This PowerPoint presentation was prepared for a September 2007 United Nations Children's Fund (UNICEF)-hosted meeting dedicated to examining polio communication efforts in Afghanistan. In support of the final global push towards polio eradication, regional presentations were given by in-country communication and health practitioners working in Afghanistan's polio endemic regions. These were assessed by an external panel of experts in the fields of development communication, mass media, epidemiology, and anthropology, who provided communication programme recommendations based on data presented by the country teams, as well as data gathered on field visits to the endemic states. Communication strategies presented at this meeting were primarily focused on:
- Analysing the results of programmes implemented through September 2007
- Detailing activities on national and sub-national levels, with a focus on transient populations, security concerns, and social mobilisation, media, and political advocacy strategies
- Suggesting communication strategy and programme refinements for the next 6- to 12-month period, designed to support Afghanistan's polio eradication efforts
This presentation provides an overview of Afghanistan's Eastern region including: the epidemiological status of wild poliovirus (WPV) in the area; polio immunisation activities conducted in the region in 2007; nomadic population movement; social mobilisation and polio communication activities; high-risk area strategies; major constraints; and finally, recommendations for moving the programme forward.
Afghanistan's Eastern region consists of 43 districts which are serviced by 144 functioning health facilities. Areas with highest population densities include the northeastern districts along the Pakistan border, as well as specific districts along the country's northwest border. To date in 2007, Afghanistan has seen two cases of type 2 poliovirus (P2) reported, in the provinces of Nangarhar and Laghman. No type 3 (P3) cases have been reported in the country since 2004.
Nomadic population movement presents a challenge for polio vaccination teams, and the region has 13 specified vaccination teams designated to immunise the 7,040 children under 5 years of age that travel annually. The polio vaccination network in this region consists of over 3,700 volunteers, 328 supervisors, 63 district coordinators, and 58 monitors. Two percent of these volunteers are female.
The current risks facing the team in the Eastern region are seen to include:
- Access issues in certain areas, due to geographical difficulties or active fighting
- Low routine immunisation (RI) in certain areas (e.g. Noristan)
- Cases of immunisation refusal
According to the presenters, the percentage of acute flaccid paralysis cases reported within seven days of onset in the Eastern region has increased from 2006 to 2007, and is currently among the highest in the country.
Social mobilisation activities in the region have included the inauguration of immunisation activities by the governor, deputy governor, and provincial commission members. Polio training has been conducted with over 500 key communicators (i.e. elders, Mullahs, teachers, and community health workers) in high-risk districts. In addition, a variety of media activities have been launched, including:
- Radio and television dramas
- News announcements
- Billboards for cart pushers at the Torkham border
- Interviews and round-table discussions
An example of the monitoring checklist used during immunisation activities is provided, with an analysis of responses gathered. Notably, 93% of respondents reported knowing about the vaccination rounds before the team arrived, but only 77% reported knowing when the next round would take place. A high level of understanding was observed regarding the transmission of WPV and the importance of sanitation in preventing the disease (80%-95%). Monitoring and evaluation of the programme is conducted by individuals from the Ministry of Public Health, the World Health Organization (WHO), and UNICEF.
In identifying high-risk areas for focused immunisation activities, the team included the following criteria:
- Polio cases present in the district
- Population movement
- Border districts
- Refusal cases
- Dense populations
- Slum areas
Major constraints to polio eradication in Afghanistan's Eastern region include a lack of social mobilisation materials, insufficient numbers of female community health workers, and difficulty in communicating with household women. In addition, cross-border movement and security concerns pose a challenge.
To conclude, the team recommended the following future steps to strengthen polio immunisation activities in Afghanistan's Eastern region:
- Improve communication for cross-border immunisation activities with Pakistan
- Initiate Days of Tranquility to allow vaccination in zones of active fighting
- Improve intersectoral collaboration and mobilisation of community structures
For a copy of the full PowerPoint presentation, please contact Kiyuri Naicker at knaicker@comminit.com
