June 2025 — Following the confirmation of a Vaccine-Derived Poliovirus Type 2 (VDPV2) case in Harare Province in July 2024, UNICEF Zimbabwe, in collaboration with the Ministry of Health and Child Care (MOHCC), conducted a rapid social investigation across three urban health facilities: Budiriro Polyclinic, Budiriro Satellite Clinic, and Mufakose Health Facility. The investigation aimed to understand community perceptions and identify operational gaps in the polio immunization response.

Key Findings

The investigation revealed a mix of strengths and challenges across the three sites:

• Community Support: Budiriro Polyclinic demonstrated strong community cohesion, high campaign visibility, and trust in health workers. Mufakose showed moderate support but faced religious resistance and safety concerns. Budiriro Satellite Clinic had lower visibility and limited insights, indicating a need for further assessment.

• Caregiver and Household Characteristics: Literacy levels were high across all sites. Budiriro Polyclinic had reliable borehole water and moderate household mobility. Mufakose showed high mobility, mixed water sources including unprotected wells, and active male decision-makers. Budiriro Satellite Clinic had irregular municipal water and lower mobility.

• Healthcare-Seeking Behavior: Caregivers across all sites trusted public health services and reported high usage, with minimal access barriers.

• Service Delivery Perceptions: Awareness of the last polio campaign was highest in Mufakose (95%) and lowest in Budiriro Satellite Clinic (65%). Caregivers generally preferred facility-based vaccination but were open to home-based services.

• Knowledge and Misconceptions: While concern about polio was high, knowledge about symptoms and OPV benefits was uneven. Budiriro Satellite Clinic had the lowest awareness, with only 15% of caregivers able to identify polio symptoms.

• Social Mobilization Gaps: Health promotion officers were only moderately involved in planning. Challenges included late delivery of IEC materials, urban complexity, and missed children due to caregiver mobility.

• District-Level Challenges: Limited leadership, financial constraints, and weak integration of social mobilization into micro-planning hindered campaign effectiveness.

Key Recommendations

1. Strengthen Leadership and Coordination

   • Fully integrate health promotion officers into all stages of campaign planning and execution.

   • Ensure consistent involvement of district-level officers beyond the campaign period to provide continuity and leadership.

2. Expand and Diversify Community Awareness

   • Launch large-scale, multi-platform education campaigns well in advance of immunization drives.

   • Use diverse communication channels—schools, churches, markets, and social media—to reach broader audiences.

   • Tailor messages to address specific community concerns, including religious objections and vaccine safety myths.

3. Improve Health Education Content and Delivery

   • Incorporate broader health topics such as hygiene, child-rearing, and disease prevention (e.g., cholera) into routine health talks.

   • Equip vaccinators and health workers with up-to-date, easy-to-understand information to address caregiver questions confidently.

4. Enhance Access to Clean Water and Sanitation

   • Address water contamination concerns, particularly in Budiriro Satellite Clinic, to support broader disease prevention efforts.

   • Collaborate with local authorities to improve the reliability of municipal water supply in underserved areas.

5. Address Vaccine Hesitancy Through Private Dialogue

   • Engage vaccine-hesitant households through respectful, one-on-one conversations to understand and resolve concerns.

   • Train community mobilizers in empathetic communication and cultural sensitivity.

6. Promote Inclusive and Door-to-Door Outreach

   • Expand door-to-door vaccination efforts, especially in areas with low campaign visibility or high caregiver mobility.

   • Ensure vaccination teams are gender-inclusive to improve access and comfort for all households.

7. Encourage Male Involvement in Immunization

   • Develop targeted messaging and community activities that involve men in child health and immunization advocacy.

   • Highlight the role of fathers and male guardians in supporting vaccination decisions.

8. Improve Operational Planning and Resource Allocation

   • Ensure timely delivery of Information, Education, and Communication (IEC) materials to all campaign sites.

   • Allocate sufficient financial and logistical resources to support micro-planning and outreach in complex urban settings.

Conclusion

The social investigation into Harare’s VDPV2 response revealed both strengths and gaps in community engagement and service delivery. Budiriro Polyclinic demonstrated strong immunization support, while Mufakose and Budiriro Satellite Clinic highlighted the need for more targeted interventions. The recommendations outlined above provide a roadmap for strengthening Zimbabwe’s immunization infrastructure and ensuring that no child is left behind in the fight against polio.