Routine Immunization Buddy System (RIBS) is an intervention research project funded by the Gates Foundations’ Grand Challenges Exploration (GCE) grant. RIBS is a human-centered solution aimed at removing barriers that hinder the Northern Nigerian woman from demanding and accessing immunization services, by empowering her with practical knowledge on vaccination, providing access to loans to boost her financial capability and a network of peers for psychosocial support. This research will help derive insights that will contribute to the knowledge base influencing demand generation strategies and inform potential scale-up to other parts of the state, the country and other PHC program areas.
RIBS places caregivers with children eligible for vaccination in support (buddy) groups. Within these groups, beneficiaries will have access to knowledge sharing sessions on vaccination using a tool “Hannun Rigakafi” (immunization hand) and they will schedule and attend immunization sessions in groups or in pairs (i.e. one-to-one). In addition, some beneficiaries will be provided access to small-scale business loans (i.e. buddy groups as cooperative groups) and will be provided trainings on basic business management skills
The project is a three-arm cluster randomized controlled trial design of 96 clusters (with 8-13 caregivers in each cluster) conducted in Soba and Jema’a Local Government Areas (LGAs) in Kaduna state. Intervention group 1 caregivers participate in knowledge sharing sessions and are provided economic empowerment opportunities, intervention group 2 caregivers participate only in knowledge sharing sessions and do not receive economic empowerment opportunities, and control group are caregivers engaged on the project but have no access to any project intervention.
Project beneficiaries are spread across three archetypes; those with children who have received all vaccines due for their current age (i.e. they are Appropriately Immunized-AI), those whose children have missed any of the due vaccines required for the children’s current age (i.e. they are Partially Immunized-PI), and those whose children are left outs i.e. not received any of the vaccines due to the child (i.e. Zero dose).
The 12-month research will be conducted in two (2) phases – an initial pilot phase (phase 1) will be done for 6-8weeks across 12 clusters, after which it will be scaled up to 96 clusters over the remaining months.
The pilot phase of the project commenced in November, 2020 in eleven (11) clusters/settlements in Soba and Jema’a LGAs and has enrolled 114 beneficiaries into the different study arms. At baseline, the immunization status of all children of caregivers enrolled in Unguwan Tunku settlement in Soba LGA was zero-dose (they all had never received any vaccination), however, within the first week of implementation, the project recorded that all of these caregivers accessed vaccination at the health facility. The immunization status of these children has transitioned from zero dose to Partially immunized (PI). Two (2) caregivers not enrolled on the project but with eligible children also accessed vaccination services at the health facility. In addition, all remaining eligible children in the settlement that had never been immunized were visited and immunized due to project influence. This resulted in a settlement with about 90% of eligible children that have never been immunized now having all of them immunized with at least the BCG vaccine. This means 55% of all zero dose children enrolled on the project in Soba LGA and 38% for both LGAs have progressed through the immunization status stratum with immunization coverage for BCG reaching a 100% for target population including project beneficiaries in Unguwan Tunku.