13,510 Community Engagement for Polio Action, The Drum Beat 755, April 25 2018

The Drum BeatCommunity Engagement for Polio Action – The Drum Beat 755
April 25, 2018
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Community engagement (CE) is widely recognised to be a crucial strategy for increasing demand for polio vaccination and fostering a sense of local buy-in (commitment) to the otherwise abstract goal of global polio eradication. In fact, at age 84, two years before his death, the developer of the oral polio vaccine (OPV), Albert Bruce Sabin, MD, recognised this: “Even the most primitive societies have their own types of community organization that could be utilized for this purpose to deal first with polio and subsequently with other problems…” In that spirit, the Global Polio Eradication Initiative (GPEI) stresses that CE “does not just happen during vaccination! days. It is an ongoing conversation with the community that requires an iterative loop of listening and responding.” GPEI partners like the United Nations Children’s Fund (UNICEF) work with communities to build social demand for vaccination and to present health workers as trustworthy, admirable, compassionate, helpful, and competent. As some of the selections below illustrate, social mobilisation often centres around involving the very community members that the behaviour change strategy hopes to reach.

  • 1. Role of Social Mobilization (Network) in Polio Eradication in India
    by Anisur Rahman Siddique, Prem Singh, and Geetali Trivedi
    The authors of this article contend that one of the major reasons behind the interruption of polio transmission in India was the deployment of UNICEF’s Social Mobilization Network (SMNet, or SM Net). A 3-tiered structure, the 7,300-strong SMNet mobilises communities by spearheading civil society participation at district, block, and community levels. This article reviews SMNet’s strategies for delivering results, including its: underserved strategy; tracking of beneficiaries and high-risk groups; counseling and mobilisation activities; evidence-based planning at block and district level; capacity building and supportive supervision; monitoring and management information systems (MIS); and strengthening of routine immunisation and convergent health issues. It next examines SMNet’s social impact, in the categories of: empowering women; empowering children (e.g., through its bulawa tolis, establishes the groundwork and consciousness for their future participation in similar pro! grammes); reaching mobile and migrant populations; and broadening the role of religious leaders. One “universal take-away from the SMNet programme is that the community trust is critical to the success of any behavior change programs. Externally imposed agencies fail to bring about long term change without the trust of the community and this trust can be built only if the members of the network are integral to the community.” [Aug 2016]
  • 2. Evaluation of Social Mobilization Network (SM Net): Final Evaluation Report
    by Dr. Helen Guyatt, Flavia Della Rosa, Catharine Russell, and Florence Muiruri
    In 2013, scattered polio outbreaks in Somalia prompted a proactive vaccination response by the SM Net in that country. In 2016, Kimetrica was contracted to conduct an evaluation of the outcomes and impacts of SM Net on activities, including coverage of polio immunisation activities, community-level support for immunisation, and local perceptions of trust in health service delivery. Primary and secondary data support the claim that “the SM Net programme has been a great success in the communities it was able to reach. Initial hostility and mistrust have generally been overcome, coverage rates have increased, and the number of unvaccinated children has decreased. For example, overall coverage rates increased by 7 percent, from 90 percent in 2013 to 97 percent in 2016….Furthermore, whereas initially 1.2 percent of parents refused to let their children be vaccinated, by 2016, this fell to 0.6 percent.” [Jul 2017]
  • 3. Social Mobilization for Polio and other Supplementary Immunization Activities in Somalia
    From UNICEF and WHO, this illustrated resource manual has been prepared to guide facilitators and trainers conducting orientation and familiarisation sessions with frontline social mobilisers and health and allied workers engaged with polio prevention and other supplementary immunisation activities (SIAs) in Somalia. Its purpose is to guide an initial workshop and to help clarify the roles and responsibilities of field workers engaged in social mobilisation. [2014]
  • See also:
    Evaluation of Social Mobilization Network (SM Net): Inception Report
    Polio-Free India: The Role of the Social Mobilization Network (SMNet)
    Evaluation of Social Mobilization Network (SMNet)

  • 4. Eradicating Polio: Working with Religious Leaders to Enhance Community Ownership
    This document provides an insight into how UNICEF joined hands with religious leaders to give a new turn to the polio eradication programme in Uttar Pradesh (UP), India, an intervention that further created a strong platform to address other health and social challenges among minority communities. Religious leaders play a critical role, this document explains, because of the credence given to their words and the faith placed in them. Their stature in the community provides them with a “social capital” that can be harnessed for eliminating myths and promoting appropriate behaviour. Through a process described in this publication, local religious leaders like Imams, Madarasa in-charges, Hajis, Maulvis, and others became local influencers in the polio eradication programme by addressing the community through announcements during Friday prayers, fairs, community gatherings, and religious meetings. Relevant materials in Urdu were developed and regular meetings with the ! religious leaders held to clarify doubts. The local religious leaders were also trained to answer queries about polio and the OPV and to counter prevalent misconceptions. The one-to-one interactions with religious leaders were strengthened through the use of various audio-visual channels. [Jun 2013]
  • 5. Listening to the Rumours: What the Northern Nigeria Polio Vaccine Boycott Can Tell Us Ten Years On
    by Isaac Ghinai, Chris Willott, Ibrahim Dadari, and Heidi J. Larson
    Between July 2003 and August 2004, five northern Nigerian states boycotted the OPV due to fears that it was unsafe – in a move that proved a huge setback for polio eradication. As explored here, it was necessary for the GPEI to rapidly establish local ownership to enable immunisations to resume, and it was to these personnel whom they turned. For example, Muhammadu Maccido, the Sultan of Sokoto, the highest ranking traditional and spiritual leader in northern Nigeria, had refused to comment on polio vaccination early in the boycott. After targeted meetings and engagement from GPEI representatives, the Sultan publicly declared OPV safe in March 2004 and personally led vaccination drives. [Dec 2013]
  • 6. Eradicating Polio in Pakistan: An Analysis of the Challenges and Solutions to this Security and Health Issue
    by Shoaib Fahad Hussain, Peter Boyle, Preeti Patel, and Richard Sullivan
    This analysis focuses on the historical and contemporary challenges facing Pakistan’s polio eradication programme and the impact of conflict and insecurity there. In exploring lessons and solutions learned from the campaign, it sheds light on strategies to combat vaccine hesitancy, engage local communities, and build on progress towards polio eradication in Pakistan. There have been examples of visible partnerships between political and religious authority figures playing a role, such as in ending the 2003 polio immunisation boycott in Northern Nigeria. Saudi Arabia’s enforcement of World Health Organization (WHO) recommendations with fatwas (formal Islamic rulings) to vaccinate pilgrims undertaking the Hajj in 2005 also helped dispel suspicions that the polio eradication campaign aims to sterilise Muslims. This strategy has also been applied in Pakistan, where prominent Islamic scholars issued a fatwa endorsing the polio vaccination campaign and have also led door-to-door c! ampaigns in parts of the country. [Oct 2016]
  • See also:
    Learning from Polio Eradication: Community Involvement in Reaching Under-Immunized in Northern Nigeria

  • 7. Social Mobilization and Community Engagement Central to the Ebola Response in West Africa: Lessons for Future Public Health Emergencies
    by Amaya M. Gillespie, Rafael Obregon, Rania El Asawi, et al.
    This article describes the lessons learned about social mobilisation and community engagement in the emergency response to the Ebola outbreak, with a particular focus on UNICEF’s C4D work in Guinea, Liberia, and Sierra Leone. The basic principles uncovered from this response can be applied to future disease outbreaks. The common thread could be said to be that communication and CE activities need to be implemented early and to be flexible, adaptable, well-coordinated, and guided by data and evidence. Ultimately, in any future public health emergency (e.g., a polio outbreak), it needs to be remembered that these emergencies are as much a social as a health phenomenon – and that early, genuine engagement with communities is crucial. [Dec 2016]
  • 8. Community Engagement in Liberia: Routine Immunization Post-Ebola
    by Juliet Bedford et al.
    In Liberia, as in the other most-affected countries in West Africa, the Ebola epidemic led to a disruption in essential health services and resulted in low coverage of routine immunisation. In response, a national integrated polio, measles, and deworming campaign was implemented across Liberia, May 8-14, 2015. This article provides an overview of its community engagement and social mobilisation activities and reports the key findings of a rapid qualitative assessment conducted immediately after the campaign that focused on community perceptions of routine immunisation in the post-Ebola context. [Aug 2017]
  • See also:
    Emergency Risk Communication: Lessons Learned from a Rapid Review of Recent Gray Literature on Ebola, Zika, and Yellow Fever

  • 9. Community Engagement and Integrated Health and Polio Immunisation Campaigns in Conflict-Affected Areas of Pakistan: A Cluster Randomised Controlled Trial
    by Muhammad Atif Habib, Sajid Soofi, Simon Cousens, et al.
    The researchers conducted a community-based 3-arm cluster randomised trial in healthy children aged 1 month to 5 years that resided within the study sites in 387 insecure areas in 3 districts of Pakistan at high risk of polio. Clusters were randomly assigned to receive routine polio programme activities (control, arm A), additional interventions with community outreach and mobilisation using an enhanced communication package and provision of short-term preventive maternal and child health services and routine immunisation (health camps), including OPV (arm B), or all interventions of arm B with additional provision of inactivated polio vaccine (IPV) delivered at the maternal and child health camps (arm C). A consistent pattern across sites and across rounds was observed of higher coverage in the 2 intervention arms (B and C) than in control arm (arm A). [Jun 2017]
  • 10. ‘We All Work Together to Vaccinate the Child’: A Formative Evaluation of a Community-Engagement Strategy Aimed at Closing the Immunization Gap in North-West Ethiopia
    by Tracey Chantler, Emilie Karafillakis, Samuel Wodajo, et. al.
    Increased attention is being paid to the role of CE strategies in improving demand for immunisation. The International Rescue Committee (IRC) developed a multi-pronged CE strategy (the Fifth Child Project, or FCP) in an effort to close the immunisation gap in Benishangul Gumuz Regional State (BGRS) in north-west Ethiopia. This paper reports qualitative findings from a formative evaluation of the FCP’s CE strategy and related tools, including the vaccine defaulter-tracing tool (DTT) and a colour-coded health calendar. Findings highlight the fact that, through the FCP, the follow-up of unimmunised children became more personalised, and the calender stimulated health discussions between mothers and fathers within homes as well as between health workers and families. “Core to this is two-way communication.” [Apr 2018]
  • 11. Strengthening CORE Group Polio Project Impact: Community-Based Surveillance Activities in South Sudan – 2017 Annual Report, The Bill and Melinda Gates Foundation
    This is an annual report on the work of the CORE Group Polio Project (CGPP) in South Sudan. The CGPP’s community-based surveillance (CBS) system detects and reports suspected polio cases in South Sudan. Through the efforts of a network of 2,366 men and 991 women community volunteers, this approach has pushed past growing insecurity and lack of access to reach children in the unstable areas of the country; 90% of the suspected acute flaccid paralysis (AFP) cases detected in the reporting period were found by CGPP volunteers. In fact, since 2014, there has been a steady increase in the proportion of AFP cases reported by CBS versus those reported through facility-based surveillance. The report explains how the CBS system works. [Dec 2017]
  • 12. Fighting Polio: Why Radio Dramas Failed in Pakistan?
    by Altaf Ullah Khan, Faizullah Jan, and Sayyed Fawad Ali Shah
    As part of its Learning by Ear project, in 2012-13, Deutsche Welle (DW) radio’s (Urdu and Pashto) services aired a series of radio dramas in an effort to change behaviours of the residents of Federally Administered Tribal Areas (FATA) and Khyber Pakhtunkhwa (KP) in Pakistan. This study examines the content of the episodes of one such drama, “Loye Jazbe” (“High Desires”), which aimed at changing behaviours about polio vaccination among its listeners, and evaluates its effectiveness. One of the problems was that all the writers and actors were residents of Peshawar. Pashto as spoken in the urban areas is distinctively different from Pashto spoken in the rural areas of Pakistan and FATA, and the producers hired writers and actors who did not speak Pashto the way the intended audience speaks it. “The producers did not involve members of the target community at any stage of the production process.” The researchers suggest that future EE programming c! ould benefit from the principles of Community Based Participatory Research (CBPR). Involving community members in the dramas and letting them perform different characters could have improved the parasocial interaction between the audience and the actors, which is regarded as vital for the success of EE interventions. [Jan 2016]

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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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