Immunization Equity: Trust, Inclusion & Community Voice

In Moldova, childhood immunization coverage rates are around 88% (UNICEF, 2024), yet Roma children remain systematically excluded from both vaccination services and the data systems that render them visible. This paradox exposes a critical failure in how we conceptualize and measure health equity. It demands a rethink of who holds power in social and behavior change (SBC). 
This presentation introduces a methodologically innovative, community-led approach that disrupts traditional power dynamics in health research. Conducted in partnership with Tarna Rom, a Roma-led NGO, the study reveals that vaccination gaps stem not only from hesitancy but from systematic exclusion across the health sector and beyond. Key barriers identified include: Roma families being denied access to services, coerced into paying illegal fees, and subjected to discriminatory treatment. 
Rather than designing interventions for Roma communities, the project establishes a local committee comprised of health care providers, teachers, religious leaders, Roma mediators, and other key stakeholders, and conducts participatory co-design workshops with Roma families and stakeholders from local public authorities, health, education, and social services who hold decision-making power. This dual approach positions Roma caregivers as authors of solutions while ensuring interventions can be implemented by those with authority to change discriminatory practices. By the time of the Summit, two behaviorally informed, co-created solutions developed jointly by Roma communities and institutional stakeholders will be finalized with the ultimate goal of embedding them within Moldova's national immunization strategy for implementation. 

Children outside the formal education system in Indonesia, including those in religious schools and out-of-school settings, remain among the most underserved and underrepresented in national immunization efforts. While Indonesia's national immunization program has expanded in recent years, most notably with the inclusion of the human papillomavirus (HPV) vaccine within the School Immunization Month (BIAS) initiative, the COVID-19 pandemic disrupted services in 84% of health facilities, reducing access and leaving many children vulnerable to vaccine-preventable diseases. Since 2022, the BIAS program has aimed to restore momentum, yet reaching children beyond formal schools remains a challenge due to gaps in student records, limited healthcare access, and persistent vaccine hesitancy. To address these barriers, BIAS program applied three strategies: community engagement through 40 trained change agents who conducted 535 education sessions with 22,485 participants; social media campaigns in collaboration with government partners, which reached 3.8 million people in five months; and cross-sectoral collaboration to extend services to informal education settings. These interventions achieved an 11.04% increase in immunization coverage, marking the first inclusion of Community Learning Activity Centers (PKBM) in BIAS and demonstrating a replicable model for advancing equitable immunization access.

In Cameroon's most zero-dose-affected district, caregivers reclaimed the power to shape how immunization is discussed, understood, and delivered. This SBC initiative prioritized community voice and peer agency through a unique combination of locally produced storytelling, dialogue-based outreach, and targeted behavior change techniques.
Seven short videos were co-created with local caregivers, each addressing a key behavioral barrier, ranging from mistrust in health services to family pressure and misinformation. The videos featured real stories, acted by community members, and were used by 20 Parent Champions, caregivers trained in Social and Behavior Change (SBC) techniques through an adapted version of the Make Me a Change Agent manual.
Champions were equipped with tablets preloaded with all videos, and trained to begin household visits with open-ended conversations to identify caregivers' specific barriers. Based on the responses, they would quickly select and screen the most relevant video, ensuring real-time content relevance and emotional resonance.
This peer-led model resulted in 728 children vaccinated and a 92.5% referral completion rate within three weeks. Caregivers reported increased trust, motivation, and self-efficacy.
This presentation will showcase how a behaviorally grounded, community-delivered video strategy shifted not just vaccine behavior, but who holds power, voice, and trust in immunization communication. It offers a scalable model for SBC in equity-priority settings.

While client experiences of negative interactions with healthcare providers are well documented, less attention has been given to the challenges providers face in delivering empathetic, high-quality care. This study explored perspectives on barriers to person-centred care among healthcare providers in rural and peri-urban public clinics in South Africa. 
Semi-structured interviews were conducted with 35 nurses across seven clinics, including clinical nurse specialists, primary healthcare nurse specialists, an ART nurse specialist, professional nurses, and enrolled nurses. Data were analysed thematically using the COM-B framework to identify structural, interpersonal, and individual barriers to person-centred care.
Structural barriers included understaffing, high workloads, rigid protocols, and excessive administrative demands, which left providers feeling constrained and demotivated. Interpersonal barriers involved poor teamwork, limited supportive supervision, and a perceived lack of appreciation from both colleagues and clients. Individual-level challenges centred on limited skills for handling difficult client interactions and managing stress.
The findings underscore the importance of addressing not only client-facing issues but also the structural and psychosocial factors that shape provider behaviour and motivation. Interventions that improve workplace conditions, strengthen supportive supervision and teamwork, and build skills in communication and stress management may enhance both provider wellbeing and the quality of care clients receive.