Let's Talk about Protection

Summary of Taking Action

Assessment: 
The health mediators originate from the vulnerable Roma communities in Bulgaria. Blagoevgrad is a city in South western Bulgaria where about 500 Roma live in very poor segregated neighborhood – they don’t have proper housing, nor infrastructure (the streets are muddy paths; there is no sewage and running water). In addition, many Roma women and mothers are illiterate; local population has very low health awareness. The only source of reliable health information is the Roma health mediators – 2 Roma women. We tried to address precisely the lack of awareness on the importance of obligatory vaccinations – very often parents didn’t take their children to the GP and many children have missed immunizations. Since Health mediators are trusted by the local community we decided that we should undertake some actions to make it easier for the parents to follow the immunization schedule and to know when immunization has to be administered.

Planning:
We organized a meeting with representatives from the local community and discussed the vaccination issue – what are the fears of the parents regarding vaccination; do they have information about the diseases that are vaccine-preventable; what kind of explanation and materials are going to be adequate for them? Our mission was to provide information to the mothers and to motivate children to perceive vaccination as behavior that raises their social status. Our plan was to develop materials that work well with our two target groups – parents and children and then to promote them with the help of the Regional Community Health Mediators network.

Taking Action
We developed two materials – immunization schedules-stickers with special design that is attractive and shows the diseases against which the child has to be vaccinated as well as the exact time period when the vaccine should be administered. The diseases are written both with their “official” names and with their popular naming so the parents could understand them. The material targeting Roma children were special colored small badges saying “I am protected” – the badges were given to children who successfully passed through vaccination as a reward and as an acknowledgement for this socially tolerated behavior.
The Health Mediators started to visit each family with children in the neighborhood and to explain them why vaccination is important and why the vaccine-preventable diseases are dangerous for the children’s health. Then, after the explanation, the Health mediator showed the immunization schedule-sticker to the mother and proposed her to stick it together somewhere in the house where she could see it when passing by every day.

Evaluation:
An internal evaluator made interviews with local general practitioners and a pediatrician who have Roma patients from the neighborhood as well as with Health mediators. In general, the feedback was that the work of the community Health mediators is very valuable since they convince the families to take their children to vaccination – sometimes they even accompany the parents with the child. The Health mediators reported that they succeeded to inform all families and to stick the immunization calendar in their houses (65 calendars in total); badges were given to 43 children that passed through vaccination in the period (December 2013 – June 2014). They had problem with only one family in convincing them to take their child to immunization because their older daughter had an allergic reaction after vaccination several years ago.

Sustaining the Work:
Key finding from the work with Roma families was that they would take their children to vaccination if they trust the doctor. If a family is not in good relationship with the doctor, often the vaccination would be missed – mainly because parents are not aware of the reasons why it is important. Our main task is to ensure that parents are informed about the diseases and that they would make a decision to vaccinate their children motivated by the well-being of their child and not because they like the doctor or not. In this regard we registered successes in Blagoevgrad community – however the changing of attitudes is a process that takes a lot of time – we rely on forming new attitudes among Roma children that receive encouragement when they get vaccinated. All of them were very proud with their badges saying “I am protected” (Almost like “I am a hero”). As a result from the success in Blagoevgrad we decided to produce such vaccination schedules-stickers and disseminate them among all working Roma Health mediators in Bulgaria which are more than 170 in 2015.