The mass media alone are not effective change agents.

Social mobilization programs for immunization have been used by African leaders, however, coverage from 20% to 70% in capitals like Mogadishu, Maputo, and Dakar were the result of short campaigns rather than the consequence of knowledge, attitudes, and practices (KAP) improvement. One-party states relied on their network of cadres issuing decrees from the top down to enforce completion of these immunization campaigns. Sometimes resistance developed against these programs, as the military mobilized people (e.g., Somalia). These efforts became rather superficial once the temporary pressure evaporated. In Mogadishu coverage increased from 22% to 70% in 1985, and within a year it dropped back to 8% above the original level. Nigeria, Senegal, and Togo where they used regular mini campaigns had better results. Research data from Botswana, Kenya, Lesotho, Malawi, Mozambique, and Zambia were analyzed. In 1983 in Kenya 73% of health workers never advised their clients, and 82% were incompetent to do so. Data also showed that clinics provided the bulk of information to women aged 15-45 in lower income groups, but they rarely consulted village health workers. Radio and TV programs were not reaching people because radio ownership was not universal (47% in Zambia and 30% in Zimbabwe), and batteries were often not available. In addition, most people turned to the radio for entertainment. In 1989, vaccination coverage was 19% in Luanda, Angola, but only 5% of 232 respondents to an evaluation could name the immunizable diseases. An identical percentage was familiar with these diseases in a Zambian study in 1986. Media experts proposed dramas to raise interest, but innovative mass media programs of dissemination of the message advocated in the 1960s did not prove effective to bring about KAP changes. Training of health and paramedical personnel by mass organizations as initiated in Ethiopia may prove to be worthwhile.