Marklate ('Vaccinate')

Marklate's broad-based strategies were developed through partnership and participation involving all sectors and levels of society, and included training health workers, expanding the number of vaccination sites, and encouraging outreach services. To begin this process, the UNICEF national social mobilisation team, working in collaboration with the Ministry of Health, formed action groups to promote Marklate among political bodies, farmers associations, market women, and other groups. Messages and materials for Marklate were selected from UNICEF's Facts for Life handbook and translated into local languages. The team then turned to social networks, such as traditional entertainers, women's associations, schools, and religious groups to spread the messages among the general population.

The involvement of religious leaders in Marklate, through interpersonal communication, was a key programme strategy. The social mobilisation team first invited representatives from all religions in Sierra Leone to a leadership workshop that ultimately proved unproductive (participants engaged in debate about the differences in their beliefs rather than discussed strategies for promoting immunisation). Reasoning that Muslims were the largest segment of the population (60%) and that vaccination coverage rates were the lowest among Muslim children, the team organised a 3-day leadership workshop specifically for Islamic leaders. The team helped the attending religious leaders, Islamic scholars, and prominent Muslims from government and business to form a new NGO - the Islamic Action Group - as a vehicle for disseminating the messages. Quotations from the Koran were also identified to support child survival and other development initiatives. The Islamic Action Group encouraged different Islamic organisations around the country to use their networks to spread these messages and inspire local leaders. Smaller action groups were established in each of Sierra Leone's 12 districts.

When UNICEF met resistance among some religious leaders, who considered vaccination anti-Islamic or suspected a secret family planning agenda, the social mobilisation team organised a series of national and district-level workshops. The leaders who attended came to understand, and then began explaining to their congregations, that parents held a duty to secure their children's well-being. Imams included messages promoting child survival and development in their sermons and announced the times and locations of immunisation sessions. Some allowed their mosques to be used as vaccination sites.

Islamic women also participated as communication agents for change. The National Council of Muslim Women, an umbrella organisation of 96 different women's groups, attended leadership workshops and conferences. Some of the leaders then organised their own meetings and special events to further promote Marklate and enlist the support of their members. At vaccination sites, the women participated by preparing food for workers, assisting in registration, and providing entertainment by singing about Marklate. They also went door-to-door to reach out to reluctant families, making arguments in favour of vaccination. Organisers say that the women, most of whom were mothers themselves, were particularly credible as advocates.

Inspired by the work of the Muslim groups, Christians approached UNICEF to ask how they could participate. The UNICEF social mobilisation team and the Ministry of Health organised a national leadership conference with the Christian Council of Sierra Leone. Participants formed an NGO similar to the Muslim group, called the Christian Action Group, to help organise district-level activities. They selected biblical passages supporting childcare and community development to use as messages. Pastors and priests shared information on immunisation with their parishioners and organised workshops and special events, such as 'crusades' in sports stadiums featuring preaching, testimonials, gospel singing, and talks by health providers. Other awareness-building activities included an evening candlelight parade and a parade with floats built by community organisations to promote child survival and other development themes. Mothers' Unions, a women's network in local churches, played a role similar to the Islamic women's groups, going directly to communities to promote and support vaccination.

Organisers explain that, initially, Christian and Muslim women and men went separately to the communities. Eventually, the group leaders saw the advantages of making field visits together, and a bus schedule was organised to accommodate both Christians and Muslims on the same trip. By arriving together in a community with the same objectives and activities, but addressing their own congregations, they sent a powerful message to the community, according to UNICEF.

Immunisation & Vaccines, Health, Children.

Although Sierra Leone began an 'Expanded Programme on Immunization' in the late 1970s, it crumbled after just a few years; high levels of illiteracy, lack of mass media, and religious-based resistance among Muslims were cited as barriers to its success. By 1986, when Marklate was initiated, only 6% of children under the age of one had been fully immunised; the aim was to reach 75% coverage of all children with 6 antigens by 1990. However, by 1988, less than a quarter of all children under one had been vaccinated. A Knowledge, Attitude and Practice (KAP) study found that almost 90% of respondents had no knowledge, or the wrong knowledge, about when and where to vaccinate their children.

In 1990, after two years of the social mobilisation activities described above, the immunization programme reached its goal, moving from 6% to 75% coverage of Sierra Leone's 135,000 children under one year of age.

Organisers suggest that the relationship established between Christian and Muslim women persisted after Marklate concluded. Churches and mosques, along with village meeting places, became forums for inter-religious debate not only on immunisation but on other ongoing development issues.