On a recent day in May in a village in the state of Zamfara in northern Nigeria, Lawal Ango, a field manager with New Incentives, introduced himself to a crowd of community leaders sitting under the shade of a tree. Around 100 people were there for a meeting with Lawal and a health educator from the local government to learn about New Incentives’ cash incentives program and the health benefits of getting children vaccinated. 

The awareness meeting was one of more than 2,500 that New Incentives facilitated in the month of May alone. As New Incentives expands to new areas—and sets ambitious enrollment targets—holding these awareness meetings is a critical component of ensuring the organization gets as many babies as possible enrolled in the program and vaccinated against deadly diseases.

Northern Nigeria has one of the lowest childhood vaccination rates in the world, and most of the “zero-dose” children (those who have not received any doses of diphtheria-, tetanus-, and pertussis-containing vaccines) are concentrated in poor, rural areas such as this. The region has experienced recurrent measles outbreaks over the last decade, and the COVID-19 pandemic led to setbacks in routine vaccination coverage. New Incentives aims to enroll approximately nine million infants in our evidence-based program by the end of 2026. 

“The goal of the meetings is to make communities aware of the life-saving benefits of vaccinations and the incentives—if they aren’t aware, they can’t take advantage of them. The sessions are also designed to address misconceptions around the safety of vaccines and address any other questions that participants might have,” says Pratyush Argawal, Chief Operating Officer at New Incentives.

Building trust, raising awareness

In these areas, community leaders are the ones to guide community members on what is socially and religiously acceptable and expected, which is why getting buy-in from community leaders is so important. 

Before New Incentives staff arrive in a village, trusted leaders have invited community members to attend. Weeks before the awareness meeting, Lawal calls the ward focal person, the clinic in charge, and the local health educator to plan and schedule a time for the awareness meeting. The ward focal person then invites leaders from the community to attend, including traditional leaders, imams, local business owners like barbers and bakers, and members of local development committees. After scheduling the meeting with relevant parties, Lawal makes follow-up phone calls to the ward focal person to make sure all the relevant community members have been invited. 

Although Lawal facilitates the meeting, it is led by the health educator from the local government area, a person the community members already know and trust. The health educator introduces New Incentives’ program, known in Nigeria as the All Babies program, and provides basic information about the program, including:

• Who is involved: The All Babies program is a nonprofit program that collaborates with health authorities and partners in the state to save lives, and the program is fully approved by the state.
• How the incentives work: The All Babies program offers cash incentives; the educator uses infographics and hands out awareness cards to participants and talks about how the incentives work and who is eligible.
• Why the program exists and its aim: Too many infants are not vaccinated and are vulnerable to disease, and the goal is to create more demand for vaccinations
  

Throughout the meeting, the health educator invites questions and ensures that the participants have understood the information. Lawal emphasizes the information about the program and is available to answer any questions. A common question from husbands is why the All Babies program takes photos. Lawal says, “I tell them we are working with money and need to do it for evidence to prevent fraud and keep the program going, to prove that the money is only given to the caregivers.”

Asking for support from community leaders

During the awareness sessions, the educator explains key factors that are needed for the program to be successful, gently asking for their support. They talk about the importance of full coverage—that all villages, including the most remote within the clinic catchment area, need to send all infants to get vaccinated. They talk about full retention—of having infants come to all six immunization visits. And they talk about the importance of timeliness—having infants get vaccinated on time. If the mother cannot safely come after birth, Lawal explains that “the mother’s sister can come, a grandmother can come, others can come, and it's best an infant gets immunized as early as possible to not miss out on some vaccines.” 

Boosting demand with awareness: “We have to be vigilant”

In addition to holding awareness sessions before New Incentives begins programming in a new area, field staff also hold sessions in areas with low enrollment or retention rates to identify and address what’s keeping people from getting their children vaccinated. In some areas, for example, husbands have restricted travel for their spouses, so New Incentives has had a series of husband awareness sessions targeted specifically to this group. 

“Not every state or area is the same, and beliefs are different everywhere, so we have to be vigilant—tracking where enrollment or retention is low and coming up with a strategy that’s targeted specifically to that area, that challenge,” says Mustapha Kabir, New Incentives’ Operations Coordinator. 

Last year in Sokoto State, we learned that the proportion of infants in the program who were getting fully vaccinated was very low. Through conversations with clinic staff and health authorities, staff identified several reasons for lower enrollment, including 1) husbands restricting travel for their spouses, 2) greater cultural barriers and inadequate buy-in from traditional and village leaders, 3) some aversion to program requirements and queues and other issues in urban areas, and 4) especially difficult terrain. 

New Incentives used a combination of approaches to address these issues, including holding awareness meetings with different groups such as clinic staff, health educators, senior traditional leaders, and district head representatives; doing targeted “outreaches”—i.e., mobile immunizations—to bring the program to these communities, and mobilizing local community members to build community buy-in. 

After all awareness sessions, we track enrollment rates to see if any increases are observed, and they often are. Where we don’t see a sizable increase in enrollments, we continue to gather information, analyze data, and problem-solve. Where needed, the awareness meetings are followed by outreaches to make it easier for caregivers to get their infants vaccinated.

Truly connecting with caregivers

The success of these awareness meetings—and ultimately building trust in communities to achieve our enrollment goals—depends on dedicated staff like Lawal. He started as a field officer in 2018 and before that, spent many years working in community health for other organizations. Now, he is able to train field officers to go to communities and generate awareness of the importance of vaccinations. “Lawal truly takes the time to connect with caregivers, village leaders, imams, and others in the communities,” says Pratyush Agarwal.

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