrence that follows
immunization; it may or may not have a causal relationship to the vaccination. AEFIs consist of both
common mild side effects that go away quickly and very rare more serious symptoms or illnesses,
most of which just happen to occur at that time and would have occurred with or without the
vaccination. The adverse event may be any unfavourable or unintended sign, abnormal laboratory
finding, symptom, or disease. AEFIs can either be the result of the vaccine or immunization process,
or coincidental events that are not due to the vaccine or immunization process but happened to occur
after immunization. If an AEFI occurs, the most important thing to do is to communicate correct
and reassuring information as quickly as possible. People need to know that their concerns are
shared by health services, the situation is being investigated and will be addressed, and they will be
kept informed.

Causes Of Adverse Events Following Immunization

The majority of AEFIs are actually not due to the vaccine itself – many are coincidental events, while
others are due to human or program error.

Vaccine product-related reaction: An AEFI that is caused or precipitated by a vaccine due to one or
more of the inherent properties of the vaccine product.

Vaccine quality defect-related reaction: An AEFI that is caused or precipitated by a vaccine because
of one or more quality defects of the vaccine product, including its administration device, as provided
by the manufacturer.

Immunization error-related reaction: An AEFI that is caused by inappropriate vaccine handling,

prescribing, or administering, and by its nature is preventable.

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MODULE 6 - ADDRESSING NEGATIVE RUMOURS, MYTHS, AND MISCONCEPTIONS 57
 Immunization Error-Related
Possible Adverse Event
Reaction
Non-sterile injection Infection
•• Reuse of disposable syringe or needle •• Local suppuration at injection site
•• Improperly sterilized syringe or needle •• Abscess
•• Contaminated vaccine or diluents •• Cellulitis
•• Reuse of reconstituted vaccine at •• Systemic infection
subsequent session •• Sepsis
•• Toxic shock syndrome
•• Transmission of blood-borne virus like HIV,
hepatitis B, or hepatitis C
Vaccine prepared incorrectly
•• Vaccine reconstituted with incorrect drugs
•• Effect of incorrect diluent or drugs
or other substance substituted for vaccine
or diluent.
Immunization injected in wrong site
•• Subcutaneous instead of intradermal for
BCG •• Local reaction or injection site abscess
•• Too superficial for toxoid vaccine (diphtheria, •• Sciatic nerve damage (and ineffective
•• pertussis, and tetanus [DPT]; diphtheria and vaccine)
•• pertussis [DT]; or tetanus toxoid [TT])
•• Buttocks
•• Increase local reaction
Vaccine transported or stored incorrectly
•• Ineffective vaccine

•• Avoidable severe reaction such as

Contraindications ignored
anaphylaxis
Citation: United Nations Children’s Fund (UNICEF) Regional Office for South Asia. (2005). Building trust and responding to
adverse events following immunization in South Asia: Using strategic communication. Working paper. Kathmandu, Nepal:
UNICEF Regional Office for South Asia.

Immunization anxiety-related reaction: An AEFI arising from anxiety about the immunization.

Coincidental event: An AEFI that is caused by something other than the vaccine product, immunization
error, or immunization anxiety.

The following points are important to communicate when discussing potential AEFIs:

•• Adverse side effects following vaccination are very rare.

•• The occurrence of adverse events does not mean that vaccines are unsafe.

•• If a child has high fever or becomes severely sick immediately following vaccination, the child
should be brought to a health worker for advice and/or treatment.

•• If a child experiences an adverse event, the caregiver should write down what happened and
the date and time it happened and report it to the FLW immediately. The doctor, nurse, or health
department should file a ‘Vaccine Adverse Event Report’.

58 MODULE 6 - ADDRESSING NEGATIVE RUMOURS, MYTHS, AND MISCONCEPTIONS

 Activity: Adverse Events Following Immunization Case Study
1. Ask a volunteer to read the following case study aloud.
2. Divide the participants into groups of four.
3. Ask the groups to discuss for 15 minutes how and what the FLW could do to restore
trust in immunization in the community where an AEFI has occurred.
4. Ask each group to share with the larger group their top two ideas for restoring trust.

The Kivanjititis Campaign in Chimorgia

Chimorgia (a fictional country) implemented a nationwide mass Kivanjititis (a fictional
vaccine-preventable childhood bacterial disease) campaign in August 2018. Two weeks
after the start of the campaign, FLWs in Sanjimania District started to hear that several
families were saying that their children developed symptoms including diarrhoea,
high fever, and injection-site abscesses after receiving the Kivanjititis vaccination. Five
children were admitted to the district hospital. Tragically, two of these children died in
the hospital a few days after being admitted. One week after the deaths of the children,
admissions of children citing similar symptoms increased to 13. However, the condition
of most admitted children improved quickly. According to some caregivers at the hospital,
another young two-year-old boy with similar symptoms in the nearby district of Loehria
seemed to have died on the way to the hospital within around the same time that the
two other children died. The investigation team attributed the incidents to immunization
error-related reactions and action is being taken to correct the cause of the error.

Caregivers are demanding an explanation, saying:

•• ‘It is your fault, why are you doing this to us? Why did you kill our children? What is
your motive?’
•• ‘We do not even know whether the vaccines are safe. We will never
vaccinate again.’

Case study adapted from: United Nations Children’s Fund (UNICEF), & World Health Organization. (n.d.).
AEFI and IPC skills: A four-hour training course for health workers. New York: UNICEF.

Note to Facilitator

Before initiating the communication response, first, an analysis of how many sick children were and
were not recently vaccinated should be conducted, followed by an investigation of the cases to try to
determine the cause(s).

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MODULE 6 - ADDRESSING NEGATIVE RUMOURS, MYTHS, AND MISCONCEPTIONS 59
 Reflection Questions

•• What would it take to restore trust between FLWs and the communities across
Chimorgia?

•• What should be said to caregivers whose children suffer from an AEFI?

•• What could have been done before the incident to reduce its impact on people’s
confidence in vaccination?

IPC/I Audio Job Aid: Side effects of immunization

This audio job aid explains common side effects from immunizations and what can be done to reduce
the severity of common reactions to immunizations. The audio job aid also illustrates how side effects
can fuel rumours about the safety of immunization.

Reflection Question
•• How would you use IPC skills to address a caregiver who is concerned about vaccine
safety due to a misunderstanding about side effects?

Session 6.3 Risk Communication

Risk Communication Essentials

Listen to what the public is saying.

Understand local perceptions of the disease, injections, and the vaccine.

Make sure everyone is giving out the same information, tailored to the specific situation
and audience.

Enlist trusted spokespersons to provide information.

Make sure to communicate the benefits of vaccination.

Avoid technical terms and long words or phrases.

Anticipate counterpoints and prepare effective responses.

60 MODULE 6 - ADDRESSING NEGATIVE RUMOURS, MYTHS, AND MISCONCEPTIONS

Techniques For Handling Difficult Communications
•• Respond to negative questions with a positive answer.
- Example Question: ‘How many children have died from vaccination?’ Answer: ‘Since our
immunization program began, XX children have been vaccinated and very few (or none) have
died from vaccination itself. Without vaccination, children’s risk of getting a potentially life-
threatening disease is far greater than the risk of the vaccine.’

•• When responding to a difficult point or question, respond to the comment but add something
positive.
- Example Comment: ‘One person died shortly after receiving the vaccine! How can you
explain this?’ Response: ‘Immunization saves lives. The death was related to an allergic
reaction and not the safety of the vaccine.’

•• Immediately correct information that is wrong.

- Example Comment: ‘Many children tested positive for HIV shortly after receiving the vaccine.’
Response: ‘One child in this community tested positive for HIV when they received their
health screening and vaccination. This was their first vaccine. The positive HIV test result is
not linked to the vaccination.’

•• Be assertive but not aggressive and state the facts simply, factually, and in a friendly way.

•• Do not repeat any negative questions/statements in your answers:

- Example Comment: ‘Some children have become ill from vaccines. Why do we have
immunization?’ Response: ‘Vaccines save children’s lives.’

Activity: Practice with difficult conversations

During this exercise, participants will practice using the risk communication essentials and
techniques for Difficult Communications listed above to respond to community members’
aggressive and difficult questions and comments following rumours of an AEFI.

1. Review the two lists mentioned above.

2. Ask each participant to work with the person sitting next to them.
3. Together the pair should brainstorm a few rumours they have heard. These can be actual
rumours in their community or rumours borrowed from other contexts.
4. Then, go to each pair and ask them to name one of the rumours they have heard.
5. Write the rumour on the board or a flip chart paper.
6. Keep going around the room until you have a list of at least 10 rumours.
7. Then ask for volunteer pairs to role play a community member and an FLW discussing the
rumour.
8. They should select one of the rumours from the list the group generated.
9. Give the pair two to three minutes to act out a dialogue. They should try to make the dialogue
as realistic as possible.

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 MODULE 7
10. At the end of the dialogue, ask the group to provide feedback on how well the FLW addressed
the rumour.
11. Repeat the exercise with a few more pairs or the entire
participant group.
12. Select a few participants to share their reflections on the activity.
What was difficult? Is this how we typically address rumours?
What other tips and recommendations should be added to the
essentials and techniques lists?

Key Takeaways
•• Be sure to inform your supervisor and other health staff if negative rumours about immunization
are circulating in your community.

•• While discussing a potential AEFI, it is important to communicate about the safety of the
vaccine, things to be done in case a child becomes sick immediately following immunization,
and the fact that adverse events following vaccination are very rare.

•• Make sure that accurate knowledge about immunization services is widely circulated. You can
do this by posting notices where they will easily be seen, telling all your clients when you see
them at the facility, in their homes, at the market, and so forth.

•• Ongoing health education sessions in the facility and community are key to preventing the
spread of rumours.

62 MODULE 6 - ADDRESSING NEGATIVE RUMOURS, MYTHS, AND MISCONCEPTIONS

Action Planning
And Workshop
Closing
Objectives

Understand the benefit of receiving

community feedback and using it to

improve services

Learn strategies to gather feedback

from community members in an

open and honest manner

Learn to work with influential

members of the community who can

©UNICEF/Keïta
advocate for immunization

Trainers' Facilitation Guide - For Global IPCI

63
Session 7.1 Collecting And Using
Community Feedback
Community feedback is an essential component of an effective immunization program. Listening
to community feedback can alert FLWs to problems and guide actions to address them. To ensure
that you are continuing to provide the best possible service, you must listen to what caregivers
and communities are telling you. Doing this will give you the information you need to improve your
interactions with communities and caregivers and to help managers make better decisions about
immunization services, which should, in turn, improve caregiver satisfaction and increase the number
of children within your community who receive timely vaccinations.

Why Collect Community Feedback

Actionable feedback guides better decision making. Communities know what does and what does
not work for them. Given the opportunity in a safe environment, they will tell you if what you are
doing is unsatisfactory and praise you if you are doing it right. If people feel afraid of giving honest
but critical opinions – for example, being asked in a health facility about services or being asked by
a health worker who typically gets angry when people ask questions – they will simply give you the
answers they think you want to hear, which will not be useful. Providing a safe environment means
letting them know you really value and want to use their feedback and will not use anything they say
against them. This is crucial; otherwise, people will only tell you what they think you want to hear.
Community and individual feedback is useful because it can:

•• Identify caregivers at risk of not fully utilizing immunization services

•• Identify caregivers who are not happy with immunization services or have problems using them
(e.g., because of the service hours)

•• Identify and help you stop recurring problems

•• Help quickly and proactively solve the problems that are causing caregivers to not return for
services

•• By listening, show caregivers and communities that you care and help build mutual
understanding and respect, which goes a long way to building a positive relationship

•• Identify potential immunization advocates

Strategies For Getting Community Feedback

Four actionable strategies to get community feedback.

Caregiver Interviews or Surveys

These can be as simple as brief exit interviews where you ask caregivers a few questions. Exit
interviews are useful for learning how well FLWs communicated and caregivers understood key
information, such as the return date. However, exit interviews are not good for learning opinions on
services, as caregivers may be reluctant to say anything critical while they are in or near the health
facility. Consider what locations are appropriate as you decide where and how to conduct interviews.

64 MODULE 7 - ACTION PLANNING AND WORKSHOP CLOSING

Short Message Service Surveys

Although surveys conducted via mobile phone through an SMS or digital messaging service can help
you reach a large number of caregivers quickly and relatively inexpensively, it is crucial to carefully
interpret study findings to consider what were the characteristics of people who did and did not
respond (e.g., gender, age, or family income).

Suggestion Boxes

Make sure the box is easily accessible. Attach a pen or pencil to the box and put a small stack of
blank paper or brief questionnaires next to it. Keep questions simple (e.g., ‘How was the service
today?’). Ask for the FLW’s name and the service provided (immunization or other), so you can follow
up accordingly. To ensure that low-literate caregivers can respond, suggest in the health talk that they
ask someone in their community or health facility to write their message.

Focus Groups and Group Discussions

A focus group is a discussion among a group of people who are asked about their perceptions,
opinions, beliefs, and attitudes about a topic or service. To be effective, this type of discussion
requires an experienced facilitator to guide the participants. Group discussions, on the other hand,
are less formal; FLWs can lead them even if they do not have a lot of group facilitation experience. To
lead a group discussion, begin with general questions and then ask deeper, more specific questions
to get a better understanding of what the community thinks and identify ways to make the caregiver
experience better.

To organize your own focus group or group discussion, invite six to 10 people who are similar in a
relevant way to come in for a couple of hours. You will want to have separate groups for:

1. Caregivers (male and female) who are following the immunization schedule for their child

2. Caregivers (male and female) who are not having their children immunized

3. Caregivers (male and female) who are not following the immunization schedule

4. Mothers-in-law

5. Young parents

If few children are not receiving vaccinations, you can combine groups 2 and 3.

Using And Reporting On Community Feedback

Be sure to act on community feedback and report on how it is used – or how you would like to use
it, if you need support to make changes. At a minimum, reports should summarize who provided
the feedback (respondent type), how and when it was collected, the findings from the collected
feedback, and recommendations for changes or continuation based on the feedback. Share the report
with colleagues, managers, supervisors, and communities.

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MODULE 7 - ACTION PLANNING AND WORKSHOP CLOSING 65
 Activity: Prototyping a Feedback System
In this exercise, the participants will develop a model for a community feedback system
that they can implement when they return to their facility. Allow 30 minutes to develop a
‘quick’ feedback system model. The groups can choose to present their model however
they choose (e.g., a skit, a role play, a song, a poster, a video, or radio drama).

1. Divide the participants into teams with four participants in each group.

2. Each group should develop a single model of a community feedback

system. They should consider the following:

a. Should the feedback system be community or facility based?

b. Who can provide the feedback and how?
c. Is the feedback tied to individual performance or overall facility
performance?
d. What are the categories for feedback?

3. The model should be something that can be easily implemented by an

FLW.

4. Give each group 10 minutes to present their model.

5. Each group should be prepared to answer the following questions:

a. How would they implement this in their own context?

b. How would they promote the system to the community?
c. How would they monitor and incorporate the feedback on a regular basis?
d. How should FLWs be rewarded or recognized based on the feedback they receive?
e. What can supervisors do to support any areas the community determines require quality
improvement?

6. Once all the groups have presented, ask the participants to decide which of the feedback systems
seem most effective and feasible.

Session 7.2 Mobilization

In your efforts to increase immunization coverage and decrease dropout rates, you are likely to come
across various interested groups of people and organizations. These may include health staff at various
levels, politicians and policymakers, community leaders, representatives from the private sector and
nongovernmental organizations (such as UNICEF and the African Medical and Research Foundation),
caregivers, and journalists. You may also want to meet with small groups of people who have been
minimally reached by the immunization program.

Communities can support the immunization program in several ways. Mobilization activities will help
you work with the community and influence stakeholders to generate community-level action to
strengthen the immunization program.

66 MODULE 7 - ACTION PLANNING AND WORKSHOP CLOSING

 Six Basic Ways Community Members Can Support Immunization:

1 Using services

Informing other community members about vaccination and immunization services,

2 discussing any concerns and barriers to use, and helping people problem solve how to
overcome them

3 Collaborating with health services by participating in microplanning

Assisting in outreach by, for example, recording in the tally sheet or register and alerting
4 the community when the outreach is about to begin

5 Giving feedback on services

Participating in actions to improve people’s service experiences, such as by making

6 privacy screens or, in an emergency, picking up a vaccine at the district store and bringing
it to the local health facility

Meeting With Community Leaders

Community leaders may include traditional village heads, religious leaders, elders, school leaders, and
the leaders of women’s and youth groups. You should try to gather information about the community
you are working in before you meet such community leaders. To increase the effectiveness of your
meeting, you should identify who the relevant participants will be, decide on an agenda with them
(and what issues to discuss), and make sure that all the people you want to attend the meeting are
aware of the agenda and the time and location of the meeting. To gain the maximum benefit from the
meeting, try to find out in advance what the participants already know about immunization. Based on
what you learn, you can introduce the topic and build up useful discussions.

Some possible issues you may want to discuss with religious leaders:

•• Any concerns the leaders and families may have about immunization
•• Any religious or traditional beliefs about disease or immunization
•• Barriers that may prevent people from accessing immunization services, such as distance,
seasonal work commitments, traditional festivals or customs, lack of money for transport, and
inconvenient days, times, or sites for immunization sessions
•• The most appropriate times and locations for immunization sessions
•• Possible ways of reaching more children in the community
•• Whether immunization could be promoted by being mentioned regularly at religious or other
gatherings

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MODULE 7 - ACTION PLANNING AND WORKSHOP CLOSING 67
Preparing for dialogue: key messages

As you have a better understanding of the concerns and priorities of community members, you
can begin to craft key messages that will help you have productive and effective discussions about
immunization. In social and behavior change communication (SBCC), a key message is a statement
containing key points of information that help motivate behavior change. In order to be effectively
received and understood in the way you intended, a message needs to include a clear call to action and
address the behavior or attitude you want to influence. A helpful guideline to effective communication
is given by 7 C’s. These seven communication principles provide a checklist for making sure that your
messages are effective.

7’s of Communication

•• Clear: be clear about your purpose in communicating with another person

•• Concise: stick to your main point
•• Concrete: be specific about the benefit of the action you are encouraging
•• Correct: be sure that the information you are communicating is accurate
•• Considerate: respond to your receiver/audience’s needs, their requirements, and emotions
•• Complete: include all of the necessary information for the reaction you desire
•• Courteous: take into consideration relevant viewpoints, the feelings of the receiver/audience, and
engender a feeling of trust

Activity: Communication Campaign

In this exercise, the participants will individually identify an influential person whose support
and action could strengthen the immunization program and improve coverage in their
community. They will then develop messages to discuss with that person. The key steps are:

1. First brainstorm with the individuals in the community who can influence immunization coverage.
2. Think about their current level of support for vaccination. Your target audience for advocacy will
be the influencers who can either mobilize resources towards the immunization program or
motivate caregivers and other community members to demand and utilize immunization services.
3. Select two target audiences.
4. Develop one message for each audience that can be used to reach that individual or group of
individuals.
5. Determine how you would reach the audience with that message through, for example, a
community drama, poster, song, or radio drama.
6. Make a plan to share the message with the influencer within the next few weeks.

68 MODULE 7 - ACTION PLANNING AND WORKSHOP CLOSING

 Key Takeaways
•• Community feedback is an essential component of an effective immunization program.
Collecting feedback from the community can help you to identify core issues, make better
decisions, and build a positive relationship between you and the community.

•• Immunization coverage rates can be increased and dropout rates reduced through effective
advocacy and communication activities; inadequate communication with local people, in
particular caregivers, can seriously affect the success of the immunization program.

•• Community or religious leaders can be asked to announce information about immunization to

gain support and help dispel myths and misconceptions.

Reflection Questions
•• What are some of the effective messages you have used in the past to discuss immunization
with caregiver and community members?

•• How can you improve those messages based on 7c’s of communication?

•• What can be done to integrate more community outreach and education into your current
work?

Session 7.3 Apply Your Skills

Activity: Individual Interactive Immunization Education Session
This final learning session will challenge participants to apply what they have learned
throughout the day to plan a community discussion for a mixed (varying literacy, hesitancy,
and vaccine-knowledge levels) community audience. The presentations will be delivered
individually but presented to a small group of three other training participants.

1. Divide the participants into groups of four.

2. Instruct each person to select a topic to present for 10 minutes. They can choose any
topic relevant to caregivers in their community. For example, they
can attempt to address a specific rumour, address an AEFI, or
explain how vaccines work. Encourage participants to choose a
topic that will challenge them and help them do their work better.
3. Give them 45 minutes to prepare their presentation. They can
use their prior experiences, the skills gained in the workshop,
or the knowledge of their fellow group members to develop
their lesson.
4. They can use the 45 minutes to develop and outline key
messages; information, education, and communication support
materials; or creative dramas, skits, songs, or poems that can be
used to inform and motivate caregivers.

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MODULE 7 - ACTION PLANNING AND WORKSHOP CLOSING 69
Presentation Flow

•• Each person will have 10 minutes to deliver their interactive immunization education session,
which should include a brief question and answer period.

•• Two group members should act as ‘community members’ during the ‘community discussion’,
asking questions and sharing information and stories as community members would.

•• One group member will be the observer. The workshop facilitators will also serve as observers
during the presentations.

•• At the beginning of the presentation, the presenter should describe the community member
audience participating in the discussion.

•• The community members are free to ask questions as they would during a real session.

•• Following the presentation, the observer should provide constructive feedback.

•• Repeat this process until each participant has delivered their 10-minute education session.
Note to Facilitator:
If you are training a large group, consider creating larger groups to reduce the number
of presentations.

After each presenter has presented:

•• Ask for positive and constructive feedback about how group members can improve their
capacity to deliver high-quality IPC.

•• Refer to the appropriate section in the manual and conduct a quick recap of relevant points

•• Ask participants what was challenging about the exercise.

•• Thank and congratulate the participants.

•• Summarize and draw lessons from the discussion.

Session 7.4 Post-Test And Workshop Evaluation

Post-test
1. Distribute a copy of the post-test to each participant (see Appendix A).

2. Allow 20 minutes for the participants to complete the post-test

3. Collect each post-test.

4. Score each post-test.

5. Review the results as a group.

70 MODULE 7 - ACTION PLANNING AND WORKSHOP CLOSING

Evaluation
1. Ask participants if they have any questions or final concerns to discuss; respond to any outstanding
questions or concerns.

2. Provide each participant with the workshop evaluations worksheet and a writing utensil (see
Appendix H).

3. Request that each participant complete the workshop evaluation sheet.

4. Encourage participants to share any feedback or thoughts they would like with the group or
facilitator.

Session 7.5 Commitments And Certificates

Please find sample certificates in Appendix L.

•• Congratulate the participants on a job well done.

Activity: Commitments
Ask each participant to write down three commitments
for continuing to improve their interpersonal
interactions with caregivers and clients. They may
choose to share.

Activity: Certificates (in appendix L)

•• Distribute certificates to each participant

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MODULE 7 - ACTION PLANNING AND WORKSHOP CLOSING 71
 ©UNICEF/Veska

END OF TRAINING

72
RESOURCES

American Academy of Pediatrics. (2018). Common immunization myths and misconceptions: Talking
points and resources for busy healthcare professionals. Presentation to the Immunization Action
Coalition. Available from: http://www.immunize.org/catg.d/s8035.pdf

Federal Democratic Republic of Ethiopia Ministry of Health. (n.d.). Immunization care module:
Ethiopian Federal Ministry of Health. Available from:
http://www.open.edu/openlearncreate/mod/oucontent/view.php?id=53349

Ministry of Health (MOH). (n.d.). Immunization manual for health workers. Nairobi, Kenya: MOH.
Available from:
https://www.mchip.net/sites/default/files/mchipfiles/Immunization%20Manual%20for%20
Health%20Workers_updated.pdf

PSI (formerly Population Services International). (2013). Interpersonal communication toolkit.

Available from:
http://sbccimplementationkits.org/provider-behavior-change/wp-content/uploads/sites/10/2015/11/
IPC-toolkit-English.pdf

United Nations Children’s Fund (UNICEF). (2014). Training curriculum: Increasing interpersonal
communication skills for the introduction of inactivated polio vaccine (IPV). Available from:
http://www.wpro.who.int/immunization/documents/polioendgame/curriculum_manual_ipc_unicef.
pdf?ua=1

United Nations Children’s Fund (UNICEF), & World Health Organization. (2012). Strengthening
interpersonal communication skills of health workers for the Expanded Program on Immunization:
Facilitator’s guide. Islamabad, Pakistan: UNICEF. Available from:
https://www.unicef.org/cbsc/files/UNICEF_3-hr__IPC_Session_FacilGuide_for_PAK_TOT-PCV10_
Introduction-23-08-12.pdf

United Nations Children’s Fund (UNICEF), & World Health Organization. (n.d.). AEFI and IPC Skills: A
Four-Hour Training Course for Health Workers. New York: UNICEF.

United Nations Children’s Fund (UNICEF) Regional Office for South Asia. (2005). Building trust and
responding to adverse events following immunization in South Asia: Using strategic communication.
Working paper. Kathmandu, Nepal: UNICEF Regional Office for South Asia.

This content is adaptable for in-service, pre-service and periodic capacity building initiatives.
All the materials highlighted in this guide are also available and can be downloaded
in English, French and Arabic at: (ipc.unicef.org). You are encouraged to share your
experiences on this website and if you need additional guidance, feel free to contact
UNICEF via email: [email protected]

Trainers' Facilitation Guide - For Global IPCI

RESOURCES
73
Appendix A.
Pretest And Post-Test
Pretest/post-test with answers highlighted
1. Which of the following can be frontline workers (FLWs) in the context of immunization?

a) Physicians/doctors

b) Nurse and midwives

c) Community health workers

d) Community outreach workers and mobilizers

e) Community volunteers

f) All of the above

2. Which of the following is not a desirable practice of an FLW in immunization

communication?

a) Building trust with caregivers and clients

b) Educating and informing caregivers, community members, and influential leaders

c) Speaking harshly to caregivers

d) Addressing fears and misconceptions at the community level

e) Sensitizing, mobilizing, and generating demand for immunization

3. Which of the following statements is most generally true about behaviour change
communication?

a) It is important to understand a person’s current level of knowledge and their attitudes

and beliefs to successfully motivate behaviour change.

b) Providing someone with new information is enough to change their behaviour.

c) Behaviours are easy to change.

d) People make decisions independent of peer, community, and media influence.

74 APPENDIX A - PRETEST AND POST-TEST

4. Which are reasons to use a client-centred approach to immunization communication
and services?

a) Improve the reputation of staff at the facility and community levels

b) Provide the caregiver/client with positive memorable experiences

c) Satisfy the needs and expectations of the caregiver/client

d) Decrease the number of caregivers/clients who discontinue immunization services

e) All of the Above

5. Which of the following is an example of an FLW demonstrating empathy?

a) A mother expresses uncertainty about the safety of vaccines and the FLW dismisses
her concerns.

b) A baby begins to cry after receiving a vaccination so the FLW asks the mother to
quiet the baby.

c) A father forgot to bring the child’s immunization card, so he is refused service.

d) A caregiver is concerned the injection will hurt the child so the FLW explains that she
understands her concern and reassures her the pain will quickly pass.

e) A grandmother arrives late for the child’s vaccination appointment after traveling a long
distance to the clinic, and the FLW tells her that he also has a long journey to the clinic but is
never late.

6. Which of the following does not demonstrate respect for a caregiver (or client)?

a) Encouraging the caregiver to express their ideas

b) Showing your appreciation for the caregiver’s knowledge and questions

c) Interrupting the caregiver when they speak

d) Showing compassion if they share an issue or concern

e) Using appropriate body language, including pleasant facial expressions and

appropriate eye contact

7. Place these problem-solving steps into the correct sequence:

a) Brainstorm strategies to address the problem (2)

b) Select the best solution (4)

c) Develop a plan of how carry out the solution (5)

d) Identify the problem (1)

e) Take action using the plan (6)

f) Determine which strategy might be the most effective (3)

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APPENDIX A - PRETEST AND POST-TEST
75
8. Which of the following is true about the immune system?

a) The immune system is an infection that harms the body.

b) Skin and mucous membranes are not part of the immune system.

c) The immune system does not help the body fight disease.

d) Vaccines help the immune system fight disease.

9. Which of the following are reasons a caregiver might be hesitant to vaccinate their child?

a) Their own experience with vaccine-preventable diseases.

b) Their own experience with vaccination.

c) Information they gather from the media, family, and friends

d) Bad experiences with service providers

e) All of the above

10. Which of the following is most unlikely to be an effective technique for community
engagement?

a) Holding focus group discussions caregivers

b) Placing a stack of information pamphlets in the clinic

c) Organizing community meetings or conversations

d) Conducting home visits to discuss immunization

11. Which of the following is not a reason to hold a community conversation?

a) If you feel that you are not appreciated by the community and want recognition

b) If you have large numbers of families who do not bring their children for immunization
c) If you have a high dropout rate
d) If any children have had serious adverse reactions after immunization
e) If you believe there are negative rumours circulating in the community about immunization

12. Which of the following are systematic ways to collect community feedback?

a) Interviews or surveys with caregivers

b) SMS surveys

c) Suggestion boxes

d) Focus group discussions

e) All of the above

76 APPENDIX A - PRETEST AND POST-TEST

Appendix B.
Barriers Review Image

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APPENDIX B - BARRIERS REVIEW IMAGE
77
Appendix C.
Barriers And Facilitators To
Effective Communication
Barriers to Effective Communication Facilitators of Improved Communication
Language differences (caregiver and •• Learn key words and phrases in the local language
frontline workers [FLWs] speak •• Use an experienced translator
different mother tongues) •• Use images
Vocabulary – use of technical
•• Use words the caregiver is likely to understand
terms, jargon, and difficult words

•• Speak clearly
Poor clarity of speech
•• Give clear, understandable responses
•• Limit the information and provide cues to help the
Too much technical information caregiver remember
•• Ask yourself: ‘Am I giving too much information?’

Lack of focus on the caregiver •• Become sincerely interested in the other person

•• Listen well and check your own understanding of what

Different assumptions the other person said
•• Check the caregiver’s understanding.
•• Try to see things from the other person’s point of view
Different points of view •• Think: ‘How is it possible for someone to
misunderstand my message?’

Cultural differences •• Seek to understand and accept the culture

•• Be honest
Lack of trust
•• Reassure the caregiver
•• Take a few seconds to control your emotions
Emotions •• Comfort the caregiver and give them a few moments
to control their emotions
•• Be honest
Conflicting body language
•• Practice noticing and adjusting your body language

Sending discouraging feedback •• Use encouraging nonverbal communication

The rush to serve many •• Smile and be polite anyway

people waiting •• Tell the caregiver who can provide more information

Caregivers’ fear of speaking and

•• Compliment the caregiver and encourage questions
asking questions

Lack of respect for clients

•• Treat everyone with respect
and caregivers

78 APPENDIX C - BARRIERS AND FACILITATORS TO EFFECTIVE COMMUNICATION

Appendix D.
Job Aid: Counselling The Caregiver
Skill/Technique Example
Explore caregiver’s understanding of
childhood immunization. Ask caregiver if
‘I am happy to see you here today. What
they have any questions about what will
questions do you have about your child’s
happen during this immunization session. If
immunizations today?’
this is the child’s first session, ask what the
caregiver understands about immunization.
[In response to the statement: ‘That malaria
vaccine didn’t work. My baby has had malaria
Correct misconception and rumours and twice since the last immunization.’] ‘We don’t
provide information and education about have a vaccine against malaria here yet, but the
important related issues. four vaccines your baby gets today will protect
him against several other very dangerous
diseases.’
Use appropriate vocabulary and assess the
caregiver’s level of understanding. Explain
what caregiver should know to have a basic
understanding of immunization (in small
pieces, do not give them everything at ‘One of the vaccines protects against several
once). Tailor the information to the diseases. These are a type of pneumonia, a
caregiver based on their experience, serious type of diarrhoea, diphtheria, pertussis,
knowledge, concerns, and what they tetanus/lockjaw, and hepatitis.’ [Use the local
need to know today. Use short sentences term for each disease.]
that will be remembered easily. Pause
frequently and repeat the key details. Avoid
overloading the caregiver with information
they do not need and will not remember.
Check caregiver’s understanding after each
chunk of information, and correct
misunderstandings. Pause every so often ‘I would like to make sure that I have made
to check the caregiver’s understanding. everything clear. Would you tell me what you will
Only the caregiver can confirm what is do if the baby gets a slight fever tonight?’
understood. This is best done with open-
ended questions.
Gently correct misunderstandings. Take
responsibility for not communicating well ‘I think I did not explain X very well. What I am
and explain the misunderstood information trying to say is…’
in another way.

Encourage the caregiver to voice

‘Please ask any questions you have. I am here to
questions, fears, and concerns. Reassure
help you, and any question you have is a
the caregiver that any question, fear, or
good one.’
concern that they have is worth discussing.

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APPENDIX D - JOB AID: COUNSELING THE CAREGIVER
79
 Skill/Technique Example
‘Every vaccine we are giving has been given to
Address the caregiver’s fears and concerns. millions of children without hurting them. Even
Try to understand the cause of the my own children are fully vaccinated because I
caregiver’s fears and concerns. want to protect them from disease whenever
possible.’
Discuss/give concrete behaviours that the
‘According to what we discussed, you will keep
caregiver can accomplish. Do not ask the
this immunization card in a safe place and bring it
caregiver to do something that he or she
when you come back, right?’
will find impossible to do.
‘I’d like to remind you about three things that
we talked about: (1) the vaccines your baby got
today will protect him from several illnesses; (2)
Summarize key information. Deliver
the baby might get fever or get pain where the
the four key messages and make sure
needle went in – if that happens, give them half
that the main points are clear to
a tablet of paracetamol for the fever; (3) please
the caregiver.
keep the yellow card somewhere safe and bring
it with you next time; and (4) bring the baby back
in four weeks for the next round of vaccines.’
Motivate the caregiver. Explain to the
caregiver that if they continue to bring the ‘Your baby will have a better chance at life if you
child in for immunization, the child will bring him for all his vaccines.’
be safe from certain diseases.
Check on acceptability/mutuality of
decision making. Make sure that the
caregiver understood the decisions
‘We will work together to make sure your child
taken and agreed. If the caregiver feels
stays as healthy as possible.’
unhappy with or does not seem to own the
decision, address whatever is making them
hesitant.
Closing. Ask the caregiver if there is
anything else they would like to know.
‘Is there anything else you would like to know?
Praise them for being honest about their
I’ll see you in four weeks. Thank you for coming.’
concerns and for making the best decision
for their child.

80 APPENDIX D - JOB AID: COUNSELING THE CAREGIVER

Appendix E.
Steps To Community Meetings
The table should be read from top to bottom, then left to right. Cut out into tiles and distribute
to teams for an ordering activity.

Discuss the meeting with

Decide on the purpose of local leaders and influences; Facilitate the conversation,
the conversation invite them to attend, as allowing time for questions
appropriate

Document questions,
Determine the target Research the topic to be
concerns, and necessary
audience covered
follow-up actions

Determine which attitudes,

Prepare the key talking points, Develop an action plan to
beliefs, behaviours, and
meeting agenda, and address on any issues raised
perceptions need to be
relevant materials during the meeting
addressed

Promote the meeting through

Select a date, time, and Follow up with meeting
relevant communication
venue attendees
channels

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APPENDIX E - STEPS TO COMMUNITY MEETINGS
81
Appendix F.
Sample Community Conversation Agenda

1. Introduce yourself and the team to the community or group. If possible, let the group introduce
themselves, too.
2. Give a brief introductory talk.
3. In the introduction, explain the objective to the community and create an environment conducive
to learning and sharing. You can tell the community that you and your team have come to work
with the community to help improve their well-being.
4. Tell participants you would like to focus today’s discussion on childhood immunization to prevent
some of those health problems, and that you want them to participate fully in the discussion,
sharing their ideas, experiences, and opinions.
5. Ask the participants if they have seen children with vaccine-preventable illnesses in their
community. Ask participants how they can protect their children from such illnesses. Direct the
discussion to a point where the participants themselves decide that something has to be done
to protect the children in their community.
6. Show participants a picture of healthy, happy children with their parents. Allow the participants
to comment on what they see in the happy picture and let them discuss if they see many such
families in their community.
7. Ask participants what they feel are the benefits of childhood immunization. Discuss, helping
them to think of more benefits or adding to their ideas as necessary.
8. Divide them into groups of six to eight and ask them to think of steps they can take to ensure
all the children in their community are fully immunized. Let them write each suggestion down
on a paper or choose a group member to remember and report to the full group.
9. Have everyone come together again to present their ideas.
10. Ask the whole group the following questions:
a. Who are likely the most influential people they can work with to bring about the desired
change?
b. What will happen if we do not achieve the desired change?

11. Wrap up by sharing key immunization messages that are relevant to participants, such as
childhood vaccines and the diseases they prevent, the need to bring children back for all their
vaccine doses on time to best protect them, the value of the health card and the need to bring
it to each visit, and the ways to convince hold-out families to get their children vaccinated.
12. Ask participants they have any questions. For questions that you believe some community
members can answer, ask for answers from the community members before adding any
additional points. Commit to following up with answers to the questions that you cannot
respond to at the meeting.

82 APPENDIX F - SAMPLE COMMUNITY CONVERSATION AGENDA

Appendix G.
Job Aid: Tips For Using Immunization Support
Materials Effectively
IEC (information, education, and communication) materials are visual or audio aids that help
providers and caregivers better understand and remember information about diseases, prevention,
treatment, health behaviours, and other health topics. The visual and audio aids and materials can
be used during group discussions or during one-to-one IPC sessions.

IEC materials improve communication by:

•• Helping explain complex information

•• Serving as a talking points reminder
•• Simplifying complex information
•• Generating discussion
•• Reinforcing key points and messages

How to Use IEC Materials

Become familiar with the materials provided during this workshop and take a new look at materials
you already have. Make sure they are they up to date and that the visuals and language are
culturally appropriate. Practice using any materials before meeting with caregivers and communities
so that you are sure you know what is in them and where to find the information you want.

Tips for Using Flip Charts

When using a flip chart, always face the group members. Hold the flip chart so that everyone in the
group can see it. If the group is large, move around the room with the flip chart to give everyone a
chance to see each picture. Memorize the main points but explain them in your own words. After
discussing the flip chart, summarize (or have participants summarize) the key messages – what
they really need to remember.

Tips for Using Video or Audio

Know what you want to achieve by using the video or audio – what is your objective? If the video or
audio will not help you achieve your objective, find one that will. If the video or audio is long, decide
which segments to play and where to pause for discussion. Introduce the video or audio, then play
it. Watch for audience reactions to give you clues about what to discuss after playing. Pause the
video or audio in appropriate places for discussion or to take questions. When discussing the video
or audio, ask questions about what the audience saw/heard, felt, liked, and could relate to. You can
use or adapt any discussion guide that accompanied the video or audio.

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APPENDIX G - JOB AID: TIPS FOR USING IMMUNIZATION SUPPORT MATERIALS EFFECTIVELY
83
Tips for Using Booklets, Discussion Cards, Brochures, and Posters
If you are using a pictorial source, ask the caregiver what is happening in the pictures. Build on
what the caregiver has said to further explain each page of the material to the caregiver. Point to
the picture as it is discussed. Observe caregivers to see if they look puzzled or worried. If they do,
encourage them to ask questions and discuss any concerns.

When possible, give materials to the caregivers and suggest that they share the materials with
others, even if they decide against the health practice discussed.

Appendix H.
Workshop Evaluation Questions
1. Which topics covered in the training did you find most relevant?

2. Which activities did you like the most?

3. What did you like the least about the training?

4. What could be done to improve the sessions?

5. On which topics would you have preferred additional time?

6. Do you feel you confident about applying what you learned in the training to your work?

7. In what ways has the workshop inspired you to change or introduce new ideas into your work?
Please explain.

8. Who do you think would benefit most from this training course?

9. Any other comments and suggestions?

84 APPENDIX H - WORKSHOP EVALUATION QUESTIONS

Appendix I.
Recommendations For Follow-Up And Supervision
After Ipc/I Training

Managers and supervisors of FLWs should cofacilitate, observe, or participate in at least part of
the IPC/I training. This will help inform their IPC/I follow-up and supervision approach. Managers
and supervisors may also attend sessions of particular relevance, such as new competencies,
competencies needing the most improvement, or competencies the managers or supervisors want
to develop themselves.

Facilitators, managers, and/or supervisors should provide follow-up assessment and support of
IPC/I training. Follow-up should be conducted no later than one month following the training.

Key objectives of follow-up after IPC/I training are to:

•• Reinforce the knowledge learned in the training (e.g., vaccine information, responses to
frequently asked and difficult questions)

•• Reinforce the interpersonal skills learned in the training (e.g., active listening, group facilitation)

•• Reinforce the attitudes the training sought to develop (e.g., respect, equity)

•• Identify and, if possible, help mitigate reduce problems faced by participants in their work
situation that affect consistent use of good IPC/I

•• Assess participants’ use of good IPC/I skills in their routine immunization duties in order to
provide them with constructive feedback, coaching, and on-the-job or refresher training

•• Obtain feedback useful in improving and advocating for future IPC/I training

Scheduling post-training follow-up

Plan to assess training participants for the first time about one month later, giving participants time
to practice IPC/I competencies with caregivers and communities in real-life circumstances. Try to
follow up before three months at the latest to help FLWs maintain the positive changes they have
made. Follow-up can take four hours or more, depending on the number of FLWs being followed up
and the number, type, and location of activities to be observed.

Assessment of IPC/I competencies

It is important to emphasize to participants that this is not an examination, but rather a way for
facilitators to assess the training, help reinforce the competencies learned, and help with situations
that participants have found difficult to manage since the training. If assessing a group of FLWs,
begin the day with a welcome and introduction that includes expectations for the visit. Give the
FLWs time to describe their experiences – successes, benefits, challenges, wishes – trying to
implement IPC/I.

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APPENDIX I - RECOMMENDATIONS FOR FOLLOW-UP AND SUPERVISION AFTER IPC/I TRAINING
85
If you are a facilitator conducting a follow-up visit, briefly meet with facility in-charge and staff to
explain the visit’s purpose and the activities expected to take place that day. Identify the FLWs you
will assess. Ask staff if they have observed any differences in the way those trained in IPC/I are
interacting with caregivers. Establish a friendly atmosphere for the visit.

Ask to see where immunization, group discussions, and counselling take place. Identify a quiet
area to conduct the ‘classroom’ parts of the follow-up (conversations with participants, quiz, and
training). If the training included community outreach, ensure that plans have been made and
confirmed with community leaders and members to conduct home visits and/or a
community meeting.

Conduct the assessments in a similar way to the training’s field practice sessions. Observe,
remaining silent and not interrupting interactions. Give feedback to the FLW immediately afterward,
starting with praise for things done well. Having the whole group present will make it feel more
like the training and enable all participants to gain from watching others interact with caregivers
and community members. This step is not essential, as it might embarrass some participants. Ask
each participant how they felt they did. Then ask other participants to give feedback – starting with
praise, followed by suggestions for improvement. You also may wish to ask the participants some
knowledge questions as well.

An alternative is to ask the participants which competencies they feel unsure of and to spend time
on these skills. If identified before the follow-up (e.g., by phone, SMS, or email), plans can be made
ahead of time as needed. This might include, for example, scheduling an immunization discussion,
community meeting, or a home visit with caregivers whose children are behind on
their immunizations.

Explain your purpose to anyone included in such a session. Also explain how the assessment will
be conducted and reassure them that they are not being judged.

An extremely effective way to improve counselling is to videotape/record a person counselling a

few people. Then, the facilitator should ask the counsellor to assess his or her own performance,
what he or she did well and could have done better. Then the facilitator can add his or her own
observations. This can be done in training and/or in follow-up and supervision visits. This will not be
possible in all settings, but it should be considered where feasible.

86 APPENDIX I - RECOMMENDATIONS FOR FOLLOW-UP AND SUPERVISION AFTER IPC/I TRAINING

Training Follow-up Checklists
Use the IPC/I supportive supervision checklist or FLW self-assessment checklist to help assess
participants’ on-the-job IPC/I. The FLW self-assessment checklist is more detailed than the
supportive supervision checklist. Alternatively, develop a checklist tailored to the training conducted
and job expectations. Be sure to photocopy enough forms before leaving for the follow-up.

Avoid treating the checklists as a test. Checklists serve as a reminder of what to look for when
assessing each FLW’s use of IPC/I. They outline the way that FLWs should counsel and include the
key information they should communicate. They also reflect the attitudes FLWs should exhibit.

Supportive Supervision of Interpersonal Communication for Immunization: A Manual for Supervisors

of Frontline Workers provides specific guidance for enabling and supervising good IPC/I.

Centralized group follow-up

If individual follow-up is not feasible, for example, if all training participants come from different
areas, one alternative would be to convene participants for a group follow-up session that uses role
playing to assess competencies or allows FLWs from different sites to provide routine immunization
services in a designated facility and community. This could be combined with a refresher training.

Distance follow-up
If in-person follow-up is not possible, plan to follow up with participants by telephone or video
conference. Telephone conversations can be relatively brief but should have a structure for asking
how easily the FLW has been able to use what was learned, what is going well, what has been
difficult, and include time for problem solving and coaching. Video conferences can be longer and
include role playing (if the video conference involves two or more participants) or observation of
immunization services.

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APPENDIX I - RECOMMENDATIONS FOR FOLLOW-UP AND SUPERVISION AFTER IPC/I TRAINING
87
Appendix J.
Training Schedule
Annex A 5-Day Training
Day 1 Training Schedule
9:00 Greeting Announcements 12:30 -
9:15 - 13:00 Lunch
Session 1.1
9:30
9:45 Session 1.2 13:15 -
Session 1.5
10:00 Tea Break 13:30
10:15 Session 1.3 13:45 -
10:30 - 14:15 Session 1.6
11:00 Session 1.4 Part 1
14:30 Afternoon Break
11:15 Energizer 14:45 -
11:30 - 15:15 Session 2.1
12:15
Session 1.4 Part 2
15:30 -
Closing and Feedback
15:45

Day 2 Training Schedule

9:00 Greeting Announcements 12:30 Lunch
9:15 Energizer 12:45 -
Group Bonding Activity
9:30 - 13:00
Session 2.2
9:45 13:15 -
Session 3.2
10:00 Tea Break 13:30
10:15 - 13:45 -
10:45 Session 2.3 14:15 Session 3.3

11:00 Energizer 14:30 Afternoon Break

11:15 - 14:45 -
11:45 Session 3.1 15:15 Session 4.1

12:00 - 15:30 -
Lunch Closing and Feedback
12:15 15:45

88 ANNEX A
 Day 3 Training Schedule

9:00 Greeting Announcements 12:30 -

9:15 Energizer 13:00 Lunch
9:30 -
10:15 13:15 -
Session 4.2 Group Bonding Activity
13:30
13:45 -
10:30 Tea Break 14:15 Session 5.2
10:45 -
11:15 Session 4.3 14:30 Afternoon Break
14:45 -
11:30 Energizer 15:15 Session 5.3
11:45 -
12:15 Session 5.1 15:30 -
Closing and Feedback
15:45

Day 4 Training Schedule

9:00 Greeting Announcements 12:30 -

9:15 Energizer 13:00 Lunch
9:30 -
10:00 Session 6.1 13:15 -
Group Bonding Activity
13:30
10:15 Tea Break 13:45 -
10:30 - 14:45
11:15 Session 7.1
Session 6.2

11:30 Energizer 15:00 Afternoon Break

11:45 15:15 -
Session 7.2
12:15 Session 6.3 15:30
15:45 Closing and Feedback

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ANNEX A 89
Annex A Continued

Day 5 Training Schedule

9:00 Greeting Announcements 11:00 Session 7.3 Part 2

9:15 Energizer 11:15 -
9:30 - 11:45 Session 7.4
Session 7.3 Part 1
9:45
10:00 Tea Break 12:00 -
Lunch
10:15 - 12:15
10:45 Session 7.3 Part 2 12:30 -
Session 7.5
12:45

90 ANNEX A
Annex B 3-Day Training

Day 1 Training Schedule

9:00 Greeting Announcements 12:30 -

9:15 Session 1.1 13:00 Lunch
9:30 -
Session 1.2
9:45 13:15 -
Session 1.5
10:00 Tea Break 13:30
10:15 Session 1.3 13:45 -
10:30 - 14:15 Session 1.6
11:00 Session 1.4 Part 1
14:30 Afternoon Break
11:15 Energizer 14:45 -
11:30 - 15:15 Session 2.1
12:15
Session 1.4 Part 2
15:30 -
Closing/Feedback
15:45

Day 2 Training Schedule

9:00 Greeting Announcements 12:30 Lunch

9:15 Energizer 12:45 -
9:30 - 13:15 Session 4.1
Session 2.2
9:45
10:00 Tea Break 13:30 -
Group Bonding Activity
10:15 - 13:45
10:45 Session 2.3 14:00 -
14:45
Session 4.2
11:00 Energizer
11:15 -
11:45 Session 3.3 15:00 Afternoon Break
15:15 -
12:00 - 15:45 Session 4.3
Lunch
12:15

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ANNEX B 91
 Day 3 Training Schedule

9:00 Greeting Announcements 12:30 Lunch

9:15 - 12:45 -
9:45 Session 5.1 13:15 Session 6.1

10:00 Tea Break 13:30 Group Activity

10:15 - 13:45 -
10:45 Session 5.2 14:15 Session 6.2

11:00 Energizer 14:30 Afternoon Break

11:15 - 14:45 -
11:45 Session 5.3 15:15 Session 7.4

12:00 - 15:30 -
Lunch Session 7.5
12:15 15:45

ANNEX C 1-DAY TRAINING

Day 1 Training Schedule

9:00 Session 1.1 12:30 Session 2.2

9:15 - 12:45 -
Session 1.2 Session 2.3
9:30 13:00
9:45 Session 1.3 13:15 -
Session 4.1
10:00 Tea Break 13:30
10:15 - 13:45 -
11:00 14:15 Session 4.2
Session 1.4

14:30 Afternoon Break

11:15 Session 1.5 14:45 -
Session 4.3
11:30 - 15:00
Session 2.1
11:45 15:15 -
12:00 - 15:45 Session 7.4
Lunch
12:15
16:00 Session 7.5

92 ANNEX B, C
Appendix K.
IPC/I Self-Assessment Checklist
Purpose
This checklist is designed to help you:

• Honestly assess how often you are using good interpersonal communication skills during
immunization sessions and outreach/education
• Identify areas for improvement
• Set goals and develop plans for improving your use of effective IPC skills
How to use this checklist
Use this checklist periodically (perhaps daily at first, then weekly or monthly. Your supervisor might
choose to make this checklist part of the formal supportive supervision process. In this case, you
would, for example, share a monthly or quarterly self-assessment with the supervisor. Whether part
of the formal supportive supervision process or not, you can share all or parts of your findings with
supervisors to make them aware of your improvements, to seek help in setting goals, and to get
on-the-job coaching or training.

Give yourself credit for any improvement, no matter how small, and for maintaining good IPC
practices despite challenges you face. Also give yourself credit for recognizing areas where
you need to improve. These are important steps to making good IPC as routine as any of your
immunization activities.

Consider sharing all or parts of your findings with colleagues to get encouragement, advice, or
support, or even to help them make similar changes.

Instructions for use

Date of this assessment: Date of next assessment: Date of next supportive supervision visit:

My Goals for this period were to:

1.

2.

3.

I did this
Effective IPC Recent Example Challenge/Goal
Never/Seldom Often
IPC Process
Welcome the caregiver
Sincerely praise caregivers for bringing their babies
for immunization
Ask the appropriate routine immunization questions
Use relevant support materials, including health
card, to explain to caregivers

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APPENDIX K - IPC/I SELF-ASSESSMENT CHECKLIST
93
 I did this
Effective IPC Recent Example Challenge/Goal
Never/Seldom Often
Communicate the key immunization messages:
o The vaccines being given during the visit
o The possible side effects and what to do
o To safeguard and return with the health card
o The day and time for the child’s next doses
Check caregivers’ understanding by asking them to
repeat what was covered
Ask caregivers for any immunization questions or
concerns they may have
Respond truthfully, understandably, and reassuringly
to caregivers’ questions and concerns
Ask caregivers to repeat what they need to do
Encourage caregivers
Summarize key information, including the key immu-
nization messages
IPC Skills
Avoid judging or scolding the caregivers
Avoid rushing the caregivers (exercise patience)
Show respect by listening attentively
Show respect through tone of voice
Give credible, evidence-based vaccine and
disease information
Use simple language the caregivers understand
Avoid overloading caregivers with information
Make eye contact (if appropriate) while listening
& talking
Show empathy nonverbally and by reflecting
caregivers’ feelings
Reflect back caregiver statements and feelings to
show or check understanding and encourage dia-
logue
Use open-ended questions to seek more
information about concerns or practices as needed
Use gestures and short responses to encourage
dialogue
Sit or stand at the same level as caregivers
Ensure there are no physical barriers (such as a
desk) between me and caregivers
Discuss and try to correct caregivers’ immunization
misconceptions/rumors
Other:

IPC in Immunization Group Discussions

Before the session, find out what participants likely
know, think, and do about the proposed topic
Opening
Begin on time
Greet participants warmly
Introduce yourself
If appropriate, have participants introduce
themselves
Clearly state the purpose of the session
Say how long you expect the session to last
Facilitation
Put the participants at ease
Ask participants what they already know about
the topic
Seek participant input early and often
Communicate information in a lively fashion

94 APPENDIX K - IPC/I SELF-ASSESSMENT CHECKLIST

 I did this
Effective IPC Recent Example Challenge/Goal
Never/Seldom Often

Use visual aids, including props

Ask participants what they see in the visual aids
Use appropriate language and relatable concepts
Encourage the exchange of ideas among
participants
Reassure caregivers
Respond to caregivers’ questions, concerns, barriers
Highlight links between the topic and issues of
concern to caregivers
Include ample time for Q&A
Include positive reinforcement of immunization
behaviors
Solicit group consensus
Manage challenging behaviors well
Content
Use story, video, interactive exercises
Invite participants to share what they already know
Engage participants in discussion of immunization
key benefits such as:
o Saves millions of lives every year
o Prevents serious illness and permanent dam-
age
o Saves time and money (clinic visits, medicines,
hospitalization)
o Protects those who can’t be immunized for
health reasons
o Is safe, effective, free
o Where and when immunization is available
o Complete in 1st year of life for best protection
Provide information that is easily understandable
and relevant for the entire group
Seek positive examples from participants
Use positive examples from community
Engage participants in discussion of key immuniza-
tion messages:
o Vaccines and the diseases they prevent
o Possible side effects and what to do
o Importance of safeguarding, referring to, and
returning with the health card
o The immunization schedule (number and timing
of visits)
Encourage full participation
Ask participants for examples
Encourage participants to respond to each other as
appropriate
Ask participants to restate what you said in their
own words or language (if session is in a different
language)
Solve a problem together (for example, how to keep
track of the health card)
Don’t scold or embarrass participants
Balance eye contact around the group when
speaking
Ask shy participants easy questions, then praise
them
Reinforce participation with verbal and non-verbal
communication
Sing a song together, preferably related to the topic
Closing
Summarize key points from the discussion
Have participants summarize key points
Suggest or review actions agreed upon by partici-
pants

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APPENDIX K - IPC/I SELF-ASSESSMENT CHECKLIST 95
 I did this
Effective IPC Recent Example Challenge/Goal
Never/Seldom Often

Ask participants to raise their hands to show they

commit to the full immunization of their children
Thank and encourage participants for their efforts to
protect their children
Thank and praise participants for their participation
Inform participants about the next session
Ask participants for feedback on the session
Other IPC/I Activities
Review the IPC/I participant handbook
Review the IPC/I FAQs
Identify or create useful materials and visual aids
Conduct community meetings
Conduct home visits
Reach out to community leaders and encouraged
them to support immunization
Follow-up with caregivers who had questions
or concerns
Follow-up with caregivers whose children have
missed a scheduled immunization
Help caregivers overcome obstacles to complete
and timely immunization
Problem-solve alone
Problem-solve with colleagues
Seek the guidance of my supervisor to overcome
a challenge
Share successful practices with colleagues

Changes I see from using good IPC skills

How using good IPC skills is affecting my work:

How using good IPC skills is affecting caregivers/my clients:

How using good IPC skills is affecting my life/outlook:

Other:

Things/challenges that made it difficult to practice good IPC:

Ideas for overcoming these challenges:

96 APPENDIX K - IPC/I SELF-ASSESSMENT CHECKLIST

Challenges to What would solve Whose help I need Timeframe
practicing effective the problem
IPC

My IPC goals for the next month/quarter (circle one):

1.

2.

3.

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APPENDIX K - IPC/I SELF-ASSESSMENT CHECKLIST 97
Appendix L.
Certificates
Certificate on next page

98 APPENDIX L - CERTIFICATES
Trainers' Facilitation Guide - For Global IPCI
APPENDIX L - CERTIFICATES 99
Notes

100 NOTES
 ©UNICEF/Sokol

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101