Executive Summary

This document reports the findings of an assessment conducted between June 2003 and January 2004 of communication programs in support of the Polio Eradication Initiative (PEI). The United States Agency for International Development (USAID) Washington solicited the CHANGE Project to carry out an assessment of communication programmes in support of polio eradication (PE).

From the late 1980s until the mid-1990s, communication largely played a secondary role in the PEI. Because many of the difficulties that PE has encountered in the past years have been defined as “communication obstacles,” communication has gained more attention and recognition. However, increasing awareness about the importance of communication does not mean that the status of communication programmes is comparable to other aspects of the PEI (vaccine procurement, cold chain, surveillance). Social mobilisation/ communication committees (SMCCs) have been established, but staff and resources are thin (particularly at state and district levels). Most SMCCs are active only a short time before National Immunisation Days (NIDs). Consequently, plans are put together haphazardly and the quality is uneven. Although there are more communication positions, polio partners (PP) need to make a stronger commitment by adding and training staff.

This report reviews the design and implementation of programmes for advocacy, social mobilisation (SM), and information, education, and communication (IEC) activities. Through global advocacy, the partnership has garnered a good deal of support from heads of state, international organisations, the private sector, and celebrities. Below the global level, however, advocacy activities have had mixed success. SM has been central to NIDs by putting in action a variety of community organisations. However, PP have not taken advantage or capitalised on either the social energies or the organisational capital to improve the chronic problems with routine immunisation (RI) and surveillance, particularly in African countries.

IEC strategies have been used with interesting and positive results, but more systematic, evidence based planning has been missing. Decisions have generally not been based on studies of populations’ knowledge and attitudes about immunisation. Had this data been strategically used IEC interventions could have been more effective in reaching zero-dose children. Data on the main sources of information on the time and place of vaccination show similarities across countries and regions. Sources are different in urban and rural settings: whereas radio, television, and religious organisations (mosques, churches) and leaders (priests, imams) are effective means of information in cities, interpersonal communication (IPC) between caretaker with local leaders and health workers is crucial in towns and villages.

One of the most important lessons about the impact of communication programmes is the need for integrated media strategies. When communities hold favourable attitudes towards immunisation and logistics work well, conventional communication activities can successfully promote demand and convey basic information. However, when communities are filled with negative rumours or resist polio vaccination during NIDs, other communication strategies are needed. The media are important to create awareness, but their impact is limited if IPC and SM are not conducted to guarantee that caretakers will bring children to vaccination booths or wait for vaccination teams (VTs) at home. Without IPC and community action, the media have limited impact on turnout figures and coverage rates.

This report also examines the functioning of communication programmes within the institutional structure of the PEI, namely the inter-agency coordination committee (ICCs), the social mobilisation/ communication committees (SMCCs), and the interaction and coordination among PP. It is concluded that an effective ICC needs to meet four conditions:

1. Regular participation of all major partners
2. A clear agenda that reflects the priorities of all partners
3. Good communication system between national ICC and state ICCs
4. Sustainable and effective leadership

Country experiences show that ICCs and the partnership function better when roles and
responsibilities are clear, partners are in regular contact to build trust and facilitate coordination, and are unequivocally committed.

The performance of the SMCCs has been highly uneven. At the national level, they have been
increasingly effective in recent years (although with important variations across Countries), but remain relatively disempowered. At state levels, they lack sufficient human and technical capacity and leadership to carry out activities and coordinate with the national SMCC. One of the key deficits is the lack of a sufficient number of staff with the appropriate technical expertise and management skills. Generally, the Ministry of Health (MOH) has a small number of officers in communication positions that generally lack formal training in communication. PP have better capacity than governments, but their capacity is
stronger in the capital city than in peripheral areas. The fact that communication staff working for PP particularly outside the main cities are typically hired on short-term contracts has resulted in constant turnover and weak ownership.

Institutional problems are also related to limitations in technical and personnel capacity in communication programmes. The most important limitations have been:

• The lack of communication staff with a broad perspective of communication at all levels;
• The lack of expertise in communication planning for SM among PP, especially at MOHs at central and local level;
• The lack of expertise in operations and evaluation research and strategic orientation
  towards immunisation as a social practice;
• The poor quality of IPC skills among HWs and VTs.

Notwithstanding these limitations, communication programmes in support for polio eradication have made a number of contributions in terms of building capacity:

• Developing micro plans
• Organizing social mobilisation
• Carrying out advocacy among local leaders
• Dealing successfully with rumours and resistance
• Identifying hard-to-reach populations

That capacity is not equally distributed across organisations and administrative levels, and the quality of those skills can be improved.

Change Project website on June 7 2006.