Is the messenger more important than the message? A theory of change for the IFRC Network s risk communication and community engagement intervention for vaccination in Nigeria and Ethiopia

IntroductionCommunity engagement is increasingly seen as essential within vaccination programming to improve uptake of vaccines, build trust and foster community ownership. Yet the goals and mechanisms of such interventions are often contested or not explicit. This article aims to address this by examining how those directly involved in implementing community engagement understand its intended aims and outcomes. We use as a case study a risk communication and community engagement (RCCE) intervention implemented by the Nigeria and Ethiopia Red Cross/Red Crescent with support from the IFRC for COVID-19 vaccination. MethodsWe conducted 41 interviews, 12 participatory workshops and citizen ethnography in Dire Dawa, Ethiopia and Kano, Nigeria including with Red Cross/Red Crescent and vaccination staff, vaccine users and community members. We explored how participants understood the RCCE interventions theory of change, including how it was expected to work, for whom, under what circumstances, and why. ResultsParticipants described RCCE activities as a mix of two-way (such as house-to-house visits) and mass approaches (such as media campaigns). These interventions were primarily seen as enhancing vaccine knowledge and countering misinformation. Key mechanisms included vaccine users willingness to act on the information provided, however this was heavily influenced by the credibility and trustworthiness of the bearers of vaccine information. While feedback mechanisms existed, communities were not involved in designing vaccination strategies. Efforts were shaped by a context with unpredictable vaccination campaigns, supply constraints and parallel RCCE efforts by community actors. ConclusionsWe show that in this theory of change messengers are more influential than the messages themselves. By developing a theory of change with our participants, we highlight the lack of clarity within the sector regarding the definition and expected impact of community engagement and reveal a gap between community engagement practice on the ground and normative goals such as co-production and dialogue. Key messagesO_ST_ABSWhat is already known on this topicC_ST_ABSRisk communication and community engagement (RCCE) is widely used to improve vaccination programmes, but there is limited evidence on how such interventions are expected to work, for whom, under what circumstances and why. What this study addsWe examined how those involved in implementing a Red Cross/Red Crescent and IFRC RCCE intervention in Ethiopia and Nigeria understood the aims and outcomes of this intervention. Whilst our study participants believed their main goal was to share correct vaccine information to counter rumours, we found that trust in the people who delivered the information was often more important than the information delivery itself. How this study might affect research, practice or policyOur research highlights tension between normative ideals of community engagement and how it is understood and practiced by implementors in humanitarian contexts, and underscores the need to move beyond knowledge-deficit approaches.