![The Drum Beat]() |
The Drum Beat – 647
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| Key Choices for the Polio End-Game |
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| This issue of The Drum Beat uses as a springboard the blog Polio Eradication: key choices for the end-game to explore in depth a question that blogger Sebastian Taylor identifies as we look to achieve the global eradication of polio, once and for all, by 2018. The question is: Do we (i) «ramp up visible and effective delivery of polio vaccine, with emphasis on those remaining under-immunised areas and, even in the face of increased and potentially violent opposition»; or (ii) «submerge the programme in a wider programme of delivering health services and other development benefits long desired by the communities involved?»The hope is that this Drum Beat will spark reflection and discussion among our readers on this question. Please consider registering for and then sharing your thoughts within our free, open discussion forum, Polio Networks, which is a networking space for those committed to positive criticism and innovation in polio communication.
For context, see:
Please also explore our Polio theme site for more. |
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| POLIO ERADICATION: KEY CHOICES FOR THE END-GAME: A Blog by Sebastian Taylor |
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| «The killing of polio vaccinators in Pakistan and then Nigeria in late 2012 and early 2013 has raised the stakes once again in the contest between those who would protect children and those who would use the polio programme for their own political ends….The question is, what should [the] response be?….The overarching message is this: the time for monolithic, massively-applied strategies (based on population-level ideas of national commitment and national programming) is over, and has been for some time….What happens next must be a series of locale-specific micro-strategies, tailored by use of good data whose meaning is commonly agreed across all programme partners, backstopped by continuing improvement in the quality of the ambient larger-scale supplementary and routine immunisation processes.» [Jul 2013]. Click here to read the entire blog. |
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| THE IMPORTANCE OF COMMUNITY-LEVEL APPROACHES |
1. Pakistan Battles Polio, and Its People’s Mistrust
by Donald G. McNeil Jr. |
| Two years ago, after India’s success in eliminating polio and hints from the World Health Organization (WHO) that it might issue travel warnings, Pakistan’s government went on an emergency footing. For example, more than 1,000 «mobilisers» were hired to visit schools and mosques to counter rumours that the vaccine contained pork, birth control hormones, or HIV. Volunteers have taken initiative in what is described here as a courageous way. The women of the Bibi family, in Karachi, formed a vaccination team; 2 of them, Madiha, 18, and Fahmida, 46, were gunned down in December 2012. Not only are the remaining female members of the family still vaccinating, but Madiha’s 15-year-old sister volunteered for her spot. Also, mullahs were courted to endorse vaccination. They issued 24 fatwas, and glossy booklets of their directives were printed for vaccinators to carry. Prominent imams have posed for pictures as they vaccinate children. [Jul 2013] |
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2. Partnering with Religious Leaders to Eradicate Polio
by Bhumi Bhandari |
| «The religious leaders possess a unique opportunity to mobilize communities toward the eradication of Polio.» As reported here, the United Nations Children’s Fund (UNICEF) is regularly in touch with religious leaders as well as with the Department of Religious Affairs in the southeast region of Afghanistan to seek their support in addressing the economic and social factors that contribute to the spread of this disease. For example, UNICEF organised an orientation for the religious leaders of Paktia province in March 2013 to mobilise them prior to the National Immunisation Day (NID). «[A]t the end of the orientation, the religious leaders we met promised to encourage and facilitate the immunization of the children in their respective communities.» [May 2013] |
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| 3. Analysis: Polio Eradication in Nigeria |
| This article describes and analyses new communication strategies that are being implemented in an effort to eradicate the wild polio virus (WPV) from Nigeria as part of the Global Polio Eradication Initiative (GPEI). National efforts began with a forum of traditional religious leaders and the media to establish support for upcoming immunisation rounds. The forum created a list of action points that led to actions such as a series of community dialogues which, in partnership with the Federation of Muslim Women Association of Nigerian (FOMWAN), mobilised 313 schools, sensitising 685 teachers. FOMWAN also played a role in 76 ceremonial events that reached 4,831 women. In the ensuing house-to-house mobilisation, over 72% of non-compliance cases were resolved. [Jul 2013] |
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4. In Fighting Polio, Information Is Half the Battle
by Arash Shinwary |
| This article explores the strategies of Radio Mashaal, which is working in Pakistan’s Federally Administered Tribal Areas (FATA) to counter the propaganda put forth by militant groups that is described here as interfering with efforts to eradicate polio in that country and, hence, around the world. As reported here, Radio Mashaal regularly engages the public through call-in shows, often inviting doctors to answer questions directly from listeners and raise awareness as to when polio vaccination campaigns commence. Women figure prominently among those who call in, often seeking reassurance that the polio drops pose no threat to their children. In addition to doctors, Radio Mashaal has invited mullahs to participate in programmes to explain to audiences that the polio vaccines do not violate Islamic doctrine. [May 2013] |
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| 5. From No to Know – Social Mobilization: Lessons from Polio Program |
| A Project Concern International (PCI) India consultation focusing on the role of social mobilisation in polio eradication notes that mobilisers were chosen from the local community. «They spoke the same language, had easy access to households, and knew how to influence families in their area. Being part of the community makes a lot of difference and enhanced the accessibility to the program in high risk areas.» To illustrate this and other strategies, a theatrical performance was held at the consultation event with a narrator. This 45-minute wordless performance («Pantomime») outlined the 11-year journey of engaging the community in polio eradication, such as by utilising the wisdom of the local community through dialogue about the optimal timing to approach a family with immunisations, and overcoming communication challenges encountered by mobilisers and vaccinators. [May 2012] |
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| EXAMPLES OF COMMUNITY-LEVEL RESEARCH |
6. Fatigue and Fear with Shifting Polio Eradication Strategies in India: A Study of Social Resistance to Vaccination
by Rashid S. Hussain, Stephen T. McGarvey, Tabassam Shahab, and Lina M. Fruzzetti |
| This qualitative study contextualises some sources of fear and «resistance» to the GPEI as it was carried out in India during the summer months of 2009 to provide insight for future eradication endeavours. The researcher used the method of participant observation to collect data both at clinics run by the GPEI and the door-to-door vaccination programme. One finding: There was a failure on the part of vaccination teams to share information with families regarding either the intensification of the vaccine programme, use of mOPV1 versus the trivalent OPV, or risks associated with vaccination. It is noted that UNICEF’s SMNet, which this study was conducted with, had improved communication between the GPEI and local communities by holding educational skits and plays about polio and recruiting grassroots stakeholders such as religious clerics to advocate for vaccination. Another insight to emerge relates to community participation: «If the public had been involved from the beginning, it is possible that some of the resistance may have been reduced.» [Sep 2012] |
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7. Methods for Evaluating the Impact of Vertical Programs on Health Systems: Protocol for a Study on the Impact of the Global Polio Eradication Initiative on Strengthening Routine Immunization and Primary Health Care
by Svea Closser, Anat Rosenthal, Thomas Parris, Kenneth Maes, Judith Justice, Kelly Cox, Matthew A. Luck, R. Matthew Landis, John Grove, Pauley Tedoff, Linda Venczel, Peter Nsubuga, Jennifer Kuzara, and Vanessa Neergheen |
| This paper describes a research protocol integrating use of comparative ethnographies to assess the historical impact of the GPEI on routine immunisation (RI) and primary health care (PHC) in diverse country and programme implementation contexts in Africa and Asia. The authors reflect on this study’s illustration of the utility of mixed-methods research designs. «Using qualitative and quantitative methods together, including participant observation, and making use of comparative ethnography are useful tools for crafting health systems research that is attentive to local context even as it has the ability to describe global trends.» [Sep 2012] |
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8. Landscape Analysis of Routine Immunization in Nigeria: Identifying Barriers and Prioritizing Interventions
by Cecily Stokes-Prindle, Chizoba Wonodi, Muyi Aina, Gbolahan Oni, Tope Olukowi, Muhammad Ali Pate, Lois Privor-Dumm, and Orin Levine |
| «We anticipated that solutions for routine immunization in Nigeria would need to be local ones. Our role as researchers was to listen, organize, synthesize and disseminate….Everyone wants to know how to crack the polio nut in Nigeria, and raising routine immunization (RI) rates is part of the answer.» One finding is that, within and across intervention packages, the appropriate priorities must be set by on-the-ground decision-makers. [International Vaccine Access Center (IVAC), with funding from the Bill & Melinda Gates Foundation and the GAVI Alliance and in partnership with the National Primary Health Care Development Agency and Solina Health, Apr 2012] |
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9. Big Data: How We Communicate Vaccine Matters
by Steven Shie |
| Noting that lack of understanding of vaccine is a challenge that both developing and developed countries are facing, Steven Shie points out that scientific data alone cannot address the public’s concerns with vaccine, as these concerns are often deeply rooted in culture, history, and political systems. (Shie cites the killing in June 2013 by extremists in Pakistan of two polio vaccine volunteers). Thus, what is needed is not just scientific evidence of the contribution that immunisation makes to public health but, beyond that, comprehensive data that capture trends on a global level as well as social, economic, and political context for each region in order to gain understanding and insights that can help public health professionals and healthcare communicators develop more effective communication strategy and tactics to enhance the public’s confidence in vaccine. [Jun 2013] |
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10. Lessons from Polio Eradication
by Heidi J. Larson and Isaac Ghinai |
| As reported here, the research team at the London School of Hygiene and Tropical Medicine has established an early-warning system to detect and investigate vaccine rumours and public concerns before they erupt into widespread vaccine refusals. One finding is that the GPEI has realised that the effectiveness of engagement strategies needs to be measured by the outcomes of those strategies – namely, the number of children vaccinated and the number of polio cases – not just the number of community meetings or posters promoting vaccination and announcing immunisation days. Similarly, there has been a move to map key influencers of vaccine acceptance or refusal. [May 2011] |
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11. Interpersonal Communication and Risk Perception Determinants in the Polio Eradication Campaign in Zaria, Northern Nigeria
by Yakubu Ozohu-Suleiman |
| Ethnic and religious leaders are believed to have been largely instrumental to the success or failure of polio eradication campaigns in various parts of northern Nigeria. It was found that leadership (ethnic and religious) persuasions were of little significance in the campaign acceptance or resistance. Rather, the risk of vaccine contamination and related health consequences, based on personal persuasions of husband/wife and friends/relations, accounted for the resistance decisions of the individuals in the local communities. [Apr 2009] |
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| INTEGRATING POLIO WITHIN OTHER IMMUNISATION SERVICES |
12. Performance and Determinants of Routine Immunization Coverage within the Context of Intensive Polio Eradication Activities in Uttar Pradesh, India: Social Mobilization Network (SM Net) and Core Group Polio Project (CGPP)
by William M. Weiss, Manojkumar Choudhary, and Roma Solomon |
| Questions have arisen as to how the polio eradication effort in India may have affected RI programmes for polio and non-polio antigens. As explained here, SM Net’s 3-level network of community mobilisers carries out activities such as ensuring that all children in their allocated households are given all childhood vaccines, in addition to OPV. The authors of this study conducted secondary data analysis of the latest project household immunisation survey in 2011 and compared these findings to reports of past surveys in the CGPP programme area and at the Uttar Pradesh state level. One finding was that DPT1, a measure of access to immunisation, was affected by exposure of caretakers to IEC (information, education, and communication) materials that promoted RI, and that were provided by CMCs (community mobilisation coordinators) at the same time the CMCs were promoting participation in mass polio vaccination campaigns. [May 2013] |
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| 13. Freedom Polio |
| Freedom Polio is a mobile health (m-health) solution designed for effective community-level health management in India. It is designed as a universal model based on the new strategy shift from fixed site immunisation to mobile vaccination strategies («house-to-house» immunisation) in the final battles against polio and achieving higher rates of RI. It was important to integrate a platform with complete mobility tools for community health workers (CHWs) capable of doing on-the-ground activities. Also, the supervision-level health officers needed mobility tools integrated in the design of the solution for monitoring, decision making, and designing effective immunisation in villages and community areas. [ZMQ Development (ZMQ) and CGPP] |
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14. India’s Health Workers on How to Eradicate Polio
by Naveen Thacker |
| According to this article, polio vaccination activities can – and must – work in tandem with RI systems. A study carried out in 2009 found that the majority of rural frontline health workers in Uttar Pradesh and Bihar stated that polio immunisation activities benefit the other health initiatives they carry out. Ninety-five percent of those surveyed said that, as they interact directly with families and explain the benefits of the polio vaccine to skeptical parents, they are able to increase acceptance of vaccines more broadly. [Jun 2013] |
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| This issue of The Drum Beat was written by Kier Olsen DeVries. |
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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, DFID, FAO, Fundación Nuevo Periodismo Iberoamericano (FNPI), Inter-American Development Bank, Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, MISA, Oxfam Novib, PAHO, The Panos Institute, Puntos de Encuentro, The Rockefeller Foundation, SAfAIDS, Sesame Workshop, Soul City, STEPS International, UNAIDS, UNDP, UNICEF, USAID, The Wellcome Trust, World Health Organization (WHO), W.K. Kellogg Foundation.The Drum Beat seeks to cover the full range of communication for development activities. Inclusion of an item does not imply endorsement or support by The Partners.
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. |
| Please send additional project, evaluation, strategic thinking, and materials information on communication for development at any time. Send to drumbeat@comminit.comThe Drum Beat seeks to cover the full range of communication for development activities. Inclusion of an item does not imply endorsement or support by The Partners.
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