This project draws on the respect that people hold for their religious leaders, using the powerful voice of these leaders to communicate key health messages and to motivate behaviour change. A key strategy was participation: 4 Muslim leaders called "imams" became personally involved in the production of printed materials and engaged in informal and structured dialogues with worshippers. Muslim government officials also participated actively.

The programme strategy was developed through close personal contact and collaboration with the Muslim community, which is a minority population in Bihar. It was crucial to learn how best to address this community specifically without exacerbating any existing attitudes of stigma and discrimination. A UNICEF health officer began by approaching local Muslim leaders, including a Muslim consultant who was also a medical doctor, to develop a culturally appropriate strategy for a low coverage population. Together the UNICEF officer and consultant approached the 4 leading imams in Bihar, visiting them individually in the imam's office next to the mosque. They brought materials on polio eradication and shared information to address, and explain how to alleviate, common concerns. One issue they stressed was that polio knows no borders nor religion and that, in this sense, all people are of one community. They concluded by showing the imams an actual vial of oral polio vaccine. Later, the head imam called UNICEF and asked for a second meeting to discuss how they might support polio vaccinations. The personnel also met with the state secretary of health and the minister of health - both of whom were Muslim - to ask for their active support.

Working with UNICEF, the imams produced a pamphlet with key messages, calling on Muslims to get their children vaccinated. The pamphlet was translated into both Hindi and Urdu, for two reasons. First, while Muslims recognise Urdu as "their" language, most Muslims in Bihar can only read Hindi. Second, by using the language of the majority as well as the language of the minority, organisers were able to reinforce the message that vaccination is an issue for the community at large; for this reason, too, the slogan 'We are one community' was emphasised.
This communication strategy was critical to prevent any stigmatisation. The cover featured a photograph of a mosque; the back showed two female Muslim vaccinators. (Note: The pamphlet was later revised to eliminate the photo of the mosque, since it was considered a sacrilege to discard a photograph of that nature. Instead, photos of Muslim children being vaccinated were included on the cover.) All imams signed the text. The draft was then reviewed by the Inter-agency Coordination Committee, the minister of health, and the health secretary. Copies of the final version were printed by UNICEF and delivered to the Ministry of Health for distribution to all districts. Social mobilisation coordinators and NGOs also distributed the pamphlet.

After consultation with the imams, UNICEF approached a Muslim NGO to distribute the pamphlet inside mosques and to discuss it after prayer time. The imams also promoted vaccination during their sermons and in informal discussions with congregation members. One imam launched a polio campaign in his area during a national immunization day (NID). The minister of health and health secretary got personally involved in the mobilisation effort. When they went to the mosque, for example, they made it a point to talk to their fellow worshipers about the importance of protecting their children from polio.

Immunisation and Vaccines, Children, Health.

In 2003, the northern India state of Bihar and its neighbour, Uttar Pradesh, had the highest concentration of remaining polio cases in Asia. Bihar is predominately Hindu with a small Sunni Muslim population. Many of its families have relatives in the more heavily Muslim Uttar Pradesh. This meant that rumours and concerns about the government - including its vaccination programme - spread easily from family to family across the state border. A few years earlier, studies in Bihar revealed that coverage rates for polio vaccination in predominately Muslim areas were lower than the state average.

According to UNICEF, "Since the alliance began in 2001, more Muslim families have participated in vaccination campaigns and coverage for polio vaccination has increased in Muslim areas."