Promoting Immunization and Preventing Cervical Cancer through Social and Behavior Change Communication in Nigeria

Group of nomadic children (girls) vaccinated against HPV during flag-off. Photo: Khadijah A. I. Nuhu

For 20 years, Khadijah A. Ibrahim Nuhu has dedicated her career to leading immunization social and behavior change (SBC) efforts for Nigerian women and children. Her community engagement work contributes to vaccine uptake, with the goal of saving lives in Nigeria.

As a senior SBC expert, Khadijah works on the Bill & Melinda Gates Foundation-funded HPV Vaccine Acceleration Program Partners Initiative (HAPPI) Consortium and the USAID-funded MOMENTUM Routine Immunization Transformation and Equity project, both of which JSI implements. She uses SBC strategies and communication (SBCC) in particular to increase COVID-19 and human papillomavirus (HPV) immunization coverage, and to help Nigeria move toward cervical cancer elimination efforts and strengthen routine immunization (RI).

Cervical cancer is the third-most common cancer and the second leading cause of cancer-related deaths among women ages 15–44 in Nigeria. According to the World Health Organization (WHO), approximately 50 million Nigerian women 15 years and older are at risk of developing cervical cancer. Each year, of the nearly 15,000 women who are diagnosed with cervical cancer, more than 10,000 die of it.

M-RITE vaccination team ‘ Validator’ (in apron) supports a client she referred to fill out her name card. Photo: Khadijah A. I. Nuhu

HPV vaccination is the most effective way to prevent cervical cancer, and when administered to girls 9–14 years of age, it lowers their chances of developing it (WHO 2023). Last October, Nigeria’s National Primary Health Care Development Agency (NPHCDA) began the first phase of introducing the HPV vaccine into its RI through the National Emergency Routine Immunization Coordination Centre.

HPV vaccination increases women’s and girls’ opportunities to live disease-free lives.” -Khadijah

Misinformation and myths are major hurdles to immunization efforts. Khadijah explains that this challenge has persisted in Nigeria since the early days of the Polio Eradication Initiative. Many people mistakenly believe it causes health problems later. Khadijah uses SBCC to help them understand what the vaccine is and how it can protect them.

Through the HAPPI Consortium and MOMENTUM Routine Immunization Transformation and Equity project, Khadijah provides technical assistance and works with local partners to ensure that the HPV vaccine rollout involves necessary stakeholders, is locally led, and that vaccine communication efforts respond to social and behavioral barriers and facilitators. She also develops and disseminates motivational messages that highlight the benefits of vaccination, dispel myths, and help people locate and access vaccines.

Technical Supportive Supervision to Bayelsa team. Photo: Idzi Aza Azinta

Interviewing the Local Government Area Immunization Officer in Brass LGA of Bayelsa state. Photo: Idzi Aza Azinta

Khadijah and her team are working with the national and state immunization technical working group to assess SBCC strategies through a SWOT (strengths, weaknesses, opportunities, threats) analysis. Based on their findings, they will support the Government’s effort to improve RI and primary health care services, including by developing a strategy to integrate and unify various independent communication, social mobilization, risk communication, and community efforts. The community engagement strategy will map media platforms and partners to convey RI and primary health care service information through trusted channels (e.g., radio and TV) that will most likely reach parents and caregivers of vaccine-eligible persons.

“The promotion of the HPV vaccine has to be in close collaboration with the education sector. It has to fit into their calendar and how they work,” says Khadijah. In Nigeria, the HPV vaccine is being introduced in school, community, and facility settings. Introduction in school settings may help revive proven SBCC programs to support young girls, such as peer education and school-based initiatives. As these programs gain momentum, they have the potential to improve the health and well-being of girls beyond protecting them from HPV and lessening their risk of cervical cancer.

Facilitating discussion on how to photograph women and girls. Photo: Idzi Aza Azinta

My hope for the Nigerian girl who is tomorrow’s woman is that she produces health in her home and community and is a driver of growth, empowerment, development, and innovation in her global village.” -Khadijah

Khadijah believes that women and girls are nature’s “preservation reservoir,” because they are extremely resilient and resourceful. Because of that, investing in women benefits all.