JLIF&LC SCOPING REVIEW LOCAL FAITH COMMUNITIES AND IMMUNIZATION FOR COMMUNITY AND HEALTH SYSTEMS STRENGTHENING August 2014 Joint Learning Initiative on Faith and Local Communities – JLIF&LC Scoping Review LOCAL FAITH COMMUNITIES AND IMMUNIZATION FOR COMMUNITY AND HEALTH SYSTEMS STRENGTHENING Version – August 2014 Compiled by Jill Olivier On behalf of the Joint Learning Initiative on Faith and Local Communities http://jliflc.com/ Companion pieces: An annotated bibliography on local faith communities and immunization for community and health systems strengthening Companion scoping reviews commissioned by the JLIF&LC on ‘Maternal Health and HIV/AIDS’ and on ‘Resilience in Humanitarian Contexts’ Acknowledgements: Many thanks for review comments from the following individuals: Andrew Tomkins, Angela Shen, Elizabeth Fox, Jean Duff, Katherine Marshall and Mwayabo Kazadi – and special mention for the review assistance from John Grabenstein Report prepared by Jill Olivier (author correspondence: [email protected]) Suggested citation: Olivier, J. 2014. Local faith communities and immunization for community and health systems strengthening, Scoping review report for the Joint Learning Initiative on Faith and Local Communities, London. © Joint Learning Initiative on Faith and Local Communities August 2014 Contact: Jean Duff, JLIF&LC Coordinator [email protected] 0 JLIF&LC SCOPING REVIEW LOCAL FAITH COMMUNITIES AND IMMUNIZATION FOR SYSTEMS STRENGTHENING August 2014 Executive Summary Immunization has often been viewed as the leading light of public health intervention, and the World Health Organisation (WHO) notes that the two public health interventions that have had the greatest impact on the world's child health are clean water and vaccines. Immunization sits at the heart of maternal and child health (MCH) activities as well as primary health care (PHC), and is seen as one of the major public health interventions to prevent childhood morbidity and death. Millions of dollars have been spent globally on immunization campaigns, and in 2010, the Bill and Melinda Gates Foundation called for a ‘Decade of Vaccines’, citing the potential of vaccines to save million lives. However, alongside every success with vaccine development have been equally frustrating failures. In high‐ income countries, within some communities there is general resistance to the idea of immunization (not necessarily specific to a particular disease). And in lower to middle income countries (LMIC) recurring challenges over the elimination of poliomyelitis despite massive campaigns and spending has demonstrated the major challenges – especially in vaccine delivery and intervention. In many LMICs, there continue to be missed populations and closed communities. And ironically, where the burden of disease is higher, the health systems are the weakest, making delivery of vaccines a greater challenge in the places they are most needed. If immunization is one of the leading stars of public health, then religion is the one of the frustrating complexities. However, the literature and evidence on religion and immunization is highly limited, with little coherence and major evidence gaps. The literature is dominated by grey literature and news articles which tend to present highly polarized views of religion and religious leaders. However, there is still a strong suggestion that ‘religion’ is important to immunization – in its many forms and guises. It might influence communities to refuse vaccines; or religious leaders might be essential partners in communicating immunization messages; local faith communities might be involved in immunization outreach; local faith‐ based health providers might be providing routine immunization to hard to reach communities; or international faith‐based development agencies might be intervening with communities for improved immunization as part of child health packages. We report on a broad scoping review here which set out to map and understand the available literature on ‘religion and immunization’ – in search of relevant information on how immunization impacts with religion (or ‘faith’), religious institutions and communities. The basic intention is to make note of where evidence and information can be found, and what key areas for further research, engagement and partnership can be drawn from the existing literature. This review forms part of the Joint Learning Initiative on Faith and Local Communities (JLIF&LC) which aims to develop and communicate robust, practical evidence on the under‐documented role of local faith communities (LFCs) for community systems strengthening. JLIF&LC brings together practitioners, academics, faith leaders, local community members and other stakeholders in a joint‐learning approach organized around ‘learning hubs’, each of which has a particular exploratory focus. To date, the JLIF&LC has five learning hubs: Resilience in Humanitarian and Disaster Situations, Capacity Building for Local Faith Communities, HIV/AIDS and Maternal Health, Gender‐based Violence, and Immunization, the focus of this report. This review draws together diverse materials (after assessment for quality and relevance) – and has a particular focus on LMIC settings, although given the paucity of materials, and the way issues relating to immunization cross over migrant communities, this is not a clear division (that is, information from higher income settings is included where considered highly relevant). The materials are clustered and presented in three main sections: the first focusing on religion as a determinant of individual behavior; the second on ‘interventions’ which engage deliberately with religious JLIF&LC SCOPING REVIEW LOCAL FAITH COMMUNITIES AND IMMUNIZATION FOR SYSTEMS STRENGTHENING August 2014 leaders, communities or institutions, with a focus on social mobilization, intervention and local action; and the third, the (extremely limited) literature which addresses community‐ or health systems strengthening in relation to religion and routine immunization. Key summary points and recommendations for further joint learning and research: History shows a number of intersection points between religion and immunization that extend further back than the recent surge of international interest: Understanding these histories helps to understand the current context and the current discourses visible in the different intersection points (from religious authorities opposing state control, to the effects of colonial systems on health systems and communities’ perceptions about public health interventions). It should be useful for historical reflection to be undertaken on specific contexts, and for those seeking to intervene with LFCs in relation to immunization to put serious effort into understanding local histories and contexts, otherwise it has been shown how this can become a major obstacle. There is a high level of interest in ‘missed populations and closed communities’: There is a particular interest on how religion ‘closes’ such communities to outside immunization attempts – ranging from concerns about gender empowerment, to fear and suspicion, to communities literally not opening the door. As a corollary, religion can therefore also open doors – for example, religious leaders or groups acting as intermediaries into such communities, or communication utilizing particular religious lenses. Engagement on this issue would feed well into current research and policy interests. Traditional and ‘other’ religions still missing from mobilization: Traditional (religious) and non‐mainstream religious groups remain conspicuously absent from published reports on religion and immunization. We would suggest that an urgent area for further research is considerations of mixed health and religious modalities, and how they impact on immunization uptake or refusal. Furthermore, certain un‐networked religious groups require significantly more attention (including groups that are growing massively in development contexts, such as charismatic and Pentecostal Christians – but who remain less popular and less visible at the policy and intervention levels). Further deliberate attention on ‘missed’ countries is required: The current literature and international attention is massively focused on a small handful of countries, such as India, Pakistan and Nigeria – it would seem driven in part by the resourcing of the global polio initiative and the general focus on polio in these contexts. We would suggest that attention is needed on less highly profiled countries and contexts – in which the intersection of religion and immunization would be just as valid although perhaps less spectacular. There is a particular literature gap on South America, Asia‐Pacific, and Eastern Europe. Considerations of context and complexity are important – especially working with local faith communities: Much of the argument above suggests that generalizing about immunization and ‘religion’ on broad international scales raises certain challenges. For example, considering how religious behaviors and perceptions; interventions with LFCs; and routine immunization systems intersect and interact highlights the complexity of the issue, especially when local context is taken into account. Complexity should not however prevent engagement. That is, while an understanding of local context is required for social mobilization, for health systems strengthening, and indeed for any work seeking to really understand the impact of religion or considering how to engage with local faith