Communication Strategies for Polio Eradication

Background and Progress to 2007Enormous gains have been made against difficult and constantly

evolving conditions since polio eradication activities began in 1994.

In 1999 there were 45 cases; this has been reduced to 10 cases as of September 2007. Circulation has been restricted since 2004 primarily to the South and

East with only three sub-clusters (1 P3 and 2 P1). Good overall AFP surveillance established, with some concerns

regarding accessibility. Overall good coverage in accessible areas. Gaps remain due to security.

A national PEI system through which government works with donors and partners such as UNICEF, WHO and a range of NGO’s has delivered good results in difficult circumstances over the past decade.

Urgent need to review communication strategies in this last push towards eradication

Communication and Social Mobilisation Activities

Strong political commitment exhibited Presidential Task Force, Polio Eradication National

Steering Committee, Polio Action Group Activation of IEC department for polio eradication SIA inauguration ceremonies at national and provincial

levels

Involvement of religious and community leadersBranding and national awareness campaignEnhancement of social mobilization activities in

high risk areas Development and use of social mobilization materials

Stronger focus on cross-border immunization activities

Gaps in communication strategy at national and provincial levels

Insufficient human resource capacity to implement polio SM/C strategies

Limited programme data related to communication and limited use of existing data

Lack of communication baseline data

Poor levels of monitoring and supervision especially (but not exclusively) in high risk areas

Gaps in inter-sectoral collaboration at sub-national level

Communication Challenges

Communication Challenges

Continued and increasing security restrictions impeding access to many areas in the South and East

Cross border population movement (internal and external)

Difficulties accessing households and reaching child caregivers directly

EPI

SIA data

(control room, PCA) over time

Surveillance data

Analyze to identify reasons & patterns of

missed children:•Inaccessibility (to area/household)

•Performance of teams

(fighting, IPC)

•Refusals (perceptions, mis-information, demand)

•Impact of previous interventions

Locally appropriate strategy identified

(DC, CHW/CHS, Elders, Mullah, Teachers, women’s groups)

Previous Communication Interventions:Training of CHW, Meeting with Mullahs, Community Leaders, Courtyard women

Implement and measure communication strategy (s)

Implement program activity

Collect Data

Communication StrategyDevelop a comprehensive communication strategy for

national and provincial levels using data to identify high impact activities (Oct 2007)

Ensure development of indicators and updated social mobilization microplans at district and sub-district levels to address local challenges (Nov 2007)Focus on high risk districts: Eastern and Southern region, areas

with recent WPV, high insecurity/inaccessible/refusal, low-coverage

National media programme: ongoing (TV, radio, billboards, posters)

Baseline data is urgently required: immediate need for KAPB (Nov 2007)

Utilize Pashtu news services for polio message delivery: BBC, Azadi (immediate)

Polio Communication: National Level Capacity

Polio Action Group: Improve inter-sectoral involvement and coordination at the national

level (Ministry of Women’s Affairs, Education, Religious Affairs, Rural Rehab and Dev, Def)

Translate this commitment into action at the provincial and district level

Implementing NGOs: Specify polio activities (SIA/Surv) as part of one of the 7 components of

BPHS and ensure allocation of adequate resources Hold a national meeting with NGO representatives (contracting and

non-contracting ) to ensure their buy-in. Disseminate decision to provincial/district level (Nov 2007)

Update NGO contract upon renewal to include provision of polio activities (2008)

Formally incorporate polio component into CHW training (Nov 2007)

Incorporate NGO representation within national and provincial level polio

committees (Oct 2007)

Strengthen IEC department within MoPH

Assign a polio communication focal point (IEC)(Oct 2007)

Regular refresher training of MoPH/NGO communication staff

(Nov 2007)Immediately recruit a qualified full-time polio

communication officer to provide support in implementation at the national level (International post through partner agencies)

(Nov 2007)

Polio Communication: National Level Capacity

Polio Communication:Provincial Level Capacity Ensure all high risk provinces have an assigned polio

communication focal point (Nov 2007)

Work in concert with provincial health team and report back to the national IEC polio focal point

Responsible for leadership, coordination and monitoring of SM/C activities

Receive immediate and regular communication training by IEC polio focal point supported by partner agencies (Dec 2007)

Establish provincial inter-sectoral polio communication committees for high risk provinces:(Dec 2007)

Membership: Include other line departments, NGOs ToR: Review and oversee provincial communication strategy and

plan and monitor implementation at district level

Polio Communication: District Level Capacity

Ensure all high risk districts have a district communication coordinator working in concert with polio district team

(Dec 2007)Trained by and report to the provincial

communication focal pointToR:

Develop SM/C micro-plans appropriate to the local challenges

Coordinate and monitor communication activities

Polio Communication: District Level Capacity

Currently identified network categories: Elders, Mullahs, Teachers, CHW

Enhance community involvement: Community Development Council/ Shura Local inauguration ceremony for key polio related events (community

leaders/mullahs)Enhance involvement of women (immediate)

Women’s courtyard: develop materials, strategy and indicators Female CHW : reaching homes and dissemination messages through

service delivery (next SIA)

Training: SM/C training materials recently developed and distributed

Review and update training materials with focus on local adaptation

(Nov 2007)

CORE TEAM

6 Community Activists per CHS

District Communication Coordinator

NGO/Community

Provincial Polio Communication Focal Point

Prov Health Team

Family

NGO/CHWs:Health Facility

Mullah Imams TeachersElders CHWs

Training:

Revise IPC module

Nat’l Inter sectoral

Committee Polio Communication

Officer

Data

Women Courtyard

Polio Focal Point

IEC Department

NGO, CDC, Shura,Schools,

mosques etc

Provinicial Inter

sectoral Committee

Monitoring Process

Ensure the use of updated social mobilization campaign monitoring tools in all provinces

(Next SIA)

Ensure communication monitoring data is collected and analyzed regularly and used to modify activities(Next SIA)

SecurityTremendous efforts being made at

district levels (e.g. focused district strategy (FDS), access negotiators)

Recent successes especially in accessing 2 high risk districts and obtaining support for polio from local communities

Active fighting still ongoing and some clusters within districts are either inaccessible or difficult to verify quality and performance.

SecurityNeed to map inaccessible populations/areas at sub-

district levels (Immediate)

Intensify Coordination at higher level between GoA, ISAF, and other parties involved (Next SIA, ongoing)

Assess and expand successful strategies: e.g. access negotiators (Immediate)

Pilot using community monitoring to assess the quality of campaigns in hard to reach areas: require adequate training (Dec 2007)

Using alternative social networks at community levels to gain access (On-going)

Cross Border Issues and Mobile PopulationsEfforts are being made in tracking and vaccinating

mobile and border-crossing populationsGood collaboration between Pakistan and Afghanistan

and synchronizing SIAs:Continue regular meetings between provincial level

teams

Ensure better coordination at local level to implement agreed-upon decisions regarding vaccination strategies for border-crossing populations

Coordinate sharing of common communication materials, messages, and initiatives in border areas (Nov 2007)

Ensure appropriate location, visibility and shelter for vaccination posts (especially permanent ones)

(Next SIA)

Follow-up to communication activities

Hold regular (every 2 months) national-level meetings attended by provincial communication focal points to review progress. (Nov 2007)

Expand mandate of TAG to include substantial component of communication: Include communication expert on the TAG include updates by the national polio focal point regarding

progress in the high risk provinces(Sept 2007)

A time-bound action plan should be developed by the MoPH and partners to ensure implementation of these recommendations (Oct 2007)

SummaryIncredible strides have been made against great odds

and it is critical to sustain the achievements of the program as we move into this final phase of eradicating polio.

Communication has to play a central role in what comes next.

The recommendations focus on quickly building polio communication capacity through: Strengthening current communication structures and

capacity Reinforcing the current focus on high risk districts

and locally tailored strategies Utilizing program data to focus on the highest impact

activities Monitoring and follow-up for all SM/C activities And enhancing cooperation with Pakistan to ensure

that the areas of circulation are covered.

Thank You