This report from the United Nations Children's Fund (UNICEF) presents the findings of an independent polio communication review conducted in Afghanistan, a polio-endemic country, as part of the Global Polio Eradication Initiative (GPEI). In view of the usefulness of these reviews to objectively evaluate the existing communication strategies and interventions and to guide future communication strategies and interventions, this September 24-30 2011 review followed up on the reviews conducted in 2007 and in 2008. Focused on the Western, Southern, and Northern regions of the country, the review addressed priority themes and issues that had been identified by prior Technical Advisory Group (TAG) meetings and by internal assessments undertaken throughout the year by the national and sub-national teams.
The review team comprised 6 international communication professionals representing diverse institutions and backgrounds in public health, communication, and immunisation. The review methodology consisted of appraisal of various programme documents and reported and evaluation data, meetings with stakeholders at national and provincial levels, discussions with field staff, and meetings and focus group discussions with a multitude of players in polio partners' PEI efforts. Each team attempted to arrive at a shared analysis of the problems with the provincial teams, and subsequently agree on a limited number of priority recommendations, which should be implemented within a 6-12 month period of time and monitored with indicators and milestones.
Team A visited the Southern region (Kandahar) to conduct an overall assessment of the efficacy of the Polio Communication Network and linkages with communication and capacity-building; team B visited the Western region (Herat) to review how partnerships, including cross-sectoral ones, and the media can be better used for polio communication; and team C visited the Northern region (Mazar-e-Sharif) in an attempt to understand better how polio and EPI communication can be strengthened and integrated into existing communication approaches. Section 2 of the report offers a detailed analysis of regional challenges, together with recommendations to address each challenge. A detailed implementation plan for all recommendations, by region, is also included as an annex to this report.
However, some common recommendations emerged from all regions:
- A National Communication Strategy for Polio and Expanded Programme on Immunisation (EPI) is required. - "Polio and EPI communication strategies and approaches in polio- affected as well as polio-free areas of Afghanistan are basic, and largely limited to the airing of radio and television public service announcements (PSAs) around polio campaigns....The national strategy should include a mix of communication approaches that include the use of mass media and IEC [information, education, and communication] materials as well as locally organized participatory approaches that encourage community ownership, engagement and dialogue about immunization services. Based on a national strategy, regional, provincial and district-level strategies should be developed and aligned to ensure all field activities are focused towards achieving common objectives and measurable outcomes for polio eradication and improved EPI. The next communication review should assess progress against the outcomes and indicators set forth in the national communication strategy."
- Communication materials and messages (for Polio and EPI) need to be pre-tested, branded, and standardised and should be flexible enough to facilitate local adaptation. - "There are a handful of basic IEC materials produced for EPI and Polio at the national and provincial level, but in general, they do not have synergy or impact on visibility due to the fact that materials do not share a common brand (for EPI) or a common look and feel (for Polio and EPI)....It is important to create standardised IEC materials linked to the polio programme through branding and designed for use in a context in which both audiences and service providers often have low literacy levels. Mass media products are being used in NIDs [National Immunisation Days] but they would be more effective if they were part of a well-planned national mass media communication strategy which would ensure the use of tested and standardised messages prior to NIDs and ideally between rounds as well for routine and polio vaccination. Given the very diverse contexts in the various regions of Afghanistan, communities and mothers in particular are likely to have different motivational triggers to vaccinate their children. Therefore, local strategies and messages will need to be developed based on an analysis of existing data and commissioned social research."
- Radio as a vehicle for mass media and community engagement needs to be strengthened and should particularly focus on reaching youth and women in the Southern region. - "Focus group discussions with women in Kandahar and others in Helmand consistently requested formats that offer more in-depth information beyond simple radio spots (such as radio dramas or soap operas). Other formats that seek to engage and interact with target groups through Q&As, games, etc. should also be explored."
- Strengthened and standardised interpersonal communication (IPC) training is required for vaccinators, communication partners, and the Polio Communication Network (PCN). - "All vaccinators, partners and PCN members seem to be given IPC training. However, all teams regularly heard that the quality and standardization of IPC trainings was inconsistent....IPC training should also be conducted with a range of stakeholders and partners....IPC training is particularly critical for vaccinators....This needs to be supported by communication messages for vaccinators, which also promotes and encourages the critical role that they are playing in the polio eradication campaign....With low level of literacy among staff in the field, it is critical to develop very simple training modules with visual aids in order to impart skills and messages: audio visual aids such as DVDs can be explored to help standardize the quality of training....Simple post-training testing would help determine recall and small incentives such as certificates could be included to indicate the training had been successfully completed. (Other incentives could also be included such as an award for the best role play or other aspect of the IPC component of the training which would also help ensure the IPC training component is carried out.)"
- Additional partners who can engage with communities on polio and EPI need to be mapped, prioritising those who can reach high-risk groups such as women, inaccessible and nomadic populations in the South. - "There is considerable space and support amongst stakeholders to integrate polio with other development programmes and public health messages. For instance, the UNICEF Education programme has women's literacy projects and community based schools which could incorporate polio messages through curricula materials but could also go further to explore ways to actively engage women and school children in awareness raising and IPC activities....Internal (within UNICEF) and external partnerships should be mapped out to determine the most strategic ones that can help expand our coverage and reach high risk groups such as women, inaccessible and nomadic populations in the South in particular."
Email from Kshitij Joshi to The Communication Initiative on December 11 2011.