United Nations Children's Fund (UNICEF) Regional Office for South Asia

May 2004

This UNICEF working paper describes the use of strategic communication to increase polio immunisation rates in Uttar Pradesh (UP), India, with a particular focus on Muslim boys under 2 years of age. The campaign follows a jump in polio cases from 2000 to 2002. In UP in 2002, 80% of the cases were in children under 2, mostly boys and mostly Muslim. While UP is only 20% Muslim, 68% of polio cases occurred among Muslim children.

Prior to this campaign, a UNICEF-commissioned study of the barriers to polio eradication in UP found that many people believed vaccination was ineffective and that polio could be cured. Frequent vaccination rounds in the area had also led many to believe the vaccination is either ineffective or is being used to control Muslim populations by causing infertility.

An "underserved strategy" has been adopted to address these barriers, with the focus on "engaging opinion makers, professionals and influential figures to rectify popular misconception of polio, tackle resistance and assuage fear to ensure not a single vulnerable child is missed in every round of NID/SNID [national immunisation day (NID), supplementary NID (SNID)] leading to the global deadline: 2005."

The communication campaign draws on a large social mobilisation network (SM Net) and three Muslim universities with a large network of religious, academic, professional and grassroots institutions. Teams (often made up of two vaccinators and a local community member) visit house to house in an effort to persuade families to vaccinate their children. Vaccinators are "given training to improve interpersonal communication skills."

This paper describes how the involvement of Aligarh Mulsim University (AMU) has lent credibility to the vaccination drive among Muslims. Outreach services, in the form of local clinics and "health camps" have provided community members with convenient and trusted sources of health care and vaccinations. The universities Jamia Millia Islamia (JMI) and Jamia Hamdad have also worked to increase awareness and sensitisation to vaccination issues.

The Impact section of this paper reports on the success of the programme, which saw a drop in the number of insufficiently vaccinated Muslim children from 29% to only 5% between 2003 and 2004. The rate in Hindu children also dropped from 14% to 2% over the same period.

The paper concludes with a series of observations and lessons learned (abbreviated below):

1. Involvement of religious leaders, eminent persons and medical authority effectively brings authority to bear on resistant attitudes that are founded on rumours.
2. Opinion changes through local interactions with resistant families are sustainable only when buttressed by similar opinion changes in the macro or larger environment.
3. The introduction of health services has tentatively bridged the need of preventive and curative care for children of these communities, and helped change parents' attitude towards polio immunisation.
4. Contributions of individuals working in the neighbourhoods are vital to linking the polio eradication goal to the grassroots.
5. The JMI network’s involvement in microplanning and coordination with other polio partners in communities on outreach activities is increasingly recognised by the district health department as valuable.
6. The seamless coordination between these institutions and their local networks, with the SM Net and partners, is contributing to high turnout on booth days and fruitful house-to-house search of children.

Contents:

• Introduction
• Why Muslim boys under 2 years of age?
• The Underserved Strategy
• Engaging movers and shakers in the intellectual and religious world
• Impact
• Lessons learned

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