![The Drum Beat]() The Drum Beat – 643 – Building a Communication Programme to Match the Polio Endgame Strategic Plan |
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| This issue of The Drum Beat opens with a brief review of the most recent report from the Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative (GPEI) and then goes on to focus on the major communication themes and issues it addresses. It does so in the context of the Polio Eradication and Endgame Strategic Plan 2013-2018. The «endgame plan», developed by the GPEI in consultation with national health authorities, global health initiatives, scientific experts, donors, and other stakeholders in response to a directive of the World Health Assembly (WHA), is a «long term strategy to deliver a polio free world by 2018». The plan identifies several overarching communication themes, but the question raised by the IMB is: Does the GPEI take communication seriously enough for the strategy to succeed?
Please explore our Polio theme site for more. |
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REFLECTIONS ON THE MOST RECENT IMB REPORT
by Chris Morry, The Communication Initiative |
| The most recent report of the IMB is arguably the most important document on communication to come out of the polio programme. It maintains that «communication is the poor cousin of vaccine delivery» and that communication expertise is «sparse» throughout the programme, noting that the lead agency for communication, the United Nations Children’s Fund (UNICEF), is understaffed. The IMB asks why, after so many years, do many communities still regard the polio vaccine with suspicion and why, in a country with Nigeria’s history of polio boycotts, do spurious messages from anti-eradication programme campaigners continue to find such a receptive audience?
The GPEI’s new strategic plan underlines the importance of communication when it says that experience shows that «polio virus circulation stands little chance of surviving in fully mobilized communities»; the IMB report agrees strongly. The report notes that where there is strong communication capacity: rumours and unfounded claims are quickly refuted; dialogue builds community-level support; people are better informed and have their questions quickly and accurately answered; local needs and issues are listened to; polio vaccination is often delivered in conjunction with other valued services, and there is consistent and effective advocacy on the benefits of the vaccine and the need to participate in every round. The problem is that this is not happening in enough places or at the scale required, nor is it supported by appropriate levels of technical expertise in lead agencies or on key guidance bodies such as the programme’s Technical Advisory Groups.
The challenge for the programme as a whole, and not just for UNICEF, is to place communication at the heart of the GPEI’s concerns and to ensure that everybody takes it seriously and understands that building demand and motivating communities has to be integrated into everything the programme does. These issues are not new, nor is this the first time they have been raised by the IMB and others. However, in the context of a new strategic plan and the recognition that this set of milestones and this timeline truly are an endgame either for the polio virus or the polio eradication programme, there is a tremendous opportunity to scale up the communication strategies that have worked and to place communication on equal footing with vaccine delivery. If we do not, we may find that «this close» is as close as we get. |
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| BUILDING COMMUNITY DEMAND |
1. Successful Polio Eradication in Uttar Pradesh, India: The Pivotal Contribution of the Social Mobilization Network, an NGO/UNICEF Collaboration
by Ellen A. Coates, Silvio Waisbord, Jitendra Awale, Roma Solomon, and Rina Dey |
| This paper describes SMNet’s activities and materials in detail. For example, community mobilisation coordinators (CMCs) organised children’s rallies and mosque/temple announcements, helped the vaccinators set up booths, accompanied them to houses of missed children, and assisted in convincing resistant families to have their children vaccinated. At the community level, CMCs participated in routine immunisation (RI) trainings and service delivery, and they organised mothers’ and influencers’ meetings, using educational materials and discussions to promote immunisation and other positive health-seeking behaviours. SMNet worked to secure the endorsement and active support of influencers, such as political and religious leaders, doctors, athletes, and artists, who were «respected and well-known in the community and were consequently able to influence families’ decisions and actions.» [Mar 2013] |
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2. A Conversation With: Polio Expert Naveen Thacker
by Pamposh Raina |
| In honour of World Polio Day, India Ink interviewed Dr. Naveen Thacker, who was part of the team that led India’s polio eradication effort. He describes hurdles such as pockets of resistance to the polio vaccine, particularly in western Uttar Pradesh, in minority communities. This was overcome by involving religious leaders, local medical practitioners, and celebrities, who together highlighted the necessity for polio eradication. «Where the mass marketing campaign did not reach, the door-to-door campaign by 2.3 million volunteers across the country meant that we reached children in the hardest-to-reach rural communities.» Dr. Thacker notes that, despite these efforts, some middle-class communities were reluctant to take repeated doses, as they felt their child was fully protected. The solution was to engage members of the Indian Academy of Pediatrics, who were able to convince parents of the need to take additional polio drops. [Oct 2012] |
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3. Polio Eradication: Muslim Scholars Deny Polio Vaccine Rumours
by Tahir Khan |
| This news piece out of Islamabad, Pakistan, describes a 2-day conference held in Cairo, Egypt, in March 2013 that brought together an international group of Muslim scholars, who discussed strategies for rectifying misconceptions about the polio vaccine in order to protect Muslim children from this crippling virus. The conference recommended that polio-related information and religious decrees be disseminated to parents and communities in language that is simple and easy to understand. Also explored was the strategy of religious leaders and institutions closely collaborating with the polio eradication programme in planning effective and appropriate approaches to reach children in the 3 countries where polio is still endemic. |
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4. Public Health: Polio’s Moving Target
by Ewen Callaway |
| The following vignette describes an approach to sparking community demand for polio vaccination: «Mohammed Abubakar’s home is not on any map – at least not yet. To reach his settlement in a desolate part of northern Nigeria, four health workers creep over deep-rutted roads in an old Peugeot for an hour, then ride motorcycles over narrow dirt trails for another 30 minutes….Finally, they spot a cluster of mud-brick huts, known to the Fulani nomads who live there as a ruga. ‘As-salamu alaykum,’ – peace be with you – says Ardo Babangida, a traditional leader accompanying the team. Children swarm around the visitors, and Daniel Santong, an easy-going veterinarian and leader of the group, asks to meet Abubakar, the head of the household. Meanwhile, a young colleague whips out a smart phone and uploads the settlement’s Global Positioning System coordinates into a database. Abubakar arrives…and Santong tells him that they are trying to eliminate polio in nomadic people. Abubakar clasps his guest’s hands in appreciation. He says that he cannot remember the last time that health workers came to vaccinate his children. It is a story that Santong and his colleagues are now accustomed to hearing, even though door-to-door immunization campaigns happen on a near-monthly basis in the region.» [Apr 2013] |
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| 5. CORE Group Polio Project: Examples of Videos, Brochures, Training Tools and Community Mobilisation Materials |
| This PowerPoint presentation, with an accompanying PDF document, describes and shares communication materials from the CORE Group, with a focus on its efforts to mobilise community involvement in the polio eradication programme and to improve RI in high-risk areas of UP. These materials have been sharpened over time and are now being used for participatory techniques toward behaviour change. |
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| ADDRESSING SECURITY AND SUSPICION |
6. The Last, Best Chance for Global Polio Eradication?
by Nellie Bristol and J. Stephen Morrison |
| Reflecting on the 2013-2018 strategic plan, this article addresses new security threats to polio vaccinators. It calls for operational adjustments in areas with security concerns, including lowering the public profile of vaccine campaigns and increasing flexibility in their timing and speed. One speaker at the Global Vaccine Summit in Abu Dhabi, the Minister of State for Health in Nigeria, said polio eradication has an unprecedented political commitment at the national and regional levels and that security challenges have not stopped immunisation efforts. He cautioned against «militarising» the programme, arguing that enhanced partnership between the international and national programmes and local authorities and improved efforts in vaccine education will help address potential violence. [May 2013] |
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| 7. P3 polio virus disappears from Pakistan |
| From this blog by jawihir: «Taliban militants imposed a ban on polio vaccination campaigns in FATA [Federally Administered Tribal Areas] in July 2012 in protest against drone attacks. Use of polio staff to gather DNA samples from Osama bin Laden compound in a CIA-led covert operation has also fueled suspicion about the immunization drive….Furthermore, vaccine refusal is another hurdle to the success of the polio eradication program. Polio Operations Room Bulletin reveals that only in the National Immunization Campaign conducted this month, more than 58,000 children could not be immunized due to parental refusal. The security situation has also hampered the social mobilization activities for polio eradication. UNICEF is supporting the Government to improve awareness regarding polio and to build trust in immunization. More than 1,100 social mobilization staff members are deployed in the high-risk districts; they go door to door to persuade reluctant parents. Nevertheless, with the given challenges of security and mistrust in immunization, the agencies supporting the Government consider this latest advancement encouraging.» [Jun 2013]
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8. Polio Vaccination in Nigeria: The ‘Good’, the ‘Bad’ and the ‘Ugly’
by Marycelin Mandu Baba and Michael Ayivor |
| One focus of this paper is the aftermath of the boycott of polio vaccination in northern States in 2003 amidst the rumours that the vaccine contains infertility drugs, causes poliomyelitis, and spreads HIV. After resolving the crisis, some parents in the north still resist compliance with the polio vaccination. It is noted that «community participation during micro-planning has improved significantly compared to the previous years. For more fruitful community participation during IPDs [Immunisation Plus Days], an enhanced ward level communication strategy using locally available methods and languages is now in progress for effective dissemination of information.» [Nov 2012]. |
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9. WHO Denounces CIA for Misusing Anti-Polio Drive
by Shahina Maqbool |
| As reported in this news article, Muslims are increasingly using their voices in an effort to combat rumours that threaten to destroy the global effort to eradicate polio, such as through the International Islamic Conference being held in Islamabad in April 2013. The hope is that this forum could «serve as an effective rallying point for implementation of effective strategies to overcome the remaining hurdles in way of making Pakistan polio-free.» |
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| 10. Analysis: Roots of Polio Vaccine Suspicion |
| This news piece features conversations with residents, imams, and health workers in Kano State, Nigeria, about the roots of ongoing suspicion of and resistance toward polio vaccination within conservative Islamic communities in northern Nigeria. According to the article, this situation is largely due to a deep distrust of the West, persistent rumours that the vaccine is harmful, and the house-to-house approach taken by immunisation campaigners, which many saw as intrusive or even aggressive. Moving forward, the National Primary Health Care Development Agency (NPHCDA), which oversees polio immunisation in Nigeria, plans to hold a national workshop in Abuja for Muslim clerics and traditional leaders to clear up all misconceptions about the vaccine. [Apr 2013] |
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11. Parental Perceptions Surrounding Polio and Self-Reported Non-Participation in Polio Supplementary Immunization Activities in Karachi, Pakistan
by Asif Raza Khowaja, Sher Ali Khan, Naveeda Nizam, Saad Bin Omer, and Anita Zaidi |
| «This study was undertaken in the wake of extensive media reports of an allegedly fake vaccination campaign organized by the United States Central Intelligence Agency to try to track down Osama Bin Laden by surreptitiously obtaining blood samples from his family members for deoxyribonucleic acid (DNA) testing. The campaign was run by a Pashtun government physician from the tribal area of Khyber Agency who had worked in polio vaccine campaigns….several Pashtun families gave distrust of government-run programmes as the reason for having refused to get their children vaccinated….[R]eports of the incident may have reinforced or perpetuated negative perceptions…» [Sep 2012] |
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| RAISING THE IMPORTANCE OF COMMUNICATION IN THE POLIO PROGRAMME |
| 12. Independent Monitoring Board of the Global Polio Eradication Initiative: Seventh Report |
| In a multi-page analysis of the approach to communications that the polio programme has adopted (or failed to adopt), the IMB report notes that there has been «too much of a ‘one-way’ attitude to communications, wanting to bring people round to its view rather than concentrate on listening and on dialogue….In many places, there is clearly a disconnect between the services that people really want (such as measles vaccination, maternal and child healthcare, and basic primary healthcare) and what the Programme is offering them. This is a complex issue…[that] demands…nimble and sophisticated work, in which local communications teams are able to amend their approach in response to their particular community. It demands that the partners look more deeply within their own agencies, to strengthen the links between the Polio Programme and their many other endeavours, a number of which are far higher on parents’ wish lists. It also demands that the Polio Programme reach out as widely as possible, to work through community groups that enjoy a level of trust not afforded to the Programme….It is communities themselves who understand best what they want, what they need and what they think. We are surprised not to hear the voice of the child more prominently within the Programme. It is difficult to imagine a more powerful unifier than communities hearing children ask ‘Who will protect me against polio?'» [May 2013] |
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| 13. Polio Communications Quarterly Update: Trust |
| «Refusal of the oral polio vaccine and resistance to the programme is often less about polio than about the rejection of something that is perceived to be foreign and therefore untrustworthy.» Noting that in the remaining endemic countries (Afghanistan, Nigeria, and Pakistan) – places rife with ongoing political and military struggles – increasing acceptance of the oral polio vaccine (OPV) is described here as being a challenging task, this report outlines 4 key principles of building trust: honesty, competence, morality, and genuine concern for children. UNICEF-supported social mobilisation networks are utilising trust-building strategies by continuing to forge alliances with religious and community leaders as well as with other socially respected members of society. In Nigeria and Pakistan, social mapping is undertaken at the community level to identify those who are able to influence social norms and tip public sentiment in support of OPV. Vaccinators are increasingly being chosen by the local community. [UNICEF, May 2013] |
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| 14. ‘PRiME’ing Communities for OPV |
| The context of PRIME’s development is this: UNICEF has deployed a field network of over 800 social mobilisation staff at the grassroots level. This Communication Network (COMNet) works in the highest risk areas to mobilise social commitment for polio eradication and community demand for OPV. To improve the network’s ability to focus their efforts, as well as the programme’s efforts, most strategically, PRIME: (i) is based on a system of performance monitoring, compiling Union Council and district communication data into a two-page «performance card» at each administrative level; (ii) sets targets for each indicator, clearly denoting which targets have not been met each month and providing a brief qualitative explanation of why; (iii) assesses performance holistically by a series of input, outcome, and impact indicators; (iv) uses the rate at which refusals are converted to vaccinations as the basis for COMNet mobiliser performance assessment; and (v) is automated, compiling post-campaign data into performance cards no later than two weeks after each vaccination round and ultimately posting the information online. [June 2012] |
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| 15. Reflections on Experience: Towards More Effective Polio Communication Reviews |
| «I have had the very real privilege of being involved in the Global Polio Eradication initiative (GPEI) for the past 7 or 8 years. My vantage point has been somewhat unique…» This blog from The Communication Initiative (CI)’s Chris Morry shares his personal reflections on: the importance of monitoring and evaluation as drivers in the GPEI’s evolving strategies, the changing role communication reviews (held in Afghanistan, India, Nigeria, and Pakistan) have played in strengthening communication programmes, and lessons learned about what makes for an effective review process. [Apr 2013] |
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16. Pakistan’s Polio Priorities
by Sania Nishtar |
| In this commentary, Federal Minister, Government of Pakistan, makes the case that «a high-level body as part of the prime minister’s office is essential for advocacy and mobilization of the whole of the government’s response to polio.» Sania Nishtar writes on the eve of the swearing in of Pakistan’s new government (under the leadership of Nawaz Sharif), reflecting that this could be an opportunity to finally eradicate polio from Pakistan, one of three countries where the disease remains endemic. He acknowledges that there are challenges to be overcome, including: providing security to health workers (12 have been murdered since December 2012), reaching children from marginalised and/or remote/nomadic groups, and dealing with deep-seated opposition among some religious leaders, who have persuaded parents not to vaccinate their children against polio. [June 2013] |
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| See also these past e-magazines focused on polio communication: |
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| This issue of The Drum Beat was written by Kier Olsen DeVries and Chris Morry. |
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| The Drum Beat is the email and web network of The Communication Initiative Partnership – Partners: ANDI, BBC Media Action, Bernard van Leer Foundation, Breakthrough, Calandria, Citurna TV, DFID, Eldis, FAO, Fundación Imaginario, Fundación Nuevo Periodismo, Heartlines, Iberoamericano (FNPI), IFPRI, Inter-American Development Bank, Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, MISA, Open Society Foundations, Oxfam Novib, PAHO, The Panos Institute, Puntos de Encuentro, The Rockefeller Foundation, SAfAIDS, Sesame Workshop, Soul City, STEPS International, UNAIDS, UNDP, UNFPA, UNICEF, USAID, The Wellcome Trust, World Health Organization (WHO), W.K. Kellogg Foundation.
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Chair of the Partners Group: Garth Japhet, Founder, Soul City garth@heartlines.org.za
Executive Director: Warren Feek wfeek@comminit.com |
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| The Editor of The Drum Beat is Kier Olsen DeVries. |
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