Understanding the Challenges of Advocacy Communication, Social Mobilization, and Operationalization for COVID-19 and Routine Immunization in Nigeria.

The primary goal of program communication in public health is to influence behaviors. It also aims to raise awareness and ultimately improve health outcomes. Under the umbrella of program communication exist three interconnected, interrelated, and mutually supportive communication aspects: advocacy, communication, and social mobilization (ACSM). While advocacy involves promoting political dedication and holding authorities accountable for fulfilling commitments and achieving success, social mobilization brings together various sectors and individuals to raise awareness and demand for a specific program. This study aimed to understand the operationalization and challenges of ACSM activities among health workers addressing COVID-19 and routine immunization in Nigeria. The study used a qualitative study design. In-depth interviews were conducted among health workers in the ACSM unit of the state's primary health care system, using a two-tier approach. The recorded interviews were transcribed in Microsoft Word format by professional transcribers and coded using Dedoose. A total of 38 health care workers across six states were selected to participate in this study. Our study found that ACSM coordination structures existed across the six states. Routine ACSM activities were either funded by the government or local development partners implementing programs. Lack of technological devices, unavailability of funds, unavailability of data tools, and lack of technological skills are major barriers to ACSM operationalization. This study highlighted the critical role of government and agency funding in sustaining ACSM activities. However, barriers that hinder the effective operationalization of ACSM efforts remain. Therefore, the results support the need for strategic investment in technology, staff capacity building, and appropriate resource allocation to overcome these barriers.