"The Afghanistan polio programme continues to work in extraordinary circumstances and in an environment that is not only physically dangerous but also fluid and extremely challenging to manage."
As part of the global effort to eradicate polio, this report shares the insights of a 4-person team who met in Afghanistan in November 2012 to report on progress related to the implementation of recommendations made by an independent review, undertaken in July 2012, which covered 5 main areas. Reflections on progress on these, as well as the sub-recommendations - with communication elements highlighted - are noted below.
- Management and accountability and routine immunisation:
- The follow-up team found that the recommendation to put the District at the centre of the polio programme has become a core strategy and that a new structure is emerging that incorporates a greater focus on technical support, localised data analysis, and an emphasis on prioritising activities that reduce numbers of missed children.
- "There were a number of sub-recommendations on pre and intra-campaign monitoring including District level review and planning meetings at District level where possible (or Provincial where not). The importance of these is clearly recognized by the programme and the District dashboards incorporate indicators for pre and intra-campaign monitoring and post campaign outcomes. Furthermore, the existing...structure continues to be discussed in relation to additional or revised pre-campaign and social mobilization indicators such as tracking the pre-campaign training of both vaccinators and social mobilizers and the number of social mobilizers making house to house visits prior to the campaign."
- "While not all of the ideas suggested have been piloted, a tele-survey was conducted in which 4,200 phone numbers provided by a mobile phone company were called to see if the team had been to the area, how many children were in each household contacted, how many of them had finger marking and how the household had learned of the campaign. While the impact of this is still being assessed, it is evidence that the programme has been exploring the utilization of strategies for community monitoring....Improving IPC [interpersonal communication] training for vaccinators including a checklist of strategies to support each team to identify and gain access to all children in a household and to document a time of return where children are not available was recommended along with the observation that direct training by District EPI [Expanded Programme of Immunization] personnel will be more effective than cascade training."
- The Permanent Polio Team (PPT) strategy is designed to avoid the visibility and hype of large-scale SIAs that is more acceptable in that it allows vaccination teams to move house to house in a manner that reduces numbers of missed children and allows the programme to closely monitor the performance and hold teams accountable for their activities. "This is clearly not a strategy working at small scale and is working in accessible as well as inaccessible areas."
- Inaccessibility: "Through partnerships (notably with ICRC [International Committee of the Red Cross]) and ongoing local efforts the programme has significantly reduced the number of children in inaccessible areas....[T]he strength of the programme for gaining access ultimately rests in its ability to negotiate with local communities and to have the flexibility to develop local responses to community needs. Such flexibility is being demonstrated through the use of delayed or slowed campaigns and the willingness of all to enter into dialogue with communities wherever they may....Finally, there is a process under way to develop a new campaign and materials focused on polio being 'everyone's responsibility'. This will be used throughout the country. In sensitive areas the Follow up team was told that adaptations are planned to remove logos and in some cases not use campaign IEC materials at all. The approach is planned to be high profile where possible and lower profile where necessary. It will be important to place decisions regarding the use of materials and the profile of the campaign at the District level and in consultation with local communities and other partners such as ICRC."
- Communication and demand: "The main sub-recommendations focus on taking time to assess the impact of IEC materials and mass media outlets and their impact on demand generation....[T]here has been no specific critical assessment on the use of IEC material or the impact of mass media on demand as recommended. The programme has, however, used other sources such as pre-existing maps of radio and media channels together with District level information to identify media outlets to work with and feels strongly that IEC materials have an important role to play....A new IPC training module has been developed and plans are for all social mobilizers and vaccinators to have received this new training by the end of December. Clusters identified as high risk for communication (high child absence and low awareness) now have a social mobilizer accompanying vaccinator teams assisting them to access children at the doorway, providing more complete polio and routine messaging and helping to identify missed children....Social mobilizers are also being integrated more closely with the vaccinators through joint training and microplanning and there is pilot project to have social mobilizers go out before the round to mark the number of children in each household to provide vaccinators with a more accurate enumeration of children in their area."
- Cross-border threats: There has been a focus on strengthening transit points around high-risk districts (HRDs) for some time, with the idea of vaccinating children leaving or entering inaccessible areas and/or along main transportation routes where vehicles are stopped at check points.
- Programme coordination: "[T]there is more that can be done especially through better communication and coordination at Provincial and District level and through regularized meetings or even brain storming sessions amongst agencies of relevance to the programme."
Image credit: The End of Polio