National Vaccination Crusade 1984

In order to accomplish the proposed objectives different strategies were applied during the Crusade that attempted to involve in one way or another all the possible sectors, institutions, and people in the country around the issue of children’s health:

Social mobilisation:
The National Vaccination Crusade generated a high degree of mobilisation around the health sector that included diverse institutions and types of cooperation and resources provided:

• The President of the Republic and the First Lady were engaged; requests for collaboration were sent to all governors; promotion and inauguration of the three critical vaccination days from the Presidential Palace. The President administered the first dose to a child, a gesture that was widely spread through mass media.
• Ministry of Health: communications to the Sectional Health Services chiefs asking for their cooperation; visits to specific sites for motivation purposes and the solution of main problems.
• Ministry of Government: instructions to the Departmental Governments and Mayors of the 950 municipalities of the country requesting support to health personnel; communications to promoters and leaders of indigenous affairs, promoting the Crusade.
• Ministry of Education: communications to the departmental directors and to approximately 200,000 teachers requesting the dissemination of messages related to the Crusade within the educational community.
• Ministry of Communications: use of television, radio and press for the transmission of messages related to the Crusade with the slogan "Healthy Children in Colombia"; providing telephone access for the transmission of vaccination reports between local and central level during the critical days of the Crusade.
• Ministry of Defense: cooperation with air, sea and river transportation; installation of vaccination posts.
• Social Security Institute (ISS), Colombian Family Welfare Institute (ICBF), National Training Service (SENA), National Statistics Office (DANE): human resources and printed material for the vaccination posts.
• The Administrative Department of Intendancies and Commissariats (DAINCO), The Cauca Valley Autonomous Regional Corporation (CVC), Agricultural Bank (Caja Agraria), Agricultural Marketing Institute (IDEMA): cooperation with transportation, equipment and materials.
• Catholic Church: motivation and information to its constituency about the Crusade and its importance, through various activities, including messages about its importance in sermons one week prior to vaccination days.
• Organised Volunteers (Red Cross, Civil Defense, Boy Scouts, etc.): mobilisation of approximately 120,000 volunteers for collaboration with channelling strategy, information registry, vaccinations and promotion at community level.
• Private enterprise: financial support for publicity; gifts for vaccinated children; transportation.
• Cultural and recreational groups: mobilisation of community members during the vaccination days.

Another element of mobilisation that operated during the Crusade was the "health carnival" parades, festivals, dances and theatre promoted by the health sector in order to call attention to and motivate families towards the use of the vaccination service.

"Canalisation" (Canalizacion) or Channelling:
This strategy was designed by functionaries of the Ministry of Health of Colombia and of the OPS/WHO. It utilised direct communication between the health agencies and the intended population through home visits by health functionaries or agents and community leaders to each one of the homes of the different regions, with the purpose of establishing a channel or flow of the people towards the vaccination posts. One of the objectives of the Crusade was to fortify this strategy where it was operating and to launch it within 50% of the areas where it had not yet begun (Bogota, Medellín, Cali, Cundinamarca, Valle del Cauca and Meta).

Social Marketing:
With the purpose of generating identification processes and creating units for the campaign "Healthy Children in Colombia", a character that corresponds to the drawing of a healthy and happy boy, baptised with the name of "Pitin" was created. This character arose from the idea of a real boy that participated in a national promotion in which the newspaper "El Tiempo" and the network of broadcasters "Caracol" (Colombian Radio Stations) collaborated. Pitin appeared in posters, vaccination posts and other materials and processes of the campaign, as well as in the messages transmitted through different mass media outlets

In the vaccination posts the "Vaccination Card", a document of congratulation and complementary material on health subjects was distributed by the assistants of the vaccination.

The Vaccination Crusade motivated visitors from outside Colombia to watch the implementation of its various activities. These visits generated opportunities for renewed interest and enrichment of the experience through the comments and questions resulting from the exchange of information. Some of the visitors were representatives of the Bellagio Group, of the PAHO/WHO, UNICEF, Alto Volta observers, international journalists and observers from different countries.

Information systems:
A set of norms, instruments and procedures were specially designed to gather, transmit, process and provide results according to the information needs of the National Vaccination Crusade.

Accordingly, two systems were defined to meet two different objectives from the standpoints of opportunity, flow, and set communication channels. These systems were labelled as "Periodic Information Reports on the Vaccination Crusade" and "Information for the evaluation of the Crusade."

The first system's objective was to provide an opportunity for the community’s motivation and to promote a healthy competition between different localities of a given region and between the different regions, using mass media collaboration. It was designed in such a way as to provide four reports during the days on which vaccines were nationally applied. These periodic reports - two hours apart from each other - summarised data on vaccinated children and progress towards the regional goals.

The second system was aimed at generating the minimum required information for an evaluation of the Crusade results at the local, regional and national levels. Its designs features included a flow of basic data, directly from the local to the central level, where processing and generation of required information take place. Feedback to the levels providing the basic data took place immediately.

Communication of technical standards:
In order to maximise the possibilities regarding uniformity of parameters set, as applied during the Crusade in the 33 Sectional Health Services and more than 10,000 vaccination posts, measures such as the following ones were taken:

• Training and standardisation of the Zone Managers' functions.
• Training in "canalisation" strategy and immunisation techniques at the Sectional Health Services and Regional Health Unit levels.
• Written instructions to the Chiefs, Sectional Health Services about all the steps to be taken in cases of suspected complications or deaths related to vaccinations.
• Cold chain standards dealing with the conservation, transportation and handling of vaccines.
• Technical and administrative norms about indications, age ranges, techniques, counter-indications which apply to each one of the vaccines, as well as on the characteristics of vaccination posts and the functions of each person involved in their operation.
• In addition, each of the vaccination posts received a copy of a booklet that contained the norms that have been mentioned above.

It has been suggested that the National Vaccination Crusade 1984 stands out as one of the first experiences in Latin America, and possibly in an underdeveloped country, of simultaneous and massive application of three vaccines (one oral and two injected) that immunise against five diseases: Polio, Tetanus, Diphtheria, Pertussis and Measles.

According to the Crusade, among the main achievements were the ample social mobilisation generated, the high capacity of leadership and national mobilisation around defined objectives of health improvement, the massive education on vaccination, and the rupture of preconceived ideas about it. In addition, it led to the generation of positive public opinion around the health of the children, sensitising people, and giving political and financial priority to the immunisations.

The Crusade resulted in education on health issues in mass terms. The mass media emphasised the preventive action of vaccines and the necessity of the approach of spreading technical messages on the vaccination.

The coordination of efforts between institutions, the community participation and the use of mass communication were decisive elements in the success of the Crusade. It was considered by the United Nations as one of the world-wide events of 1984.

The "canalisation" or channelling strategy, which was started before the Crusade but was reinforced during it, stands out as the main element involving local leaders and the motivational and educative processes during the visits of health personnel to the families. According to organisers, this led to an increase in the demand for vaccination service in the critical days of the Crusade.

With the realisation of the Crusade a high coverage was achieved in a relatively short time period. The proposed goal was broadly overcome; for the population below one year the coverage with complete scheme of vaccination was 67.3%, 66.8% and 81.6% for Polio, DPT and Measles respectively; for the population below four years the coverage was of 72.3%, 75% and 72.7%.

The changes from the previous years can be noticed in the following chart:

Vaccine	1980	1981	1982	1983	1984
Polio	16.1%	25.4%	27.2%	43.7%	62.8%
D.P.T.	15%	21.6%	26.3%	42.3%	61.5%
Measles	13.7%	27.5%	27.8%	43.4%	52.9%
B.C.G.	47.0%	61.2%	66.2%	79.4%	67.7%

Source: Jornadas Nacionales de Vacunación 1985. Documento Marco. Elaborado por: Comité Interno J.N.V. 1985. República de Colombia. Ministerio de Salud. Bogotá, julio 25 de 1985.