This report is on the July 2008 Core Group Polio Project (CGPP) team baseline assessment to better understand the specific barriers to polio immunisation in India. The CORE Group Polio Project (CGPP) addresses a variety of challenges to reaching inaccessible communities with vaccination services and surveillance. The baseline survey was planned with the broad objective to establish baseline values for project indicators and provide inputs for advocacy, communication, and social mobilisation (ACSM).

According to the CORE website, "India remains an epicenter of wild poliovirus transmission and is responsible for a number of cases imported in recent years into previously polio-free countries not only in Asia but also in Africa. India's total number of cases was 874 in 2007 and 674 in 2006, compared to only 66 cases nationwide in 2005. Because of the high quality of surveillance in India and the high level of resistance to polio vaccination in concentrated sub-populations, the CGPP program in India focuses on social mobilization and detailed, sub-district level micro-planning to overcome resistance in order to improve supplemental polio immunization and routine immunization coverage. The CGPP-India operates in 11 high risk districts in the state of Uttar Pradesh, reaching 21,428,498 children under 15 each year."

Specific survey objectives were to assess polio coverage given during the Pulse Polio programme; to assess the routine immunisation (RI) coverage (oral polio vaccine (OPV) zero, diphtheria-typhoid-tetanus (DPT)3, measles), and to explore some of the communication issues (barriers, resistance, etc.) A quantitative survey approach was used in 10 districts. A total of 605 mothers with children in the age group of 12-23 months were interviewed.

Findings include the following:

• Community mobilisation coordinators (CMCs) emerged as the most common source of information in a community for polio vaccination.
• There is high acceptance (82%) among mothers for repeated polio doses.
• About 70% of mothers believe that the first polio dose should be given within the infant’s first four weeks.
• Routine immunisation coverage and retention of an immunisation card is low.
• Last polio campaign reach is 96% of the households in a geographic region.
• Only one -fourth of mothers visited a polio immunisation booth.
• Awareness about acute flaccid paralysis (AFP) is low.
• There is a perception that sick children should not receive polio vaccination.
• Few mothers (40/605) reported that they have attended any meeting conducted by CMC.

The following are among the emerging recommendations:

• "Literacy levels of mothers and the fact that they are largely at home needs to be taken into account while planning any communication activity."
• "CMC being the most commonly cited source of information can play a vital role in expanding coverage and increasing acceptance of immunization services. Thus there is a need for their ongoing capacity building and review of performances."
• "Special focus is essential to assess specific barriers and devise strategies for reaching the 4 per cent households that are not covered during the campaign. Specific note of their characteristics and barriers to be assessed."

Some of the communication messages that can be focused on during the program period are: 

1. "A substantial proportion (22%) of mothers is not aware about when the first dose of polio should be given. This has an important indication for creating greater awareness about immunization schedule among mothers. 
2. There is an identified need to expand the channels through which mothers can become aware about the campaign.
3. Importantly 4 per cent of mothers said that their households were not visited by vaccinators. To ensure that efforts are in line with national goal of not missing a single child during the campaign period, program components should devise strategies to close this gap. Capacity building of CMCs to identify and work with these families with effective communication approaches and strategies will be an important input for closing this gap.
4. Retention of immunization card can also be considered a proxy indicator to gauge mothers’ engagement in routine immunization.
5.  Communication messages encouraging mothers to seek and retain immunization card can thus be integrated into the messages targeting mothers.
6. Communication messages used during IPC (Inter Personal Communication) with mothers should be designed to address the issue that sickness is not a contraindication of immunization.
7. As child grows the subsequent doses of immunization corresponding to later age declines. It is thus essential for messages to address the gaps in knowledge related to complete immunization schedule and adherence for each child."

CORE Group members in India:

• Adventist Development and Relief Agency
• Catholic Relief Services
• Concern Worldwide

CORE Group e-newsletter, June 2009, and CORE Group website.