13,285 Governance in Community Decision-Making Related to Polio Immunisation, The Drum Beat 740, August 9- 2017

The Drum BeatGovernance in Community Decision-Making Related to Polio Immunisation – The Drum Beat 740
August 9, 2017
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“It may be disappointment in government that shapes negative attitudes to a programme like polio eradication.” This is one finding from the report “Perceptions of Influence: Understanding Attitudes to Polio Vaccination and Immunisation in Northern Nigeria“, which was written by Dr. Sebastian Taylor as part of a USAID-funded research project led by The CI on the underlying family- and community-based factors (versus individuals’ decision-making) that influence Nigerians’ perspectives on immunisation. Two previous Drum Beat editions – one in July 2014 and one in August 2015 – explored this initiative in depth.

The present Drum Beat takes as an inspiration and launching point one of the research team’s hypotheses: that lower “trust in government” would correlate with higher risk of oral polio vaccine (OPV) refusal. As the researchers found, “[t]he reverse appears to be the case. Higher-risk settlements have consistently higher expectations of government (for example, in terms of service provision). But they also have systematically lesser confidence in their ability to influence government performance. It may be disappointment in government that shapes negative attitudes to a programme like polio eradication.” The selections below – some from external websites – will hopefully inspire your thinking on this trust or expectation question and related issues that impact community decision-making related to polio immunisation. One theme to emerge: Context matters when it comes to unearthing the reasons for a community’s decision to refuse or accept vaccination.

From The Communication Initiative Network – where communication and media are central to social and economic development.
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  • 1. We Need Food, Not Polio Vaccine – Jos Community
    “Communities in Jos North Local Government of Plateau have refused to participate in the ongoing immunisation exercise against polio, citing hunger as their reason….[T]he parents, who rejected the vaccine, asked government to rather work toward slashing the prices of food items….[E]ven doctors rejected the vaccines on the grounds that government was paying too much attention to polio while neglecting other serious diseases….[T]he local government…set up a social mobilisation team that was moving through affected communities to sensitise them on the importance of taking the vaccines…” [by Kingsley O., Reports Afrique News, Feb 1 2017]
  • 2. Pakistani Villagers Vow ‘No Electricity, No Polio Vaccinations’
    “Tribal elders in a northwestern Pakistani region are taking extreme measures in an effort to bring electricity to their area, saying that as long as they have no electricity they won’t vaccinate their children against polio. Several hundred residents from villages in Lakki Marwat district staged a protest demonstration on June 10 [2013] and turned away polio-eradication teams….’Our children die of scorching heat and mosquito bites; what difference does it make if they die of polio?’ one of the tribal elders was quoted as saying…” [by Sailab Mahsud and Antoine Blua, RadioFreeEurope/RadioLiberty, Jun 10 2013]
  • 3. Fifteen villages boycott polio vaccination in Bihar [India]
    “The residents of 15 villages have boycotted the polio vaccination to protest alleged lack of proper nutrition and other facilities to the children by the state-run Anganwadi Centres in Munger district, official sources said….Efforts were being made [to] talk the agitating villagers into participating in the vaccination campaign as their grievances would be taken care of by the local administration…” [Press Trust of India, Apr 25 2012]

  • 4. Polio is back in Nigeria, and the next vaccination campaign may have a surprising consequence
    by Shelby Grossman, Jonathan Phillips, and Leah Rosenzweig
    From this Aug 23 2016 blog: “…in our research paper…,[w]e found that polio vaccination campaigns elsewhere in Nigeria empowered communities to get the government to pave roads, electrify villages and fix dilapidated schools. Here’s what happens: Entire communities selectively resist vaccination, in what is locally called “block rejection.” Crucially, vaccine noncompliance does not happen because of ignorance, fear or religion – campaign monitoring data show that less than 1 percent of Nigerians hold these objections. Instead, noncompliance is a strategic move by citizens to gain the government’s attention….The government takes note of these block rejection cases. Elected officials, even powerful governors, negotiate personally with these communities…. Eradicating polio in Nigeria may prove both more challenging and more costly because of citizens’ opportunistic use of political agency. But this process may also support real improvements in government accountability in the least accountable places.”
  • 5. Casualties of War: Polio and the Golden Millimeter
    by Claire Hajaj and Tuesday Reitano
    “It appears that instead of vanishing, polio has been transformed into a lever of ideological conflict, now specifically confined to countries experiencing internal struggles linked to Islamic extremist armed groups and other strains of fundamentalist Islam.” This article explores the implications of this new paradigm for the success of polio eradication and similar development efforts in fragile states, arguing that “the eradication drive might benefit from a shift from a high-profile campaign approach to a more holistic strategy integrated with the local hierarchy of needs in charged ideological settings. Traditional strategies centered on national ownership,” which emphasise state actors and institutions, can lead to counterproductive fallout, and so – as is the central claim of the authors – international agencies need to place greater emphasis on inclusive ownership to engage a fuller spectrum of state and non-state actors in fragile states and transitional environments. [Oct 2016]
  • 6. The Impact of Open Government: Assessing the Evidence
    by Vanessa Williamson and Norman Eisen
    This Brookings Institution paper features a rubric that organises what we know about the impact of open government and identifies the contexts in which open government efforts are likely to be successful. The authors stress: “Open governance proponents should seriously consider whether the information made available is actually of interest to the principals….But it is also important to consider the possibility that local priorities might not align with those of academics, public officials, or civil society organizations….A striking example of divergent local and national priorities comes from the persistence of polio vaccine noncompliance in Nigeria. Naively, it might seem that a community would resist polio vaccination only because of fear or ignorance of the vaccine’s effects, and that an information campaign would be the best solution to ensure polio eradication. In reality, however, vaccination noncompliance in Nigeria is part of a ‘strategic move by citizens to gain the government’s attention’ and extract concessions in the form of better infrastructure and schools. The success of government interventions in this area is dependent on a clear understanding of local priorities.” [Dec 2016]
  • 7. Beyond the Health Governance Gap: Maternal, Newborn and Child Health in South Sudan
    by Sebastian Taylor
    “The emphasis [in this paper] on health systems is not intended in any way to detract from the long-term goal of changing deep structural drivers of poor MNCH [maternal, newborn, and child health], including gender inequity which flows through into both greater exposure to risk among girls and women, and less power to determine a safer reproductive pathway. However, the health system in South Sudan represents a kind of governance space in which technical interventions intersect with social attitudes, with policy as an expression of accountability between state and citizen. In that sense, the health system constitutes a perfect confluence of humanitarian protection, statebuilding, and sustainable institutional development – concentrated on the life chances of women, infants and children.”[Mar 2012]
  • 8. Social Accountability Initiatives in Health and Nutrition: Lessons from India, Pakistan and Bangladesh
    by Nicholas Nisbett, Nabeela Ahmed, Shilpa Deshpande, and Francesca Feruglio
    The focus of this Making All Voices Count research report is on accountability-seeking processes originating in communities or at local interfaces between community members and political processes. Designed to be of particular use to practitioners of health and nutrition in South Asia who encounter challenges around weak accountability and poor governance, the paper discusses key considerations for the design and analysis of social accountability initiatives (SAIs), including: the need to understand community heterogeneity; the role of community collective action and/or its role in coercion or “noisy protest” in effecting change; the ways in which cooperation, capacity, and commitment affect the community and frontline provider relationship, as well as the ability and willingness to deliver to meet demands; and the ways in which extant local political structures form the backdrop against which accountability actions play out. [Apr 2017]
  • See also:
    Polio Eradication and Health Systems in Karachi: Vaccine Refusals in Context
    A Systematic Review on Factors Affecting Community Participation towards Polio Immunization in Nigeria

RESEARCH ON POLITICS OF REFUSAL (available through subscription or purchase only)
  • 9. Parallel Dilemmas: Polio Transmission and Political Violence in Northern Nigeria
    by Elisha P. Renne
    From the abstract: “In northern Nigeria, areas with low levels of polio immunization due to persistent parental opposition as well as implementation and infrastructural problems have contributed to wild poliovirus transmission. Furthermore, political violence associated with Islamic groups opposed to the federal government has also hampered the conclusion of the Global Polio Eradication Initiative (GPEI) efforts. This violence, which began in Borno State and has spread to other parts of northern Nigeria, occurs precisely where poliovirus transmission continues….The Nigerian government’s attempts to suppress opposition to the polio eradication campaign by threatening non-compliant parents with arrest and by closing down media outlets may frighten some parents into compliance but can also breed resentment and resistance, just as military and police activities, such as house-to-house sweeps and widespread arrests, may encourage sympathy for Islamic insurgents. This situation suggests that the possible solution of one problem – the ending of wild poliovirus transmission – depends upon a solution of the other, i.e. the cessation of violent anti-government activities.” [from the International African Institute, Volume 84, Issue 3, August 2014, pp. 466-486]
  • 10. Constructive Noncompliance
    by Lily L. Tsai
    From the abstract: “Does widespread citizen noncompliance always delegitimize state authority and endanger regime stability? The evidence presented in this paper suggests that some noncompliant behaviors may actually be intended to communicate policy feedback and constructive criticism about the fit between policies and local conditions. In order to improve our understanding of these phenomena, the paper develops the concept of ‘constructive noncompliance,’ situating it within a typology of political action and illustrating it empirically using original qualitative and quantitative data from the case of rural China. By distinguishing constructive noncompliance from other forms of resistance, this paper shows that not all forms of noncompliance indicate low legitimacy or state capacity and lays the foundation for examining how different types of political action may affect policy formation, government use of coercion, the political attitudes of citizens, and their propensity for future action.” [in Comparative Politics, Volume 47, Number 3, April 2015, pp. 253-279]
  • 11. A Crisis of Trust: History, Politics, Religion and the Polio Controversy in Northern Nigeria
    by Ebenezer Obadare
    From the abstract: “In the middle of 2003, disagreement over the safety of the oral polio vaccine pitted ordinary citizens and community leaders in the predominantly Muslim north of Nigeria against the World Health Organization, the United Nations Children’s Fund and Nigeria’s federal authorities. During the crisis that ensued, five northern states (Niger, Bauchi, Kano, Zamfara and Kaduna) banned the use of the controversial vaccine on children in their respective domains. Underpinning Obadare’s paper is the assumption that the immunization crisis is best understood after considering developments in the broader politico-religious contexts, both local and global. Thus, he locates the controversy as a whole against the background of the deepening interface between health and politics. He suggests that the crisis is best seen as emanating from a dearth of trust in social intercourse between ordinary citizens and the Nigerian state on the one hand, and between the same citizens and international health agencies and pharmaceutical companies on the other. The analysis of trust is historically embedded in order to illuminate the dynamics of relations among the identified actors.” [from Patterns of Prejudice, Volume 39, Issue 3, Aug 6 2006, pp. 265-284]
  • 12. The Politics of Polio in Northern Nigeria
    by Elisha P. Renne
    From the abstract: This book “explores the politics and social dynamics of the Northern Nigerian response to the Global Polio Eradication Initiative, which has been met with extreme skepticism, subversion, and the refusal of some parents to immunize their children. Renne explains this resistance by situating the eradication effort within the social, political, cultural, and historical context of the experience of polio in Northern Nigeria. Questions of vaccine safety, the ability of the government to provide basic health care, and the role of the international community are factored into this sensitive and complex treatment of the ethics of global polio eradication efforts.” [from Indiana University Press, Jul 12 2010]

ENQUIRY: Your priorities, opportunities and challenges!
What kinds of challenges and opportunities infuse your communication and media development, social and behavioural change work? This survey is a chance for you to let us know! In 2017, we will report back on results and trends so you can gain insights from your peers in the network.
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This issue of The Drum Beat was written by Kier Olsen DeVries.
The Drum Beat is the email and web network of The Communication Initiative Partnership.

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ANDIBBC Media ActionBernard van Leer FoundationBreakthroughCiturna TVFundación ImaginarioFundación Nuevo Periodismo Iberoamericano (FNPI)Heartlines,Johns Hopkins Bloomberg School of Public Health Center for Communication ProgramsMaternal and Child Survival Program (MCSP)MISAOpen Society FoundationsOxfam NovibPAHOThe Panos InstitutePuntos de EncuentroSAfAIDSSesame WorkshopSoul CitySTEPS InternationalUNAIDSUNICEFUniversidad de los Andes,World Health Organization (WHO)W.K. Kellogg Foundation

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