“At 90 years old, I feel lucky to have taken my COVID-19 vaccine shot and feel more confident to live a couple more years. I am equally happy to witness more people taking their shots as this strengthens community cohesion,” recounts a community member in Sierra Leone. According to the Sierra Leone Expanded Programme on Immunization (EPI), as of March 2023, the target population fully vaccinated in Sierra Leone was above 84%. This achievement is partly attributed to the support provided by the Saving Lives and Livelihoods initiative in augmenting the innovative strategies that the Ministry of Health was already implementing.
The Saving Lives and Livelihoods initiative, a programme of the Africa CDC in partnership with the Mastercard Foundation, is very strategic and timely in accelerating vaccine uptake in hard-to-reach communities. The initiative’s implementing partners (IPs) in Sierra Leone are the Sierra Leone Red Cross Society (SLRCS), Focus 1000 and the Africa Medical Supplies Platform (AMSP). Each of these IPs has unique but complementing roles to achieving enhanced vaccine coverage through joint strategies with the Ministry of Health. The SLRCS supports risk communication and communication engagement (RCCE), Focus 1000 supports COVID-19 vaccination centres (CVC), and the Africa Medical Supplies Platform (AMSP) supports vaccine supply chain management.
The chiefdoms with poor COVID-19 vaccination coverage across the 16 districts were identified, and COVID-19 Vaccination Centres (CVCs) were allocated in these areas. Through a decentralized approach, district coordinators were deployed and have significantly contributed to the initiative by targeting the hard-to-reach and riverine communities.
To improve accessibility in low-coverage areas, a mobile strategy was introduced to complement the fixed post-CVCs located at the health facilities. “Today I got my COVID-19 vaccination, and I feel grateful because health workers are committing their time to ensure that I remain healthy and active to do my work and that our community people can have access to the vaccine in all chiefdoms,” said Alimamy Foday Jalloh after receiving his second dose of COVID-19 vaccine.
In creating demand for COVID-19 vaccines in Sierra Leone, the Red Cross Society has been undertaking daily social mobilization and community engagement activities. To take the message of COVID-19 vaccination to the grassroots, the RCCE team had an orientation meeting with Paramount Chiefs, religious leaders, and tribal heads from all 16 districts of Sierra Leone. These leaders are trusted within the communities and with established authority that can influence their audience and communities respectively. At the meeting, all the participants were provided simple and easy-to-understand COVID-19 vaccine messages, while concerns and comments from participants were addressed. Posters and awareness cards were then distributed. Following the meeting, twenty-five (25) religious leaders and 37 tribal heads were vaccinated to encourage their subjects and communities to have confidence in the vaccine.
Leaving no one behind is a focus of the vaccination campaign, where community participation is crucial and regular community meetings are held with the programme team. The meetings provide the community with a feedback platform allowing the programme team to listen to the community’s fears about the vaccine and provide a response to the misinformation resulting in increased trust and social cohesion. Building trust and acceptance is key in programme intervention, and community-led approaches build ownership and adaptation by the people. The Saving Lives and Livelihoods initiative in Sierra Leone focuses on local solutions for underserved communities anchored on the 100 100 70 strategy targeting the more vulnerable population.
“Working with the community is key; putting them at the centre of what we do is very important, as we are engaging the community to take the COVID-19 vaccine,” noted Kadiatu Jalloh, RCCE Officer from Sierra Leone Red Cross Society.
Understanding the community context and actions and addressing their hesitancy or resistance to the vaccine significantly promotes behaviour change. The need to consider social interaction, hierarchies and power relations in the targeted communities to form and maintain strong partnerships across all levels. Improving COVID-19 vaccine uptake using people-centred approaches has encouraged the community’s understanding of government efforts in relevant interventions to foster community-led action in Sierra Leone.