June 2024 — Social and Behavior Change (SBC) plays a vital role in enhancing child immunization by promoting understanding of childhood diseases, generating demand for services, and encouraging acceptance of vaccines. Recognizing the significance of SBC, UNICEF Botswana is currently assisting the Ministry of Health in strengthening SBC efforts to integrate the COVID-19 vaccine into routine immunization (RI) and primary health care (PHC) services.

The COVID-19 vaccination campaign faced a substantial amount of misinformation and rumors, leading to hesitancy both globally and within Botswana. This infodemic escalated online and permeated down to the community level, resulting in significant vaccine hesitancy. A similar situation arose during the Polio (nOPV2) supplementary immunization activities, with Botswana reaching 81% of eligible children instead of the targeted 90%. It has become evident that hesitancy levels have increased in certain communities since the rollout of the COVID-19 vaccine.

Botswana has achieved a COVID-19 vaccination rate exceeding 70%, reaching herd immunity. Nevertheless, uptake of booster doses has declined due to decreased risk perception. To ensure sustained high vaccination levels, it is crucial to incorporate COVID-19 vaccination into routine immunization or primary health care services.

As part of the integration process, UNICEF is collaborating with the Botswana Red Cross Society (BRCS) to support integration efforts in two districts with a high number of children who have not received vaccinations and low rates of routine immunization (Kweneng West and Kweneng West). Utilizing an integrated approach that combines COVID-19 and EPI strategies in alignment with the Journey to Immunization framework, the program aims to increase demand for health services, including COVID-19 vaccination, by enhancing Risk Communication and Community Engagement (RCCE) activities. 

The integration at various stages of implementation includes:

• Training of Volunteers: BRCS will provide training based on the Social and Behavior Change Communication (SBCC) model. Volunteers will undergo a two-day training session to equip them with the necessary skills to effectively mobilize communities. This training will serve as a strategy to track behavioral change over a 4-month period, showcasing integration from the onset.

• Selection of Communities: The focus will be on zero-dose communities for the Expanded Program on Immunization (EPI), as advised by the Ministry of Health. By targeting these specific communities, integration between various health programs can be maximized to reach the most vulnerable populations.

• Household Visits and Tracing: The project will conduct household visits to identify children who have missed vaccinations. Health education will be provided, along with onsite vaccination for COVID-19 and routine immunizations. Through household messaging and onsite vaccination, the project demonstrates integration by addressing multiple health needs in one visit.

• Health Facility Intervention and Tracing: To support the integration of COVID-19 vaccines, health workers and regular facility volunteers will be deployed to healthcare centers. They will conduct thorough reviews of COVID-19 and EPI registers to ensure no child is left behind. This approach showcases the seamless integration of services within health facilities.

• Advocacy Through Community Activities and Structures: The project will leverage community events and social activities to mobilize and vaccinate communities. By participating in events such as pre-independence celebrations, community meetings, and drought relief programs, integration is demonstrated through community engagement and participation.

• Collaboration with the School Health Program: Visits to secondary, primary, and daycare centers will be conducted to ensure the inclusion of school-aged children in the vaccination program. By collaborating with the school health program, the project showcases integration by reaching children through multiple avenues.

• Monitoring Change: Field officers will conduct bi-weekly follow-ups to measure behavioral change and trends in communities. Through the documentation of human-interest stories, success stories, and lessons learned, the project highlights the importance of monitoring change to improve service delivery. This holistic approach demonstrates integration throughout the project implementation cycle.

Botswana continues to implement the COVID-19 integration strategy. The steps outlined above are designed not only to increase the uptake of COVID-19 vaccines but also to boost primary healthcare services as well as confidence in vaccines and the health system more broadly.