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