Rivers State, Nigeria, to demonstrate how health communication and campaign ..... of Cross River State Ministry of Health, Directors of Primary Health Care, NPI ...
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Communication Strategies Evaluation of Communication Strategies in the National Immunisation Campaign in Cross Rivers State Ukam Ivi Ngwu
Abstract This study evaluates the communication strategies used in the National Immunisation Campaign in Cross River State, Nigeria between 2013 to 2016 to ascertain it effectiveness or otherwise. Focus group discussions (FGDs) and In-depth interview were used to obtain data from 64 participants (consisting of parents, policy, community leaders, health workers, media personnel). Findings revealed that programme planners used several communication strategies – interpersonal communication, local advocacy (door-to-door) using community media, mass media campaigns, social or community mobilisation, etc. While the mass media strategy proved very effective in the urban areas, those at the rural areas suffer setbacks due limited access to the mass media. As such, local advocacy through town criers and interpersonal communication with health workers were mostly their source of information. The study identified inadequate health information, unavailability of vaccines, inadequate health workers, low local participation in the planning and implementation of the communication strategies as major challenges militating against complete vaccination and eradication of childhood killer diseases in mostly rural parts of the state. The study recommends the full utilisation of local media channels and intensive community mobilisation to effectively combat vaccine resistance and promote the acceptability, usability and sustainability of immunisation Campaign in Cross River State and Nigeria at large. Keywords: Communication strategies, immunisation programme, health campaign, vaccines, Cross River State
Introduction Communication interventions in Nigeria have proved to be a vital instrument in the fight against Vaccines Preventable Diseases (VPDs). A report by UNICEF (2012) confirmed the role communication plays in health contexts. The report suggests that in the past few years, the strategic application of communication contributed immensely to 80% reduction in the number of Wild Polio Virus (WPV) cases from the 2006 level, as well as an increased impact on the overall Immunisation coverage through targeted social mobilization. And, in this case, communication is seen as an effective tool in disseminating health information that may help reduce death. Evidence suggests that effective communication strategies could have ameliorated the health information subsidy that would reduce the more than 2 million deaths and disability, yearly that are reportedly caused by vaccines preventable diseases (Multiple Indicator Cluster Survey MICS, 2007 cited in Aina & Ejembi, 2013, p.785). It is unquestionable that effective communication strategies can positively impact on immunisation programmes. For most countries, immunisation programmes are part of the strategic national health initiative. According to World Health Organisation (2014) “A International Journal of Communication: an Interdisciplinary Journal of Communication Studies, 22, September, 2017. Published by the Communication Studies Forum, Department of Mass Communication, University of Nigeria, Nsukka
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Communication Strategies National Immunisation Programme (NIP) is the organisational component of Ministries of Health charged with preventing disease, disability, and death from vaccine-preventable diseases in children and adults” (p. 1). While communication is an effective tool in disease prevention and control, Odusanya, Alufohai, Meurice, Clemens and Ahonkhai (2003) argued that “immunisation remains the primary strategy in both the control and prevention of common childhood diseases, particularly in the developing world” (p.175). This is achieved through the inoculation of vaccines to the body to help fight some of these diseases and prevent a carrier or index patient from infecting immediate contacts within their community. Yet, it is obvious that the acceptability of these vaccines is predetermined by the communication strategies used as well as the efficacy of these vaccines. Numerous communication researches provide supportive evidence about the role of communication in health contexts. For example, Harrington (2014) argued that the merits of health communication are evident in the crucial role it plays in preventing most illness, injury and premature death., Brown, Crawford and Carter (2006) bolster this point by suggesting that health communication “is not merely an accidental event that could eventually be supplanted by some other diagnostic technique, it is a necessary and irreplaceable part of the process of attaining essential medical knowledge” (p.24) and can also ensure desirable outcomes if effectively applied. Consequently, this article argues that communication aimed at educating and mobilizing public support for immunisation is an effective tool in achieving measurable standards of health and wellness. In other words, the communication strategies used in communicating can impact on the effectiveness of the health intervention. To support this contention, this research further argues that health communication goes beyond merely creating awareness of existing health challenges to penetrate entrenched cultural barriers, norms, attitude and behaviour that interact with the targeted population and existing social system. The article intends to use the case of the National Immunisation Campaign in Cross Rivers State, Nigeria, to demonstrate how health communication and campaign strategies can be effectual in health intervention and disease prevention. Clearly, in a state like Cross River, where majority of the population live in remote areas and some mothers protect their children against Immunisation even to their own detriment, evaluation of health communication strategies may provide evidence to draw inference. Additionally, ignorance, illiteracy, superstitious beliefs, and unwholesome cultural practices, may impact on whether campaign strategies can successfully educate, convince and motivate them to embrace this beneficial health programme. All of these factors pose a classic health communication challenge and require a major communication effort to overcome. It is on the aforementioned premise that this study aims to evaluate the communication strategies used in the National Program on Immunisation (NPI) in Cross River State between 2013 and 2016. To achieve this, the communication strategies used in reaching the targeted population during this period under review were explored to ascertain its effectiveness, as well as it short-comings with focus on the communication channels and messages used in terms of content, clarity and relevance as compared to the audience needs, expectation and constraints. Statement of the Problem A UNICEF report quoted by Imoh (2014) bears credence to the benefit of communication in health contexts. According to the report, in the absence of the National International Journal of Communication: an Interdisciplinary Journal of Communication Studies, 22, September, 2017. Published by the Communication Studies Forum, Department of Mass Communication, University of Nigeria, Nsukka
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Communication Strategies immunization Campaign, “approximately 216,000 Nigerian children will die each year, an average of about 600 daily. Of these, an additional 100,000 will be disabled. Measles in particular is a major public health problem with an estimated 3.6 million cases occurring annually resulting in about 108,000 deaths and 54,000 disabled” (p. 78)). Cross River State was considered for this study based on the observations and recent study by Adie et al (2014) that in Cross River State as compared to other states in Nigeria, “there has been a major reversal of health gains over the past decade: childhood immunization plummeted and has not improved much in the last decade. In consequence, the country is largely not on course to achieve the Millennium Development Goals by 2015” (p. 2). Also, Oku (2014) observed that the “demand for immunization especially in Northern Nigeria (64%) of the total population) is low and has been attributed to lack of knowledge of its potential benefits, cultural and religious inhibitions, fear of side effects, Poor attitude of healthcare providers, lack of motivation, poor interpersonal communications skills” (Oku, 2014). It is on this premise that the researcher evaluated the communication strategies used in the process of implementing the National programme on Immunization (NPI) campaign in Cross River State and ascertain how effective it has been to achieve acceptability, usability, and sustainability of the programme, strength and weaknesses as well as knowing the perception of the people towards them. Theoretical Framework The study adopted the theory of planned behaviour. The theory of planned behaviour is a continuation of the theory of reasoned action. The theory provides useful information for the development of communication strategies and it’s most times used in evaluation studies. This theory postulate that a person's behaviour is determined by his/her intention to perform the behaviour and that this intention is, in turn, a function of his/her attitude toward the behaviour and his/her subjective norm. The best predictor of behaviour is intention. Intention is the cognitive representation of a person's readiness to perform a given behaviour, and it is considered to be the immediate antecedent of behaviour (University of Tweente, 2010). Attitudes are viewed as function of behavioural beliefs. This is why Ajzen and Fishbein supported the idea that an individual’s or society’s attitude is an important predecessor to any action taken. “Therefore an important step toward influencing behaviour is a preliminary assessment of target audience attitudes, and subsequent tracking to identify any attitudinal changes” (U.S. Department of Health, 2004, p.2). The theory of planned behaviour helped to reveal the attitude of the targeted audience towards the National programme on Immunisation as well as assess the impact of the communication strategies in tracking this unwholesome behaviours and enhancing their acceptance of the programme. This is because health-related communication is fundamental to choice and making informed decision by the target audience. As the U. S. Department of Health (2004) rightly observed, “without information, there is no choice. Information helps knowledge and understanding. It gives patients the power and confidence to engage as partners with their health service” (p.2). Literature Review Numerous studies have documented the role communication plays in health campaigns. Amongst these are campaigns aimed at compliances and behaviour modification. In each context, the goal has been to educate a target audience and to provide them with the International Journal of Communication: an Interdisciplinary Journal of Communication Studies, 22, September, 2017. Published by the Communication Studies Forum, Department of Mass Communication, University of Nigeria, Nsukka
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Communication Strategies information and equip them with skills for disease prevention. One that has been critical to eradicating or controlling diseases is immunisation. Here, the review of literature is organised in three distinct areas: research that focuses on immunisation programme in Nigeria; analysis of literature on communication efforts in the immunisation process; and ones that discuss the benefits of immunisation. Immunisation Programme in Nigeria The National Programme on Immunisation is a health initiative under the purview of the government and aimed at monitoring the health status of its targeted population, as well as to help prevent the spread of emerging infectious diseases and improve the overall health status of its citizenry. Efforts of national governments have been augmented and supported by WHO’s strategic health initiatives whose overall goal is to ensure that “all countries have a national immunization programme to protect the population against vaccine-preventable diseases” (WHO 2014, p. 1). WHO, which is at the forefront of health promotion and disease prevention, first launched the Expanded Programme on Immunisation (EPI) in 1978 as one of its signature Primary Health Care (PHC) interventions. The initial EPI goals were to ensure that every child received protection against six childhood diseases: Tuberculosis; Tetanus toxoid; Haemophilus influenza type b; Yellow fever; Rotavirus; and Hepatitis B (WHO, 2014, p.1). Consequently, Nigeria launched it Expanded Program on Immunization (EPI) in 1979 to align itself with WHO initiatives, which would later be rebranded and re-launched in 1984 as the National Programme on Immunization (NPI). Immunization is a cost-effective public health strategy facilitated by the Federal government of Nigeria through the aegis of the National Programme on Immunization (NPI) to improve healthy living and eliminate or reduced to the barest minimum some perceived killer diseases (like Tuberculosis, Poliomyelitis, Diphtheria, Tetanus, Measles, Whooping cough). The standard healthy living amongst children and pregnant women intended through NPI can only be achieved by sufficient use of some communication strategies to combat possible resistance, garner acceptance and adequate utilization of the vaccines by the people who are mostly pregnant women and children. More worrisome is the mistaken believe and illusion that Immunisation is a calculated attempt by the white (Western world) to depopulate Nigeria. IRIN (2014, p.2) confirmed this position that “total of four staunchly Muslim states in Northern Nigeria are now blocking the immunisation programme, casting doubt over a plan to eradicate the disease worldwide”. Immunisation and Pre-Primary Health Care Services officially commenced in rural communities of Nigeria in 1998, when vaccine coverage for all Expanded Programme on Immunisation (EPI) diseases which include: tuberculosis, polio, diphtheria, pertussis, tetanus, measles, and hepatitis B were distributed (Odusanya et al, 2003, p.1). In 1999, a new drive to sustainably re-vitalize the immunisation system commenced in synergy with the accelerated strategy on polio eradication. Consequently, the Federal Government established the National Programme on Immunisation (NPI) whose key focus was to provide support to the implementation of state and LGA immunisation programmes. WHO provided technical support to national authorities at Federal, State, Local Government and Ward level to strengthen the implementation of the Reaching Every Ward (REW) strategy and the Government of Nigeria signed a memorandum of understanding with International Journal of Communication: an Interdisciplinary Journal of Communication Studies, 22, September, 2017. Published by the Communication Studies Forum, Department of Mass Communication, University of Nigeria, Nsukka
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Communication Strategies WHO to conduct training on the strategy for health workers at national, state, local government and ward levels. The support provided by WHO, along with other partners, to the efforts of national authorities in routine immunization contributed to improved access to and coverage of routine immunisation services. The number of fixed immunisation service delivery points and outreach immunisation sites continues to increase steadily (WHO, 2012). Communication efforts in Immunisation process This was why Bartlett et al (2003) insisted that, “In order for services and intended health behaviours to be culturally acceptable and realistic in terms of local norms and resources, the community needs to be involved in the process of planning, implementing, and evaluating intervention efforts” (pp. 38-39). This perhaps necessitated the World Health Organisation to set up the “Partner-in-Health strategy” to educate, convince and motivate mothers, pregnant women and the community leaders to accept the programme. The benefits of Immunization Immunization is the process of protecting an individual from disease through the introduction of a live, killed or partial component of the invading organism into the individual’s system. A person who is immune to a disease is one who is protected against that disease by means of antibodies circulating in his/her blood or present in the cells of the tissues of his/her body (Omole & Owodunni, 2012, p.1). Immunisation is a proven tool for controlling & eliminating life threatening infectious diseases, avoids suffering, permanent disability, deaths arising from the disease. Immunization against childhood diseases such as diphtheria, pertussis, tetanus, polio and measles is one of the most important means of preventing childhood morbidity and mortality and has reduced the incidence, recurrence and regeneration of childhood diseases in the world. This why Ophori, et al (2014) insisted in their study that the process and aim of “achieving and maintaining high levels of immunization coverage must therefore be a priority for all health systems” (p. 67). Vaccine preventable diseases have been classified as one of the main causes of underfive mortality. In 1999, these diseases accounted for 22% of both infants and under-five deaths. For infants, the most important were neonatal tetanus (11% of deaths), pertussis (6%), measles (3%) and Cerebro Spinal Meningitis (CSM, 2%). Among under-five children pertussis accounted for 6%, CMS 6%, measles 5%, and neonatal tetanus 5% of reported deaths (Okafo, 2000 cited in Omole & Owodunni, 2012, p.2). The prevalent cases of untimely deaths has forced health researchers into work in discovering more new vaccines that can help reduce this deaths to the barest minimum. Hopes were further increased when a recent study on vaccines efficacy and availability by Abdulkarim, Ibrahim, Fawi, Adebayo, and Johnson (2011) confirmed that a “number of new vaccines with major potential for controlling infectious diseases have just been licensed or are at advanced stages of development. Among the illnesses targeted are rotavirus diarrhoea, pneumococcal disease, malaria and HIV which together kill more than a million children each year, most of them in developing countries” (p. 190). Population-based immunization programmes protect whole communities. This is because when enough people are immunised, the chances of the disease transmission are slim if not totally truncated. It is therefore important for mothers to know that approximately three International Journal of Communication: an Interdisciplinary Journal of Communication Studies, 22, September, 2017. Published by the Communication Studies Forum, Department of Mass Communication, University of Nigeria, Nsukka
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Communication Strategies to five immunization visits for the infants during the first year of life and two immunization visits for the mother-to-be (pregnant women) are essential for the protection of the child or the unborn against some of the main causes of diseases, poor growth, malnutrition and early death (Omole & Owodunni, 2012, p.2). Objectives of the Study The overall objective of the study was to evaluate and ascertain the effectiveness of the communication strategies adopted by NP1 between 2013 and 2016 (two-year period of review) in Cross River State. Specifically, this study sought to: 1. Identify the communication strategies used for National Immunisation campaign in Cross River State; 2. Assess the effectiveness and impact of the communication strategies on the target audiences from 2013 – 2016; 3. Determine the extent of the involvement by the target communities in the planning and implementation of the communication strategies use in the National Immunisation Campaign in Cross River State. Research Questions The following research questions guided the study: 1. What are the communication strategies used for National Immunisation campaign in Cross River State? 2. How effective are these communication strategies on the target audiences from 2013 – 2016? 3. To what extent target communities involved in the planning and implementation of the communication strategies use in the National Immunisation Campaign in Cross River State? Methodology This study, being an outcome evaluation, adopted the ‘Ex-post facto’ research design. This is considered appropriate and suitable due to its effectiveness in studying events after they have occurred (Isangedighi, Joshua, Asim & Ekuri, 2006).
Population of the Study The population of this study was drawn from pregnant women, mothers, and fathers who were farmers, civil servants, business women etc. This is because the National Programme on Immunization (NPI) is targeted at these persons who must be vaccinated, take their children for Immunisation centres as at when due and fathers who also provide the transport and make decision for or against vaccination. The researcher also involves the staff of Cross River State Ministry of Health, Directors of Primary Health Care, NPI Coordinators, representatives from international agencies and NGOs, Health Education Officers etc who are seen as facilitators and decision makers of the NPI. International Journal of Communication: an Interdisciplinary Journal of Communication Studies, 22, September, 2017. Published by the Communication Studies Forum, Department of Mass Communication, University of Nigeria, Nsukka
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Communication Strategies Since not all members of the population are directly connected to immunization programmes, the study adopted the purposive sampling technique to select a sample size of 64 participants who are strictly stakeholders in the immunization exercise - pregnant women, mothers and father of various occupations, health workers, community leaders etc. Method of Data Collection Data for this study were collected using qualitative research method using In-depth interview and focus group discussions (FGDs). 3 FGDs were conducted in each of the 3 senatorial district of the state. 36 participants were carefully selected across ethnic ties, religion, occupation and educational levels. Data were obtained using FGDs guide. The 30 in-depth interviews conducted for this study were mostly centred on community leaders and health workers across the senatorial district of the state. Data Presentation And Analysis Data presented here are from the focus group discussions (FGDs) and in-depth interviews conducted for this study. Grounded theory and its qualitative data analyses technique was adopted as the method of data analysis. The basic idea of the grounded theory approach is to read (and re-read) a textual database (such as an interview transcript and discover or label variables (called categories, concepts and properties) and their interrelationships (Okwuchukwu, 2014). i.
Communication strategies for immunisation information in Cross River State
The FGDs show that the National Programme on Immunisation employs variety of communication strategies to get to their target audiences. These include interpersonal communication, local advocacy (door-to-door) using community media, mass media campaigns, social or community mobilisation, etc. Majority of the participants from rural communities said the often receive information on NPI activities/programmes through their local channels like town criers and community leaders, age and women groups. The people in the cities gave credit to the mass media, especially the radio as their major source of information about the programme. Some of the mothers revealed that Nurses/Midwives most time do lecture them especially doing pregnancy about immunisation. Hence, they schedule time for their patients to come for vaccination. Reacting the question raised on how did you get to know about the NPI? Some of the participants said: ‘‘I used to know when to come for Immunisation doing my antenatal days. The Nurses used to teach us about it and let us know when to bring our children for Immunisation (FGDs with community members).’’ Another participant added that: The Nurses, used to locate children in their schools and churches to vaccinate them. Sometimes, will only get to know when we see them coming with the Immunisation to give. The Church Pastors will ask all mothers present, to cooperate with the health workers and take their small children out for Immunisation. Most times, our village head use to send message through our town crier to us, about Immunisation, some time the nurses move door to door (FGDs with Community members).
International Journal of Communication: an Interdisciplinary Journal of Communication Studies, 22, September, 2017. Published by the Communication Studies Forum, Department of Mass Communication, University of Nigeria, Nsukka
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Communication Strategies ii.
On Reliable Sources of information
Most of the participants of the focus group discussions find information from community leaders to be more reliable and preferable. This is however due to the proximity as well as credibility source of information. It is believe that information or order from the Community leaders come with it accompanied sanctions. Hence, information coming from the traditional institution is treated with seriousness and urgency to avoid possible sanctions. If the town crier rings his bell, everybody must remain silent to hear the message coming from the Palace. To me, when it is coming from our Community Town crier, it gets to every member of the community. The town crier normally must go to every compound to announce it very early in the morning before people go to farm or in the evening when people are back from work (FGDs with Community Members). The participates in the city also hold a similar view, some said even when the Community method of dissemination is most time seen as a local in nature, it is the most effective because of it African nature. Over reliance on the Mass media is what is killing us, information wise. Many just hold the faint believe that once you are in the city, you must listen to the radio and television or read a newspaper. I tell you the truth; most of the people leaving in the city do not have access to the mass media. May be due to electricity problems, unavailable receivers or even lack of time and interest to listen to the media due to the nature of their work. It is better to also use some indigenous ways alongside the media in the cities too. Sharing fliers with interpersonal communication can go a long way (In-depth Interview with head of an NGO). Another participant reacting to the reliable source information stated clearly that: It is obvious that at present, there is no channel or source of information that is 100% good or effective for the dissemination of NPI messages. But the use of all available channels is the best approach to a successful intervention. This will help the government to get in touch with everybody. That is to say, if you did not get the message through the radio or television, you could get through the town crier or Nurses / Midwives who could come to the market places to inform you on market days and so on (In-depth interview with health workers).
iii.
On the level of Community Participation in the NIP
Community Participation has been viewed as an important component to enhancing the acceptability, usability and sustainability of the immunisation programme in the state. The study reveals that at present, the level of community participation in the Immunisation programme is not satisfactory. Though some of the participants claim their Community members and leaders were involved, many others say they were barely informed about the International Journal of Communication: an Interdisciplinary Journal of Communication Studies, 22, September, 2017. Published by the Communication Studies Forum, Department of Mass Communication, University of Nigeria, Nsukka
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Communication Strategies NPI scheduled for vaccination without really involving them in the planning and implementation process. Sometimes, I only get to know that the Immunisation people are around, to immunised pregnant women and children. But, the community is not fully part and parcel of the exercise. We are supposed to be involved to also help to checkmate the activities of the health workers to ensure that they are actually doing the expected (In-depth interview with Community Leaders). The benefits of the community participation was reemphasised by virtually every participants in the in-depth interview discussion. However, some participants lamented the abuse of such partnership by some health workers who share those community positions to their wards who sometimes and not even members of that particular community. When the government give chances to the community members to participate in the Immunisation process, some health workers give those chances to only their family members to benefit. This is so even when these their family members already have work to do, instead of sharing these chances to other families too, for it to go round (FGDs with Community members). Majority of the participants yearned for an increased community participation as a way to improving Immunisation in the state and achieving desired results. Just as the Chinese proverb says, tell me I may forget, teach me I may remember but involve me and I will understand. People participate mostly in an intervention when you make the problem their own problem, and give them the opportunity to proffer solutions to them. That is to say, community participation make everybody feel important, hence the likelihood of taking it very seriously (In-depth interview with a public health experts). Some FGDs participants also feel that Community participation should be strengthened and increased inter-sectoral collaboration will help address the problem of poor turnout of community members for vaccination and also improve the Immunisation campaign. Discussion of Findings Immunisation campaign has remained a remarkable preventive measure against major childhood killer diseases in Nigeria and the world at large. An evaluation of the communication strategies used in the immunisation campaign is important in determining the strength and weakness of those strategies adopted for the programme. This is necessary where resurgence of vaccine preventable diseases are emerging in people that were ordinarily supposed to be protected (Onalu, 2010). It is noteworthy here that the success of immunisation activities and the trend of immunization coverage are affected by how well the communication aspect of the programme is conducted. Findings from the study reveal that several communication strategies interpersonal communication, local advocacy (door-todoor) using community media, mass media campaigns, social or community mobilisation, etc been used to reach the target audiences. While most city dwellers admitted and appreciated the intense use of the mass media (especially radio and television) advocacy used by programme planners to reach them, the rural dwellers decried limited or no access to the mass media. Also, some community based advocacy strategy through town criers, door to door, market days, age grade and village International Journal of Communication: an Interdisciplinary Journal of Communication Studies, 22, September, 2017. Published by the Communication Studies Forum, Department of Mass Communication, University of Nigeria, Nsukka
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Communication Strategies forum strategies have also been identified as some of the communication strategies often used to reach targeted audience at the rural setting. Data from this study show that communication strategies used in the immunisation campaign in Cross River state against maternal and childhood mortality are effective. However, there is need to intensify efforts to improve more on what is already in use. Rural dwellers and some participants in the city find indigenous communication methods to be the most effective strategy because of it closeness to the people. This affirms the position of UNICEF (2005) that “Communication strategies work best when they are integrated with various strategies for behaviour change or development, social mobilisation (p. 14). Community participation, according to this study, is on a decline lately. Community members and leaders decried their non-involvement in the planning and implementation of the NPI exercise. There is need for community participation (by way of participatory communication) to achieve a successful in the NPI. This supported the view of Bensley and Brookin-Fisher (2001), who observed that people often get excited and feel a sense of belonging when their voices were heard. They feel proud to be “given the opportunity to have input when community planning takes place” (p.39). Participation gives them a sense of ownership of the programme and the need to see the success of it. The study revealed that the government / programme planners do not consult pregnant women, mothers or fathers by way of getting periodic feedback about the programme or ascertain the effectiveness of communication strategies used. Imoh (2014) had suggested a survey by programme planners to “assess community knowledge, attitudes, and practices concerning NPI nor have messages designed been pretested with the user community before production and dissemination at all levels” (p. 40). A survey conducted by the Federal Ministry of Health in some select communities in Cross River had also revealed that a high proportion of mothers and caregivers “lacked knowledge of the common causes of childhood illnesses and how to prevent them” (Ikpeme, Oyo-Ita & Akpet, 2013, p. 76). Feedback from the target population will help programme planners/government identify some of the gray areas in the programme and help ascertain the effectiveness or impact of the backup communication strategies used in the programme. Conclusion Communication is an integral part of a successful public health intervention. To achieve success, requires adequate attention on the communication strategies designed to achieve the desired outcomes. The Planning and implementation processes of the communication aspect of the National Programme on Immunisation must take in to cognisance audience analysis, appropriate channels for disseminating information, clarity of message, audience segmentation and most importantly, the full involvement of the Community members and leaders by way of participatory communication. This study identifies community participation, indigenous media and mass media intervention as the ideal strategies to achieve full participation of the target audiences of the Immunisation especially in the rural settings. It is necessary to incorporate community leaders and other relevant stakeholders to achieve desired result in the NPI. This is because the issue of maternal and childhood mortality can be easily addressed through partnership with community leaders and members. The implication of community involvement is to collectively proffer solution to matters that affect them. The use of community or indigenous International Journal of Communication: an Interdisciplinary Journal of Communication Studies, 22, September, 2017. Published by the Communication Studies Forum, Department of Mass Communication, University of Nigeria, Nsukka
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Communication Strategies methods in conjunction with the modern mass media is necessary to achieve and improved NPI in Cross River state. Recommendations Based on the findings of this study, the following recommendations are made: 1. Government/programme planners should use all available medium to reach their targeted population. 2. Adequate publicity should be done in a timely manner before the days of the immunisation exercise. 3. Community and religious leaders, age grades as well as indigenous communication systems should be fully utilised along with the mass media to reach out to target population. 4. Community and parent should cooperate for effective immunisation process. 5. Logistics funds should be released on time to enable the health workers carry out their work well. 6. Health workers should use simple English (Nigerian English) in communicating with audience in rural areas 7. Government should have a database of phone numbers of pregnant women, mothers and fathers to use same in sending periodic text messages on information about the NPI.
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