Designing appropriate, acceptable and feasible community-engagement approaches to improve routine immunisation outcomes in low- and middle-income countries: A synthesis of 3ie-supported formative evaluations.

INTRODUCTION: As global child vaccination coverage has plateaued, understanding how to increase routine child vaccination rates further is key to avoiding preventable disease and death. To analyse how community engagement strategies can increase child vaccination, we synthesise the results from formative evaluations of interventions that aimed to increase vaccination coverage in Ethiopia, Myanmar, Nigeria, and Pakistan. METHODS: This paper uses an inductive qualitative approach to synthesise the results from the six evaluations, gathering lessons for designing context appropriate interventions that are feasible to implement and acceptable to providers, communities, and caregivers. RESULTS: Assessing contextual, caregiver-level and provider-level barriers to vaccination is key to identifying appropriate engagement strategies. Across all contexts, low knowledge about the schedule of vaccines and the importance of timeliness represented a barrier to child immunisation. Despite the variability in how studies measured and reported caregiver attitudes, vaccine hesitancy was not found to represent an important barrier to immunisation. Frontline health workers played a critical role in community engagement approaches to increase vaccination. Interventions successfully obtained community buy-in by centre-staging community members, especially leaders, ensuring their participation in monitoring, and making immunisation an agenda item on community platforms. Interventions were implemented through existing health systems with substantial assistance from research teams. Limited data was available about intervention costs. CONCLUSIONS: Interventions designed around community engagement strategies can be appropriate, acceptable, and feasible approaches to overcome barriers to vaccination in a variety of low- and middle-income country contexts. However, questions remain about the ability of health systems to implement interventions at scale, both from a cost perspective and a capacity perspective.

Reimagining young people's rights in South Asia: Learnings from #FlawsInLaws.

While the criminal justice system is an essential pillar in ensuring human rights for young people, especially their sexual and reproductive health and rights (SRHR), laws and regulations are often overused or misused regarding rights related to gender and sexuality. Sometimes this is explicit, but other times it works in less overt ways to undermine young people's rights. Therefore, in 2019, CREA joined with seven partners in South Asia to launch a campaign focusing on the impact of criminalisation of young people's sexuality - rethink young people's freedoms, reimagine their rights, and help them to realise their futures. Legal and policy advocacy has often promoted reform in a way that empowers the state to legislate on aspects of sexuality, including sexual identity, conduct, expression and reproduction - sometimes expanding rights protections, but sometimes putting rights at risk. Through the campaign, the partners sought to highlight the disconnected law and policy structures about young people and their sexuality (including criminalisation, lack of comprehensive sexuality education and lacune in SRHR services), envisioning arights-affirming environment for young people and the communities that support them. We contestedthe tendency to advocate for rights' recognition through distinct, issue-based initiatives rather than a holistic, intersectional approach.