Module B: Adjust Why

Welcome to Module B!

Purpose

This module helps you reflect on why people in the priority communities aren’t vaccinating. This module will also update the priority immunization barriers that the strategy will focus on.

What You’ll Achieve

By the end of this module, participants will:

Review and update barriers to immunization for each priority group.
Identify the priority barriers that your strategy will address.

What You Need

Room Set-up

Activity #1: Review and adjust barriers

ℹ️ In this activity, participants will review and validate the prioritised barriers from Workshop 1 based on field insights to ensure the strategy is focused on the most important barriers to immunization.

How to prepare

If you haven’t already, put up the following on the main wall:
- Header Poster Module B: Adjust Why
Remove each group’s Strategy Summary Poster 2 from the main wall and distribute it to the relevant participant tables so that each group can continue to work on the same priority community and barriers as Workshop 1.
Give each group a blank flip chart or A3 piece of paper and post-its.
Create a new group focused on any health system barriers identified in Workshop 1:
- If you have identified health system barriers in Workshop 1, form a new group to focus on these barriers. Ensure that these participants are involved in decision-making that influence how health systems are structured, e.g. national or provincial level government staff or decision-makers. Instead of focusing on a priority community group in Workshop 2, these participants will focus on health system barriers. Provide them with the Health System Barriers Poster from Workshop 1.
- If you do not want to prioritise any health system barriers, then continue Workshop 2 with only groups focused on the priority communities.

Facilitation Steps

Review and brainstorm new/updated barriers
- Ask each group to review their Strategy Summary Poster 2 from Workshop 1. They should reflect on the three to five priority barriers they prioritised in Workshop 1 for their community group.
  - If you have a group focused on health system barriers, they should reflect on these on the Health System Barriers Poster from Workshop 1, Module C.
Each group should review their field interview data to see if any new immunization barriers were identified, and if they found any more information about the known immunization barriers. Ask the following questions:
- "What has changed based on field insights?
- "Have they learned any new information about any of their prioritized immunization barriers?"
- "Are there any new immunization barriers they heard during interviews?"
Each group should discuss which barriers from Workshop 1 were identified in Field Insights. Ask participants:
- “Do any of your priority barriers need to be updated or changed? Do you want to replace any of your priority barriers with a new barrier that feels more important?”
- On a blank flip chart or A3 paper, ask each group to write down on post-its any new immunization barriers or barriers that have changed based on the fieldwork.
- The health system barriers group should also reflect on whether any of the insights from the field suggest more system-wide issues, or if they have any new or updated health system barriers to consider for the strategy.

Facilitation Tip:

Walk around each table and prompt these questions to each group directly.

Activity #2: Prioritise barriers

ℹ️ In this activity, participants will re-prioritise the immunization barriers the strategy will focus on. This is the same exercise as in Workshop 1, but this time participants are thinking about whether the field interviews revealed any new barriers or changes to how they describe their existing prioritised barriers. It’s important to re-prioritise to ensure that the strategy is focused on the most critical barriers to solve and based on the field data.

How to prepare:

Give each group one copy of Table Worksheet: Adjust Why.

Facilitation Steps

Re-prioritise barriers
- Ask participants to re-prioritise barriers using two criteria on their Table Worksheet: Adjust Why.
  - Impact: Which barriers, if solved, will help the most people and have the biggest effect on immunization?
  - Complexity: Which barriers are easy to solve? Which ones are harder or more complicated?
- Ask each group to either move their barrier post-it notes or write their identified barriers into the appropriate box on the worksheet. For example, if “80% of mothers forget to return for the second dose” affects many people and has simple solutions, it would go in the High Impact, Low Complexity box. Remember, the barriers being prioritised should be a mix of:
  - New barriers identified during fieldwork
  - Old barriers that have remained relevant
  - Old barriers that have been updated based on fieldwork.
Select top priority barriers
- Ask participants to review the barriers in the High Impact quadrants (top left and right) and choose their top three to five barriers that the strategy will focus on for their priority community.
- It’s important to remind participants that it's okay if their prioritised barriers are the same as in Workshop 1. This means that the field insights confirmed that these really are the most important barriers to solve.
- They should make a note of the top three to five barriers prioritised.
- You can show participants the sample filled out barrier prioritisation worksheet for inspiration.
Present to the larger group
- Ask each group to present their prioritised barriers to the other groups. Each group should explain:
  - What they learned about their priority community’s barriers during field interviews
  - Their prioritised barriers
  - If the field interviews changed these barriers.
- Encourage participants to actively listen to each group’s presentation and allow time for each group to receive feedback on their prioritised barriers. Each group should have a note-taker to take notes of feedback they receive.
- Ask groups to refine their barriers based on any feedback they received when presenting:
  - Is there feedback that they need to incorporate into their prioritised barriers?
  - Should any barriers be added, removed, or revised based on the input they received? </aside>
Document new or updated priority barriers
- Each group should document their re-prioritised barriers onto their Strategy Summary Poster 2 from Workshop 1.
  - If a group’s three to five new prioritised barriers are mostly the same as in Workshop 1: For most groups, their barriers are likely to be mainly the same as what they documented in Workshop 1, so they can use the same original poster to update any wording on their prioritised barriers.
  - If a group’s three to five new prioritised barriers have changed significantly since Workshop 1: If a group has changed a number of their prioritised barriers, provide them with a new blank copy Strategy Summary Poster 2 to replace the old version.
For any new barriers, ask the groups to capture what category the barrier is found in and whether it has a gender component.
For the group focused on health system barriers: They should write their re-prioritised system-level barriers on the Health System Barriers Summary Poster.

⚠️ IMPORTANT: Ensure each group still only has a maximum of three to five prioritised barriers. This is critical for Day 2 where we will generate solutions focused on the key barriers.

Facilitation Tips:

Encourage active listening and feedback.
Have extra copies of Strategy Summary Poster 2 in case some groups have made major changes and need to replace previously completed ones with new ones.