Media Engagement for Supporting Demand Creation for Childhood Immunisation (MERCI)

MERCI uses a multi-media approach - radio, TV, social media, and community outreach - to address socio-cultural norms and beliefs acting as barriers to behaviour change amongst caregivers. BBC Media Action works with local Nigerian radio and TV stations; community, traditional, and religious leaders; local film and music stars; diverse populations of Nigerians; medical experts; and UNICEF staff to bring tailored media content addressing issues around polio vaccination and routine immunisation to audiences. All content is produced in Nigeria, is informed by BBC Media Action's health communication approach, and uses research to ensure programming engages and resonates with audiences. Local languages, accents, faces, stories, characters, and settings are designed to ensure that content feels credible and is trusted.

The first two years of the MERCI project focused on increasing demand for vaccination, particularly polio vaccination, in areas of northwest Nigeria that were particularly high risk due to low levels of vaccination uptake for children under 5 years old. However, after new cases of acute flaccid paralysis due to polio were recorded in northeast Nigeria in 2016, project activities expanded to address the outbreak and consequent issues arising in the complex and dynamic context in that region.

Activities include:

• Developed in consultation with polio survivor groups and field health workers, 144 episodes of the 15-minute weekly radio drama are broadcast in partnership with 44 local radio stations in areas where levels of child immunisation are low and the risk of a polio outbreak is high. In a creative way, it addresses barriers to immunisation and aims to build family and community support for protecting child health. It does this by providing information about the causes and consequences of vaccine-preventable diseases and by dispelling myths and misconceptions about immunisation. The fiction/drama element is a medium for role modeling, and the show seeks to appeal to audiences by integrating characters, issues, challenges, and storylines that reflect socio-cultural values and belief systems of different communities and ethnic groups across the North. There are occasions where Madubi is used as a tool to negotiate the uptake of healthier behaviours in relationships - specifically, to convince sceptical partners (both male and female), older relatives, and neighbours of the benefits of immunisation. Listeners can engage with the programme via social media.
• The drama is accompanied by radio and TV public service announcements (PSAs) in Hausa and other local languages that explain how immunisation can protect child health and family life. (There have been 19 radio PSAs broadcast on 76 stations and five TV PSAs broadcast on 76 stations, as well as 180+ radio PSAs produced by partner stations.) Kannywood musicians and actors are engaged here.
• The programme brings the discussion to the people, with live performances followed by discussion. Community outreach occurs while recording Madubi Live in communities in the focal states; events have been held in 26 communities. The events are unusual in bringing both men and women together and are reportedly seen as a source of pride that brought the community together. Participants report that during the events, community leaders made pledges to increase their advocacy of polio immunisation in Friday prayers and through house-to-house visits with reluctant families, while others pledged to improve their family healthcare.
• BBC Media Action is training staff from Nigerian radio and TV stations to build their skills to produce high-quality local language programming about polio vaccination, routine immunisation, and child health. Multi-layered training is tailored to suit the needs of particular stations and individuals, and includes co-production of radio programmes, Madubi Live community outreach events and PSAs, attachments with the Madubi writing team, and other hands-on technical, thematic, and editorial trainings. Capacity building also includes work with UNICEF's Journalists Against Polio network in the northeast. To date, 127 local media professionals from 18 stations have been trained.

Immunisation and Vaccines, Polio

In Northern Nigeria, polio vaccination efforts have traditionally been met with parental and community resistance, meaning some parents refuse to have their children vaccinated, or fail to bring them for vaccination if their children are not reached at home during vaccination campaigns. Nigeria is one of only three countries globally where polio is yet to be eradicated. The number of children who die there before reaching their fifth birthday is one of the highest in the world.

BBC Media Action describes Madubi's mass media advantage as follows:

• Radio: a trusted source of information.
• Scale: Audiences reached.
• Minimised risk in tense/hostile communities.
• Flexibility of reaching different archetypes effectively.
• Consistency in information provided while addressing myths and misconceptions.
• Frequent exposure to information over time.
• Entertainment.
• Support for interpersonal communication (IPC) interventions.
• Recognisable brand taken to communities via Madubi live.

BBC Media Action research shows that regular Madubi listeners are twice as likely to know that contaminated water, and 1.7 times more likely to know that eating with dirty hands, can transmit polio, compared to non-listeners. For more impact data, see Related Summaries, below.

A father in urban Kaduna State said, "Initially due to lack of awareness, there was a belief that people should stay away from polio immunization because it serve[s] as a contraceptive but as time goes on we got to understand its importance. Organisations like BBC Media Action have embarked on awareness campaign and now we are ok. Radio is the main source of that awareness and that is why we cannot do without it." A mother from that same area said, "Honestly in my house there are up to 12 women including me. Whenever the programme (Madubi) is on I...call them so that we listen to the programme together. Before, some of them do not allow their children to be immunized but due to this programme they now do. You see that we have all benefitted from it."