This discussion document grew from the work and analysis of the Communication Review/Technical Advisory Groups and is based on field experience, recommendations, and presentations from various partners within the polio programmes of India, Pakistan, Afghanistan, Nigeria, and several other countries where polio is no longer endemic. It was designed to provide a basis for discussion and further reflection towards the establishment of core standard indicators for polio communication. The draft indicators presented below seek to provide a starting point for discussion towards the adoption of a common framework for measuring impact, tracking trends, and planning for polio communication activities. They have been selected to be simple and relatively few in number. They recognise and build on the significant work underway in each of the endemic countries and make use of data being collected and programme resources already planned or deployed.

It focuses on the particular needs of polio communication programmes in High Risk Areas (HRAs) in endemic countries but these indicators and the document itself may be useful for others interested in health communication indicators.

It begins by posing a series of questions whose answers determine the overall communication strategies and approaches to be utilised. The basic questions are:

• Are key programme messages being heard and are they resonating with caregivers, health professionals and community leaders across a range of cultural, religious, ethnic, urban, and rural differences?
• Is the programme building an environment of ownership and trust?
• Does the programme have the people in place to do the work?
• Is the programme well planned and monitored?

The document argues that meeting the challenges and addressing the questions raised above requires a tighter approach to planning, monitoring, and measuring the impact of communication programmes. It also requires a stronger set of communication indicators built around a basic framework. Furthermore, being able to establish base lines and monitor trends and outcomes will require improvements in data collection in all endemic countries. What follows is a basic framework of base line data, indicators, and data sources to verify impact and develop trend analysis to respond more effectively to the specific communication needs of the programme in HRAs and populations.

Base Line Data:

1. Total number of eligible children broken down to lowest administrative level.
2. Number and location of all areas considered to be high risk and the reasons for that designation (virus circulating, poor coverage, refusals, no access etc).
3. Case characteristics and geographic areas of Non-polio AFP cases and polio cases to lowest administrative level.
4. Percentage of 0 dose low dose (under 7 doses) children broken down to lowest administrative level.
5. Percentage and number of missed children by reason.
6. Percentage of children and households converted between rounds.
7. Number and location of areas with poor coverage by reason.
8. Percentage and location of areas where teams did not visit.

The above provides the base line data needed to plan communication activities, focus resources, and track progress. By itself this does not say much about the impact of the communication activities but when related to specific communication indicators this information becomes the basis for communication planning and monitoring because it outlines:

• the number of children in total and the number missed;
• where the virus is circulating and among what specific populations (religion, ethnic group, age, dose level, etc); and
• where the missed children are and why (no team, refusal, lack of access, etc).

From this information it becomes possible to determine where problems exist, whether they can be addressed by communication activity, and, if so, what kind. They also provide a basis to measure trends which can be related wholly or in part to various communication actions taken. They provide the data to ensure that communication resources are allocated efficiently, underserved populations are identified and reached, children receive adequate doses, missed children are identified and reached, refusal families are converted, poor coverage is identified and reversed, and vaccinators are motivated.

Communication Indicators Related to Base Line:

• Resource Allocation (2 above):
  Percentage of HRAs with financial resources for communication in place prior to the round according to the level set in the micro-plan. Target = 100%.
• Underserved Populations (3 above):
  Percentage of HRAs with communication strategies, activities, and messaging specifically designed and targeted at ‘under-served’ populations as identified in 3 above. Target = 100%
• Newborns and Most Susceptible (4 above):
  Percentage of HRAs with specific communication strategies to increase vaccination of newborns and reduce numbers of low dose children. Target = 100%
• Missed Children (5 above):
  Percentage of communication micro-plan in HRAs adjusted to address reasons for missed children. Target = 100%
• Conversions (6 above):
  Percentage of HRAs with social maps that track conversions by reason. Target = 100%
• Coverage (7 above):
  Percentage of areas with poor coverage in previous round targeted for intensive activities in current round. Target = 100%
• No Team (8 above):
  Percentage of teams in these missed areas from previous round, receiving refresher/IPC training prior to current round. Target = 80%

Communication Indicators Related to Knowledge:

• Percentage of households that know about the round before hand by source of information. Target = 80%
• Percentage of households that recall 1, 2 or 3 of 3 key messages as set by the country but focused on core OPV knowledge and strategic campaign messaging. Target = 80% recall 2 or more.

Communication Indicators Related to Operations:

• Percentage of HRAs with micro-plan revised and implemented according to the plan. Target = 80%
• Number and percentage of HRAs with dedicated and trained polio personnel demonstrating effective coordination and analytic capacity. Target = 80%
• Percentage of vaccinators, supervisors, and monitors proficient in answering campaign FAQs, knowing the date of the next round and knowing what to do when they don’t know an answer. Target = 90%
• Percentage of non-converted refusal households in prior round visited by an influential person between rounds. Target: 80%

Communication Indicators Related to Media:

• Percentage of media articles by tonality. Target: 80% should be positive or neutral.
• Percentage of news articles with one or more error of polio fact. Target = less than 5%.

The full article contains explanations on the importance of each indicator, what it measures, and where to find the information sources.