Proposed Marketing Strategy to Increase the Awareness of Bulan Imunisasi Anak Nasional (BIAN) in Bandung City

: Bulan Imunisasi Anak Nasional or BIAN is an Health Ministry of Republic Indonesia program that aims to enhance the children’s health by immunize them with a mass Complete Immunization and Follow-Up Immunization in Indonesia especially for the children that did not have immunize yet since the pandemic in 2020. Bandung City which is included in West Java Province has the lowest coverage of BIAN Immunization among the other City/Districts in West Java. This research is aimed to figure out what factors affected the low coverage of BIAN Immunization in Bandung City and analyze the situation regarding the field report in the implementation phase and how to solve it by applying better strategies in upcoming BIAN events. The analysis that was conducted are External and Internal Analysis to find what factors that related to the issue. In the External Analysis, the author uses Customer Analysis, Stakeholder Analysis, and PESTEL Analysis to indicate any external factors that affected the low coverage of BIAN Immunization. In the Internal Analysis, the author uses Tangible Analysis, Intangible Analysis, and Interview Data from stakeholders that hold the event. There are several findings in External and Internal Analysis especially in Advertisement and Public Relation became the strong factor that affected the main issue because of low awareness of the target audience. From several analyses and the findings, there are four proposed strategies to increase the awareness of the target audience to participate in the event to enhance the coverage of the immunization in Bandung City. The first one is improvement in Public Relation strategy that needs to be more organized and comprehensive especially with external parties. The second strategy is improvement in Advertisement strategy, especially in social media activation and Advocacy Advertisement. The third strategy is collaboration with brands that have a strong family image in the health sector. The fourth strategy is initiation in having Key Opinion (KOL) as the face of BIAN in Bandung City. In academic recommendation, the next author should consider the current situation of the target audience especially in their awareness towards the event and the current coverage of the immunization.


INTRODUCTION
Immunization is an important thing for every human being. It helped our body protect us from any devastating until severe disease. Immunization became one of the most effective ways to increase human's health quality especially children. Therefore, the children's vaccination should be implemented in every country to prevent many diseases that may be affecting the children's future and create a better generation. There are several diseases that could be prevented by immunization such as hepatitis, diphtheria, tuberculosis, measles, pneumonia, rubella, meningitis, and others. These diseases could cause pain, disability, even death to the children who do not already get the immunization. An under five years old child could be categorized as a child with complete routine immunization if they already get 1 dose of HB0 (Hepatitis Vaccine), 1 dose of BCG or Bacillus Calmette-Guerin (Tuberculosis Vaccine), 4 dose of OPV or Oral Polio Vaccine (Polio Vaccine), 4 dose of DPT-HB-Hib (Diphtheria, Pertussis, Tetanus, B Hepatitis, Pneumonia, and Meningitis Vaccine all in one), 1 dose of IPV (Inactivated Polio Vaccine), and 2 dose of Measles and Rubella Vaccine. In addition, the children must be vaccinated with Rotavirus, Influenza, Pneumonia, Varisela, and A Hepatitis Vaccine within 1 year after birth. Between 9 years, the children could be vaccinated with HPV and Dengue vaccine. For the implementation of Immunization in Indonesia, there are a lot of parties involved to support child immunization starting from Provincial Government, District/City Local Government, until an external party outside government such as World Health Organization (WHO) and United Nations International Children's Emergency Fund (UNICEF). At the Government level, all parties are responsible for actively mobilizing the community to support and improve the implementation of child immunization by strengthening in providing information through print media, social media, advocacy, and socialization. In every District/City, the local government has their own cadre to directly support the parents in each area to immunize their children in the local Puskesmas or Posyandu. When Covid-19 pandemic hitted us around the world, the health sector was the biggest affected sector. However, the implementation of routine immunization became hampered because of several factors such as lack of health personnel because all of them are focused on Covid-19, and hampered supply of children vaccination logistics. If this problem continues, it will increase the risk of death in children because children's immunity is low and susceptible to viruses. It was proved by the increases of Diphtheria, Measles-Rubella, Polio cases in children since there was a significant reduction in routine immunization coverage, both basic and advanced immunizations. Attempting to recover from the pandemic situation, the Health Ministry of Indonesia conducted the Bulan Imunisasi Anak Nasional (BIAN). BIAN is one of the biggest national programs in the health sector to re-increase the coverage of child immunization which was previously low due to the pandemic and maintain the health sustainability in Indonesia. Bulan Imunisasi Anak Nasional (BIAN) is a national immunization program across the country to increase the coverage of children immunization in Indonesia, especially for Complete Routine Immunization and Measles-Rubella Immunization to reach Indonesia's goals for "Elimination of Measles-Rubella in Indonesia 2023". This program was first proclaimed by the Health Ministry of Indonesia which at the time of its implementation was left to each province and each province monitored the implementation in the District/City. BIAN is organized due to several factors, such as an increase in PD3I cases in Indonesia which was caused by pandemic Covid-19. Covid-19 made most of all programs in the Public Health Office slower, including children immunization because it hampered logistics, the fearness of the parents bringing their children to health facilities because of the transmissions of Covid-19, and due to lack of health workers. There are a lot of children that are not yet immunized because of these conditions that were affected by the low immunity to the virus and the transmissions of those diseases spread wide faster and more massive than before. With a high of Diphtheria, Measles-Rubella, Polio, Hepatitis A, Hepatitis B cases during the pandemic, there a lot of uncertainty things that could not be predicted by the government to maintain and increase the health quality in the society especially for the children. Based on Measles Risk Assessment WHO Tools, the risk assessment for the Measles-Rubella case in Indonesia in 2020 shows 367 districts/City in 22 provinces has a very high risk in the transmission of these diseases. That is why the Complete Routine Children Immunization and the Measles-Rubella Immunization is very important in this state. The West Java Province as the top priority Province in Indonesia for the health sector, was expected to be able to carry out the implementation of BIAN well and improve the health quality of its society especially for the children. Bandung City, as the capital city of West Java Province is expected to have a well performing implementation and strategy in the BIAN Program. The BIAN implementation has two categories of immunization such as Additional Measles-Rubella Immunization, and Chase Immunization. The Additional Measles-Rubella Immunization is the immunization for the children regardless of previous Measles-Rubella immunization status. In other words, Additional Measles-Rubella Immunization could be the first time immunization or additional/booster immunization to increase the body's immunity against Measles-Rubella virus for the children. Bandung City, the capital city of West Java Province was expected to has an excellent coverage of BIAN since the areas that are quite developed and people who have a fairly high level of education. Different from the district area, where there are still many people who do not believe in immunization and indigenous groups who refuse immunization. However, among the 27 districts in West Java Province, Bandung City has a low coverage of BIAN including the Measles-Rubella Immunization and Additional Immunization with accumulation of 60% coverage while the district area has higher coverage of BIAN immunization with total target 246.916 children but the children who have been immunized in BIAN was 148.801 children. Therefore, in order to increase the coverage of the BIAN Immunization, the society especially the target audience should have a high awareness towards the initial event by the implementation of several marketing strategy that were applied by the stakeholders such as the government and the other parties.

LITERATURE REVIEW A. PROMOTION MIX
Based on Kotler (1999), there are several marketing communication mix which are Promotion Mix. The Promotion Mix consist of Advertising, Personal Selling, Sales Promotion, Public Relation, and Direct Marketing and functioned as a marketing strategy to pursue the company's target. (Kotler, 1999, p. 719). In this research only three promotion mix that were used since BIAN is the Government program that consist of Advertising, Public Relation, and Direct Marketing 1. Advertising Advertising is an activity to promote a product or service through produce advertisement in any paid form or personal presentation of ideas packaged in Poster, TVC, or Printed Advertisement. A previous study by Mehta (2000) stated that Advertisement helps the audience to keep updated regarding the development of the market situation. The audience tends not only to pay attention to the advertisement but also is persuaded by the information in it.

Public Relation
Public Relation is an activity to build good relationships between the company and consumers through favorable publicity, building a good image of the company. The major Public Relation responsibility is to release press releases, corporate communication, counseling, and product publicity. Public Relation in the Public Health industry has built and maintained the relationship between the organizations and other parties. Public Relations in Marketing concentrate on how the organization operates such as the personnel, the stakeholders, and the public to respond to running events or campaigns (Grunig & Grunig, 1991).

Direct Marketing
Direct Marketing is an activity to connect with the consumers directly through email, text, or social media to build a personal relationship between the company and consumers. Direct Marketing is expected to build a good impression towards consumers by an immediate response to increase consumer's awareness. In BIAN implementation, the Promotion Mix is needed especially the Advertising, Public Relation, and Direct Marketing. These three elements are suitable strategies to be used in the Public Health sector to increase awareness towards BIAN Implementation especially if the government is the one who implements these strategies.

B. SOCIAL MARKETING
Social Marketing is a marketing implementation alongside several concepts and techniques to create a behavioral pattern, goals and social goods (French and Blair-Stevens, 2010). The Government started using this strategy to achieve indicators that have been applied within the community based on policy that has already been made. Public Health is one of the important sectors in which Social Marketing must be implemented to increase public awareness of the importance of health since WHO declared that the world is facing a huge problem with aging population and behavior that causes several chronic diseases. To implement the Social Marketing strategies in the Public Health sector, the Government must apply it in conjunction with service provided in the community. This strategy is expected to be one way to shape community behavior patterns towards health, including immunization. There are several indicator that the government need to enhance when doing social marketing according to Wood (2012) as follow: 1. Publics The term Publics is every stakeholder that involves creating the community including Politicians, Companies, Media, and the society itself. To implement social marketing, all parties especially the government, should focus on the public service rather than prioritize the profit from the society.

Non-Profit Service
Focused on the public and voluntary service and engaging with consumer's insight to provide the best service for the community in order to improve the initial goals in the implementation of social marketing without oriented in profit and company's financial benefits.

Marketing
By applying a good marketing strategy within the community, all parties are expected to be able to link the existing theory with the conditions that occurred at that time to form a behavior among the society. The approaches applied should be more efficient and comprehensive especially when it comes to the society which has a different kind of perception.

Suggested Sector
The suggested sector was chosen to implement the social marketing strategy to be more effective and efficient depending on the initial goals.

Functions and Technology
Several functions and technologies were needed in applying the strategies such as policy, advocacy, communication, planning by several media such as social media, promotion forms, and networking. Overall, Social Marketing especially in Public Health sectors is to achieve the awareness towards government's initial goals and how to create a behavior towards those goals then maintain the behavior that has been formed to continue the programs among the community. Also, there are several Marketing Mix that need to be applied along the process by analyzing the audience and how to communicate with them in certain forms. The management process after the implementation should be tracked to receive the feedback from the community to be improved in the future. In BIAN implementation, Social Marketing is really much needed to increase the awareness of parents to immunize their children by applying those strategies indicators to boost the coverage of BIAN especially in Bandung City.

C. SOCIAL ISSUE
Based on the Macionis (2015) in Social Problem books, Social Issue or Social Problem is a negative condition or behavior that occurred within the scope of community and needed to be addressed. There are many kinds of Social Issues that occur in a society starting from economy, social, gender, religion, and including health. There is a gap between the ideal indicator and the result in the fields which affect the dynamics in the society. Based on Meyer and Schwartz (2000), there are three main processes in analyzing the social issues in public health as follow:

Focus on The Individual
In analyzing the social issues in public health, we should identify which individuals or groups were affected by the issues. Which segments that the groups or individuals are in because the differences in applying strategy could be different. From group or individual analysis, we could identify the main reasons for the issue and how to solve them 2. Research and Findings When the social problem in public health occurs, the research process will develop and scientific methods will be applied such as epidemiology, and laboratory testing. Although the problem solving has already been made, the social influence is still involved and determines the result of the research and findings. The Government's policies affected the solving of the problem.

Valuation of Social Problem for Health Consciousness
In the end, social structures have a big part in the research process. If the result of the research is inversely proportional to the situation and social or even economic conditions in a society, it can lead to more complex questions.

CONCEPTUAL FRAMEWORK
The Conceptual Framework will discuss the connection in the business issue which contains Promotion Mix, Health Consciousness, Target's Attitude towards BIAN, and the intention of the audience to participate. 1. Advertisement Advertisement is one of the Promotion Mix that were efficient as a communication tool to increase the awareness of target audience (Kumar & Patra, 2017). A model conducted by Haan and Moraga-Gonzalez (2011) stated that Advertisement affected the high demand of the product because the consumer tends to check or study the product from the persuasive advertisement. This model was conducted to prove that Advertisement has a huge impact to consumer's attention to acknowledge the product or information. In BIAN Implementation, Advertisement will increase the awareness through several media such as posters, banners, radio advertisements, etc.  (Botan & Taylor, 2004). This indicates that the Public Relation especially in Health Campaign affected the target audience's attention to create several behaviors depending on the approach that were used. In BIAN Implementation, the Government must provide information about BIAN through advocacy in various sectors and also communication towards the society to support BIAN.

Direct Marketing
Direct Marketing could impact the attention of the target audience by enhancing their relationship through obtaining several information regarding the response of the direct marketing that were applied before (Bauer & Miglautsch, 1992). This indicates that Direct Marketing impacted the attention of the target audience depending on how the audience perceived the information that was given through direct marketing strategy. Direct Marketing in BIAN Implementation was applied through several strategies such as Rapid Convenience Assessment (RCA), message or email marketing directly to the target audience.

Health Consciouness
Health Consciousness is a condition in which someone focuses on their health condition such as inner state of self attention to self relevance (Gould, S.J, 1990). A person's high or low health consciousness or awareness will determine their attitude to change their health condition. The person who has a high health consciousness usually intends to follow a healthy lifestyle and advice from health campaigns which are held by several parties such as the government. However, in BIAN Implementation, the parents should realize the importance of their children's health to be immunized.

Attitude Towards BIAN
According to Familmaleki et al (2015) implementing the Promotional Mix by each element has its own impact that will affect the consumer's awareness and decisions which will turn to an attitude. There are several factors that affect the attitude of the customers including Culture. Culture beliefs, values, norms that they are in, these factors impact on how they behave when facing a situation (Familmaleki, Aghighi & Hamidi, 2015) This attitude is a factor to determine or predict the consumer's behavior and intention (Liang & Chaipoopirutana, 2014). By implementing the right Promotion Mix for the target audience, it will influence the attitude and choices they will make regarding the programs offered.

Intention to Participate
A previous study by Liang and Chaipoopirutana (2014) showed that there is a positive relation between values and intention of the consumers. In BIAN Implementation, the target audience should have the same perception and values about health, especially children's health, to participate in the program Research question based on the given explanation are as follows: 1. What are the factors that affect the low coverage of BIAN Immunization? 2. What strategies does the Public Health Office implement to engage the parents to immunize their children during BIAN? 3. What are the lesson can be taken from the existing marketing to be better implemented in the upcoming years?

RESEARCH HYPOTHESIS
The following are the hypothesis that will be tested based on the conceptual framework:

H1a
: Advertisement is positively correlated to Attitude Towards BIAN.

H1b
: Public Relation is positively correlated to Attitude Towards BIAN.

H1c
: Direct Marketing is positively correlated to Attitude Towards BIAN.

H2
: Health Consciousness is positively correlated to Attitude Towards BIAN.

H3
: Attitude Towards BIAN is positively correlated to Intention to Participate.

RESULT AND DISCUSSION
The results of the data processing which will be presented are gathered from 131 respondents.

Path Analysis
The questionnaire results were divided into two models. The first model shows the correlation between the independent variables (Advertising, Public Relation, Direct Marketing, Health Consciousness) and intervening variables (Attitude Towards BIAN), and the second model shows the correlation between the intervening variables and the dependent variable (Intention to Participate).  A. Improvement in the Public Relation strategy Based on the Customer Analysis that proceeds from the questionnaire to the target audience, the result shows that the target audience is more aware and interested in BIAN through Government's Public Relation efforts to inform them regarding the event. In this case, the government needs to improve their public relation towards the society and the target audience through several institutions or organizations to help them to increase the awareness regarding BIAN through several strategies such as counseling enhancement to the society. Through the public relation strategies that suit the target audience especially in Bandung City, the awareness of the society and target audience to participate in the event. There are several improvements in public relations that the Public Health Office of Bandung City needs to do such as make a strong connection with media, publicity, organization, or institution communication, lobbying, and counseling (Anom, E. 2004). The first improvement that the government needs to make is a strong connection with the media. In this case, the support of the media is highly needed to spread the awareness of the event especially in local media. The event information could be shaped as media's daily news which will inform the aim of the progress of the event from promotion phase until the end of the implementation phase of BIAN event.
The second improvement is publicity. Publicity that is needed is publicity that can be trusted by the public. Publicity that must be made by the official Government of Bandung City which is the publicity related to the management of BIAN implementation and why the event is being held to make the society, especially the target audience understand the urgency of health control in children, which is immunization. The third one is organization and institution communication. In this step, the Public Health Office of Bandung City should collaborate with several organizations and institutions to support the BIAN event because to gather a mass target audience needs a lot of parties involved. The target audience come from a variety of environments and backgrounds, it needs a certain organization and institution to support and spread the awareness of the target audience to participate in the event. It needs a strong advocacy from the Public Health Office of Bandung City to the other organizations and institutions in various sectors to understand the essence of the event to help them communicate it to the target audience. The organization and the institution that will collaborate in this program are Community Empowerment Service, Public Education Office, and internal communication with the Public Health Office of West Java Province Government. The fourth one is Lobbying. In this step the Public Health Office needs to do a deeper communication and lobbying to the higher stakeholders and decision makers to support the implementation of BIAN. This step is needed to reduce the risks that may occur and enhance the promotion phase, and the operation in the implementation phase of BIAN. The last one is Counseling. In this step all the stakeholders including the Non-Government Organizations, the other institutions, and the Public Health Office of Bandung City itself need to give a counseling regarding the BIAN to give a deeper understanding of the essence of the event to gather the target audience and participate their children to be immunize in BIAN. The counseling will be applied in the promotion and implementation phase for the target audience that have not been immunized. B. Improvement in the Advertisement Based on the questionnaire, advertisement is one of the most influential variables in the implementation of BIAN among the target audiences. There are several types of Advertisement that the Public Health Office of Bandung City could do to increase the awareness of the BIAN event. The previous advertisement that was already published was a poster filled with information about the aim of the event and why the event was held. Although the advertisement was quite informative, it needs several improvements to increase the effectiveness of the advertisement. There are several types of advertisement that can be used by the government to boost the awareness of BIAN such as Advocacy Advertisement and Social Media Advertisement. Advocacy Advertising is an advertisement which is known as a corporate and institutional image when it is used to define one or more of the advertisement contexts that will lead to "issue-oriented advertising" (Sethi, S.P, 1978). In the BIAN case, the advocacy advertisement is needed to improve the context of the event itself by a deeper creation to spread awareness and make the target audience participate and understand why they have to immunize their children. The previous advertisement from the Health Ministry only shows the poster of the event which was continued by the Public Health Office in City/District to make the same context of the advertisement. The Advocacy Advertisement could be implemented in the promotion and implementation phase. In the implementation phase through social media and printed advertisements such as in billboards, the advertisement will combine with information to get their children immunized in the nearest health facilities. Social Media Advertisement will consist of several content and context to become the center of information of BIAN Immunization events. The event itself needed to have an official account since they became one of the annual events every year especially in children immunization. In this case, the Public Health Office needs to make several accounts on Instagram and Facebook. Instagram is the most fit media to promote the event and also do the counseling to the target audience through social media since the target audience in Bandung City are identified as the target who are familiar with technology and social media. Facebook is the media which will be fit for the parents especially the 35-45 years old parents. In these social media, the Public Health Office could post several contents such as Advertisement of the event, information, and engagement post to attract the target audience. C. Improvement in the Advertisement As we know that the BIAN's target audience comes from the family environment, especially the parents of the targeted children, the collaboration with Brands is one of the effective ways to increase the interest of the event. The brands also could collaborate with the Public Health Office of Bandung as Corporate Social Responsibility (CSR) to support the Government's program. The brands that fit with this strategy are Fast Moving Consumer Goods (FMCG) that sell the family needs and are strongly associated with families, especially for mothers and kids. There are several FMCG that may suit to collaborate with the Government in BIAN events, especially in Bandung City such as ABC, Unilever, and WINGS. The collaboration will start from the promotion phase until the implementation phase. In the promotion phase, the brands could do social media activation regarding the promotion of the BIAN event that will be held in the implementation phase. In the implementation phase, the brands will collaborate with the government in event form. In the event, the brand could be the main sponsor for the event to attract the target audience to come to the event and immunize their children. Every child that has already immunized, they will get a goodie bag from the brand. This strategy is beneficial for both parties since the brand will give the exposure to the event because of the image of the brand, and the event also gives the exposure for the brand.

CONCLUSION
The following conclusions are collected based on the research questions and were concluded from the processed data of various factors that affected to the awareness level of the target audience towards BIAN. 1. There are several challenges faced to reach the initial goal of immunization coverage in BIAN. Based on the Interview data with several stakeholders such as Immunization Program Manager of Public Health Office in Bandung City and Immunization Program Manager of Public Health Office in West Java Province Government, the most crucial part that affected to the low coverage of BIAN Immunization are the undelivered advertising message, and lack of public relation support that made the target audience not aware of the event meanwhile BIAN is a mandatory especially for the childrens. The direct marketing that has been done by Puskesmas staff with RCA (Rapid Convenience Assessment)also was not effective since the parents of the target audience in Bandung City mostly are workers who do not always stay at home and have a busy schedule. The blast message to the target audience also was not effective because of the system lack that made many parents not receive the message. 2. There are several suitable proposed strategies to increase the awareness of BIAN Immunization to increase the coverage of the immunization itself such as improvement in several strategies and initiate new strategies. Advertisement strategies need improvement especially in engaging with the target audience in social media and publishing an Advocacy Advertisement to become BIAN's signature icon in order to instill a strong image in the target audience's mind. Second, the public relation strategies also need improvements such as more organized steps of approaches to several parties to support the event from the planning until implementation phase. Third, the initiation of official collaboration with brands that have a strong family image in the health sector. These strategies could increase the awareness of the target audience, with the help of the exposure from the brand, it may leave a strong image and association along in the promotion until the implementation of BIAN. 3. There are many lessons learned along the way in from the planning until implementation phase in previous BIAN especially in applying the existing strategy especially in Advertisement and Public Relation strategies. However, the existing strategies could be re-implemented in another upcoming BIAN event with several improvements and another initiation of strategies to boost the awareness of the target audience to increase the coverage of BIAN Immunization in order to enhance the children's health quality especially in Bandung City. Bandung City as the capital city of the West Java Province may need a different approach from other City/District in West Java since Bandung City is one the city with a high level of education and has a busy population, especially the parents. To run the program to a better event in upcoming years, all the stakeholders need to do well planned strategies to be executed to make the target audience have a high awareness towards the BIAN since the event in 2022 is the first BIAN in history and has a more specific target audience than the Covid-19 Immunization.

RECOMMENDATION
In the process to fulfill the initial target of children immunization in Bandung City, all stakeholders have important roles to support the high coverage of immunization especially in BIAN events. In the upcoming BIAN event in another year, it is recommended for all the stakeholders to sort the target audience data to have easier suitable approaches strategies because not all the target audience has the same situation and condition especially in urban and rural areas in Bandung City. In addition, it is also recommended for the Public Health Office to expand the collaboration with another institution and organizations to expedite the implementation of BIAN events because there are several factors that hinders the event to fulfill the initial target of coverage in some areas especially in gathering the target audience. The help from many parties could support the proposed strategy for increasing the target audience's awareness of BIAN. Another thing that needs to be considered is the adjustment of the proposed strategy in certain areas. There are many areas that have different cultures and habits in Bandung City, to support the proposed marketing strategies to be successful, the stakeholders, especially the government, needs to understand the situation and condition when applying those strategies. In addition, for the same academic research in the future, the next author should consider the current situation in the next BIAN event especially in target audience's response towards the Government's efforts to increase the awareness of the public and the current coverage result of the BIAN Immunization.