Communication-for-Behavioural Impact (COMBI) Plan for Immunisation in Georgia

An excerpt from this United Nations Children's Fund (UNICEF)/Georgia document - released in collaboration with the World Health Organization (WHO) Mediterranean Center for Vulnerability Reduction, Tunisia/Communicable Diseases Programme, Geneva, and Georgia Ministry of Health - follows:

"The essential first step in designing a COMBI (Communication for Behavioural Impact) Programme for Immunisation is determining the behavioural results desired. A COMBI mantra informs this step: Do nothing...make no T-shirts, no posters, no pamphlets, no videos...do nothing, until there is a clear sharp sense of intended behavioural outcomes.

In the case of Immunisation in Georgia, this critical first step was challenging particularly because there are just so many desired behavioural outcomes in the area of immunisation related to specific vaccines and their specific schedule.

For example, the coverage rate for Hep B [Hepatitis B] 3 (at about age 13) in 2005 was around 73%. One could have a behavioural objective directed at increasing this rate to 90%. One could similarly focus on OPV [Oral Polio Vaccine] 3 which had a coverage rate of about 84% in 2005, or TD [Tetanus and Diphtheria] at age 14 which had a coverage rate of about 75%. Or DPT [Diphtheria, Pertussis and Tetanus] 2 and DPT 3 with coverage rates in 2005 of around 84%.

It would not be advisable in a single public communication campaign to attempt to address all the behavioural outcomes expected under the general heading of immunisation, given the various vaccines and their scheduling. The public would simply be overwhelmed and confused. One needs to limit the behavioural focus if behavioural impact is desired. UNICEF/Georgia in discussion with its partners decided to focus on a critical set of vaccines which are best taken with fewer side effects if taken promptly and on schedule at 2 months (DPT 1, OPV 1, Hep B 2), 3 months (DPT 2 and OPV 2), and 4 months (DPT 3, OPV 3, Hep B 3)...

In COMBI practice one is advised not to attempt communicating more than three behaviours at a time....The 2-3-4 schedule is descriptive of three separate but similar behaviours...: the behaviour of bringing one's child in for the first time for vaccination at age 2 months is a different behaviour compared to bringing in the same child a month later, and then yet another month later. A bad experience at the first vaccination visit will adversely affect subsequent visits...

It seems, that in general, if mothers understand and are persuaded of the value of the recommended behaviour (on-time vaccinations at 2-3-4 months after birth), have a clear image of the diseases being prevented even though they may not be present now in the community, grasp the importance of timeliness of the vaccines, see that the time and effort involved are not enormous, know that the vaccines are provided at no financial cost to the parent, that side-effects of vaccines are minor in relation to the enormous disease protection the child gets, and that on-time vaccination reduces side-effect, that the source of origin of the vaccines have been declared as providing safe and high quality vaccines vouched for by UNICEF, WHO [World Health Organization] and the MOH [Ministry of Health], offered an incentive to carry out the recommended action, and can be constantly reminded and nudged to take on-time action by family (especially grandparents and in-laws), friends, the media and health professionals (nurses), then we are likely to see increased practice of the expected behaviour...

The heart of the COMBI Strategy is what the private sector would call direct sale or personal selling: the door-to-door, face-to-face engagement of the consumer in his or her home. This kind of interpersonal communication is vital for engaging parents/caregivers/grandparents in O.T.I. [on-time immunisation]/2-3-4 behaviour...

This 'personal selling' will be supported by a media-based promotional/public relations campaign comprising sustained press activity during the year, short 15 sec 'filler' radio announcements to be used by disc jockeys (DJs) in between musical pieces on radio, and radio and television discussion/chat shows with telephone call-in and done before live audiences, and possible inclusion of the behavioural theme in existing television/radio drama series...

Outdoor Promotion and Point-of-Service Promotion will also form part of this COMBI Programme..."

Please contact Maya Kurtsikidze (see below) to inquire about access to the full document in MS Word format.