Finding New Effective Ways to Engage Communities on Life-Saving Vaccinations in Kenya

As head of health promotion for Nairobi County in Kenya, Lillyan Mutua creates demand for health services such as immunization and is responsible for community engagement and outreach.  A long-time member of Sabin’s Boost community of immunization professionals, she participated in such Boost courses as “Community Activation” and “Improving HPV Knowledge and Communication,” and received one of the first COVID-19 Recovery for Routine Immunization Programs fellowships offered by the Sabin Vaccine Institute and the World Health Organization. We spoke with her about the challenges she encounters in her efforts to increase the uptake of the HPV vaccine and the importance of storytelling to spread awareness.

What does your role entail?

I lead the health promotion unit in Nairobi County, Kenya, where I work for the subnational government. My work entails creating demand for health services, community mobilization, and community organization.

As a follow up to the VARN2023 conference, I was inspired to come back to my duty station and look at where we were not doing well in terms of vaccine. We have made some progress in life-course immunization but passionately, I am looking at the HPV vaccine. When I look at the uptake and the acceptance of the HPV vaccine nationally, it is a gray area that has been occasioned by the myths and misconceptions associated with it.

Most community members think the HPV vaccine is a contraception that we are giving the girls. Most of the parents, guardians, and caregivers tell us that, because these girls are not yet sexually active, we do not need to give them the vaccine. They think the information that goes with the HPV vaccine might trigger the girls to be sexually active.

Others have religious beliefs where they do not accept that someone can be given, at any time, any type of a health service, including just vaccination. They go to receive health services when they are ill. In those groups, the vaccine has not been well-received.

What tactics are most effective in combatting these misconceptions?

Stories are very powerful in our African context. Growing up, our grandparents used to tell us stories, and these stories were one way of relating the values, the beliefs, cultures, and traditions of the community.

So, we should use this same storytelling, but in this case, when we are looking at vaccine deployment, we should use the patients who are walking the journey and who are ready to share their story about the path that they have walked with cervical cancer. Those who are diagnosed early, have gone through care and treatment, and have survived cervical cancer, they are the people who are properly placed to tell their communities, their relatives, their neighbors and the community at large about cervical cancer. They know where it pinches and can better tell the story. And by telling the story, they touch the emotions and the minds and the thoughts of their communities, of their families, and their neighbors.

Those who are diagnosed early, have gone through care and treatment, and have survived cervical cancer, they are the people who are properly placed to tell their communities, their relatives, their neighbors and the community at large about cervical cancer.

How do you engage communities to create demand for vaccination?

One step is to involve community stakeholders. When we talk about community members, we have the decision-makers and influencers. They could be the gatekeepers, the chiefs, the elders, the grandparents of the child. These are important people who can be brought on board for discussion. Then we have the administrators who, like the chiefs and the village elders, are very important.  And when we look at the religious congregations, religious leaders are brought to the table to understand why it’s important to give the girls the HPV vaccine.

Also, if there is an incident or a disaster today, most of us will learn about it from the social space. So, the health sector — the partners who are implementing health services, the people who are creating demand, the researchers — everybody should talk about what we are doing, how we are doing it, what are the outcomes of the research that has been done and share this information through social media.

It is time that we review, reinvent, and have new innovations for action. Look at our social marketing and demand creation aspects. Stop looking at the issues that impede us from having successful vaccine delivery. Let us leave the dance floor and move to the balcony to look far and wide. Look from where we have been and where we are.

Aside from leveraging social media, are there any other new approaches to your work that you are exploring?

When we go door-to-door or when we visit people informally in the community, they are easy to access and negotiate with. It’s easy to give them information because they are readily available. But when we go to the other 30% of the population who are middle class and elite, you find that most of them are away at work. Their children are in school. Only the people who are doing the domestic work are within their homes and their gates are secured by the security guards. So, it has been a bit difficult to reach them. But we are now looking for new avenues. We are looking at the religious institutions. We are also bringing on board the doctors, the pediatricians, the gynecologists, and other people working in the health space at higher levels or in elite hospitals. We are also looking at organizing communities, mobilizing communities at places of work, be it at the factory or corporate.

We also look at other spaces, like sports and events where entertainment is going on. When people are having breaks, we can give health messages. Even if it is for 10 to 15 minutes, we deliver the key messages and give them factual information. And because we still hang around, we are accessible to start a conversation so that we can address their worries and concerns. And that is called edu-entertainment. In between the entertainment, you also give health advice.

We’re also reaching out to the schools. Thanks to our Minister of Education, we are able to have health clubs with the students. Those who are 12 and below – once you give them the message, the message is not only reaching them but they will also carry it home and discuss what was said with their siblings and parents.