Global Consultants, Inc. (Coates); The George Washington University (Waisbord); CORE Group Polio Project (Awale, Solomon, Dey)
"Community mobilization coordinators played a critical role in reducing community resistance to vaccination."
This paper describes the process and outcome of a partnership approach to eradicating polio in hard-to-reach areas of Uttar Pradesh (UP), India, developed by the Social Mobilization Network (SMNet) - a network of United States (US)-based CORE Group member and local nongovernmental organisations in partnership with the United Nations Children's Fund (UNICEF). Created to address ongoing poliovirus circulation, as well as low routine immunisation (RI) coverage, the SMNet's driving goal was to improve access and reduce family and community resistance to vaccination. The partners trained thousands of mobilisers from high-risk communities to visit households, promote government-run child immunisation services, track children's immunisation history and encourage vaccination of children missing scheduled vaccinations, and mobilise local opinion leaders. What were intended to be creative behaviour change communication (BCC) activities and materials, which focused on both individual- and community-level behaviour, are explored here in detail. In short, they promoted vaccination awareness and safety, household hygiene, sanitation, home diarrhoeal disease control, and breastfeeding.
The paper describes the organisational elements of this process, such as the training of sub-regional coordinators (SRCs), social mobilisation coordinators (SMCs), district mobilisation coordinators (DMCs), block mobilisation coordinators (BMCs), and community mobilisation coordinators (CMCs). Specific activities undertaken by each as part of this partnership are outlined in the paper. For example, "During frequent UP-wide campaigns, CMCs organized children's rallies and mosque/temple announcements, helped the vaccinators set up booths, accompanied them to houses of missed children, and assisted in convincing resistant families to have their children vaccinated. At the community level, CMCs participated in routine immunization trainings and service delivery, and they organized mothers' and influencers' meetings, using educational materials and discussions to promote immunization and other positive health-seeking behaviors. SMNet worked to secure the endorsement and active support of influencers, such as political and religious leaders, doctors, athletes, and artists, who were respected and well-known in the community and were consequently able to influence families' decisions and actions."
Programme decision-makers at all levels used data gathered by SMNet (e.g. community maps and household registers) that were aggregated at community and district levels, and senior staff provided rapid feedback and regular capacity-building supervision to field staff. Use of routine project data and targeted research findings offered insights into and informed the programme's approaches to overcoming community concerns impacting immunisation coverage. "Over time, the partners began to value data and to invest resources into using household surveys and focus group discussions to assess and strengthen immunization knowledge, attitudes, and practices not only of community members but also of the SMNet field workers and local health workers. For example, a qualitative study showed that some CMCs and local health care providers had resisted vaccinating their own children and that local health care providers were counseling parents to avoid vaccinating children who showed signs of even the most minor illnesses. In response, SMNet partners revised messages and training curricula and adopted more frequent and interactive training approaches to prevent misinformation."
While the SMNet worked in the highest-risk, most poorly served communities, data suggest that the immunisation coverage in SMNet communities was often higher than overall coverage in the district. "While of course it is not possible to say definitively that the SMNet was crucial for polio eradication in India, it certainly seems quite plausible. Indeed in countries such as Nigeria and Pakistan, where polio eradication remains stubbornly elusive, the major impediment appears to be local attitudes and suspicion toward program efforts by the local population. Local adaptation of some SMNet approaches might be very helpful in ongoing eradication efforts."
As detailed here, the partners' organisational and resource differences and complementary technical strengths posed both opportunities and challenges. To cite only one aspect described within this section of the report: "Continuous and transparent communication and ongoing data-sharing among all SMNet levels, from grassroots CMCs to high-level policy-makers, helped to ensure that all partners became aware of any field challenges without delay and responded rapidly with appropriate policies and resources. This contributed to trust and respect both within the SMNet and the communities. Within the SMNet, this fostered ownership and participatory approaches to identifying and solving problems." At the conclusion of the report is a list of practical and conceptual lessons for health communication and social mobilisation, as well as for partnerships in global health.
To learn more about CORE's work on polio in India and to access resources such as information, education, and communication (IEC) materials, click here.
Global Health: Science and Practice 2013, Volume 1, Number 1. Image credit: The End of Polio