Adapting Strategies to Realities in Togo for Catch-Up Vaccination

COVID-19 Recovery for Routine Immunizations Fellowship helps Bamazi Karouwe Essohanam reach children in Togo who fell behind  during the pandemic.

Measles vaccination at Cocobou public elementary school

Bamazi Karouwe Essohanam and her immunization team knew the COVID-19 pandemic had taken a toll on routine vaccination coverage at the Dalwak Medico-Social Center in Togo, because the Center had been converted to COVID-19 care during the worst of the outbreak. When the team analyzed the Center’s data for 2022, however, they saw routine vaccination had plummeted, with fewer than 50 children receiving routine vaccinations for diphtheria, tetanus, measles and polio.

Bamazi, who holds a bachelor’s degree in public health and a master’s degree in epidemiology, joined the 2022 COVID-19 Recovery for Routine Immunization Programs Fellowship, a joint program from the Sabin Vaccine Institute and the World Health Organization to support immunization catch-up from the pandemic. “I felt it was a great opportunity to strengthen my skills to better guide the vaccination strategies wiped out by COVID-19.”

Community outreach in Baore

Through the live training sessions of the Fellowship, Bamazi was able to improve her skills and align her strategies to focus on bringing vaccination services to vulnerable groups and searching for zero-dose populations. Her team decided to conduct focus groups in local villages with members of the community and healthcare providers, guided by the support of the village chiefs, in order to understand the potential causes of this issue. “The focus groups allowed for renewed collaboration between community and providers and a real commitment to vaccination,” she says.

Raising Awareness

From there, the team met with health authorities to collect information on vaccination. They worked to raise awareness of the importance of vaccination among health workers and the community, as well as address the false rumors related to vaccination circulating in communities. Bamazi and her team succeeded in their social mobilization efforts with the help of health providers and community leaders in markets, schools, and public places. She praised the aid of community leaders in the planning and execution of vaccination activities which helped to bolster community engagement.

Throughout the process of implementation, Bamazi and her team had to adjust strategy at times due to overlapping priorities. For example, they began with a community-based search for unvaccinated children, but this required a lot of time and resources for team members to do house-to-house searches. Additionally, some community members were mobile and searching for work, so they were away from their homes. Bamzai’s team readjusted to this reality and switched to searching by health center vaccination records.

Two Strategies

Bamazi submitted a plan to the COVID-19 Recovery Fellowship that included a goal of reducing the number of zero-dose children by 10% at the Dalwak Medico-Social Center and was awarded one of 40 Phase 2 mentorships that came out of the initial COVID-19 Fellowship.

Focus group in Worgou II with village chief

She and her team created two vaccination strategies: a fixed strategy in which there is a post where parents can bring their children to get vaccinated and an advanced strategy in which a team is formed to go into the community, mobilize the population to get vaccinated, and administer vaccines to children. As part of their advanced vaccination strategy, Bamazi’s team took advantage of the national measles and rubella vaccination campaign in December 2022 to vaccinate missed children in Dalwak.

Thanks to these efforts, between July 2022 and February 2023, 1,105 children were vaccinated in fixed posts in Dalwak, and an additional 3,482 children were vaccinated through the advanced strategies Bamazi and her team implemented.  “Bringing vaccination services closer to the population through the implementation of advanced strategies reduces inequities and increases supply and demand,” she says.