This presentation by Rustam Haydarov of the United Nations Children's Fund (UNICEF) was produced for the 15th meeting of the Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative (GPEI), October 31 - November 1 2017, London, United Kingdom (UK). It covers:
- Social data in the context of current GPEI priorities
- What data are collected
- How data are used
- Challenges and gaps
- Global guidance review
- Way forward
As detailed here, the social data focus has shifted throughout the years of the polio eradication effort: from converting refusals of the oral polio vaccine (OPV) to vaccinating all missed children to building trust and, most recently, to mitigating vulnerabilities and risk. Haydarov stresses: "Vaccine acceptance is not a steady state. Hesitation can endanger success. High vaccination rates belie social fragility." Some worrisome factors include: campaign fatigue, caregivers who think polio is curable, belief in negative rumours, those who do not think giving OPV is socially acceptable, and those who do not think OPV is a priority in the absence of cases.
Haydarov explains that, in the face of such factors, the health system and community need to work together, attending to not only supply issues but also demand. The caregiver experience at the point of service can positively or negatively influence the latter; a health worker needs to have a culturally appropriate profile and to be knowledgeable, compassionate, communicative, and motivated.
Haydarov lays out the quantitative (e.g., communication indicators) and qualitative (e.g., social mapping) data that are available. He outlines the types of periodic campaign data that are collected, highlighting the need to shift outside of the "comfort zone", asking questions such as, "Are there other opportunities to engage full-time social mobilisation networks in periodic data collection and "soft knowledge generation?"
Subsequent slides examine the value of the polling on polio immunisation conducted by the Harvard Opinion Research Program (HORP), which entailed formative knowledge, attitudes, and practices (KAP) studies carried out from 2013-2017 in 7 countries. Data on rumours, for example, have informed the design of soap operas in Afghanistan such as BBC Media Action's "Ghamai". In Nigeria, the KAP data have informed actions of Volunteer Communication Mobilizers (VCMs) to engage with caregivers, and BBC Media Action programming (e.g., the Dan Birni feature film) was refocused to increase knowledge. In Pakistan, the KAP data have shaped the building trust, or "Sehat Muhafiz" strategy; for example, 12,000 print and electronic stories in English, Urdu, and regional languages had "overwhelming positive and neutral media tonality", which has shaped social norms and perceptions in the public sphere.
That said, qualitative insights are also important, stresses Haydarov - allowing one to go inside the caregiver's and vaccinator's brain.
Social research gaps include, for example, mobile and inaccessible populations: knowing not only where they are and how they move but also their values, beliefs, and health-seeking behaviour. Many questions emerge, such as: Do they trust the person trying to vaccinate them at a transit point?
Broadly, the way forward involves:
- Supporting advocacy - maintaining social data as a critical element in achieving high OPV coverage.
- Developing global guidance - e.g., a KAP management manual for communication for development (C4D) managers, based on the HORP experience.
- Continuing to build capacity - supporting high-risk countries with targeted and actionable social research strategies.
Email from Ellyn Ogden to The Communication Initiative on April 2 2018. Image credit: UNICEF