Presented at: India Expert Advisory Group (IEAG), December 11-12 2006
This paper was presented as part of a December 2006 meeting hosted by the India Expert Advisory Group (IEAG) and held in New Delhi, India. Participating organisations included the World Health Organization (WHO), Rotary International, the United States Centres for Disease Control and Prevention (CDC) and the United Nations Children’s Fund (UNICEF).
This paper places the polio eradication activities of western Uttar Pradesh within the context of a much larger global public health initiative. Despite the steadily declining incidence of polio cases in India up until 2005, Uttar Pradesh suffered a severe outbreak of cases in early 2006. This was attributed in part to the unusually high number of families resisting oral polio vaccine (OPV) in this region. Sound communication strategies therefore became particularly critical in encouraging community acceptance of a polio immunisation programme.
In November 2006, Jamia Millia Islamia was commissioned by UNICEF to assess community perceptions towards the Intensified Pulse Polio Immunisation (IPPI). Among other goals, this study sought to probe community support if the space between the rounds was to be compressed.
According to this paper, the research sought answers to the following questions (excerpted from text):
- What is the general perception of the community towards the polio eradication effort? Do they willingly support the programme?
- Do rumours and misconceptions about OPV still exist in the community? What are the common sources of rumours? What are the areas of resistance?
- Does the information, education and communication (IEC) material reach the community? How is it received? Can it convey the threat of polio to the community and prompt people to immunise their children?
- To ensure that immunity levels in the community are kept consistently high, how would the community react if the gap between two rounds was compressed? Would they accept an intensified door-to-door campaign every 15 days?
- To keep people motivated and to sustain their interest in the polio programme, what health initiatives can be combined with the programme.
Key Methods and Findings:
Data was collected from a series of 16 focus discussion groups in four locations throughout Uttar Pradesh. Respondents fell into one of four categories: mothers of children under 5; fathers of children under 5; older caregivers of children under 5; and influencers. Overall, it was found that:
- People appreciate the efforts made to eradicate polio but would like similar initiatives made for other ailments and diseases.
- People are tired of endless rounds of OPV immunisation.
- Influencers feel that the media should be controlled as it largely plays a negative role.
- Though people generally have faith in the benefits of immunisation against polio and trust the vaccine, doubts over vaccine efficacy and its composition still exist.
- In urban areas, media can be very detrimental. Rumours spread like wildfire when negative articles are published.
- IEC materials do not reach all people equally.
- Despite the atmosphere of general resistance to the idea of more frequent vaccination and a smaller gap between rounds, people will accept intensified rounds in some places if other immunisation is also included.
- To keep people motivated and to sustain their interest in the polio programme, health initiatives that could be usefully combined with the programme differ in rural and urban areas.
Conclusions and Recommendations:
It was widely believed across all groups that intensive partnership with the media to challenge rumours and misconceptions is necessary, and that the programme must engage the media at all levels. Without partnership with the media, influencers feel it would become difficult to sustain long-term community support. Further to this, additional needs of the community must be addressed in subsequent immunisation rounds, regardless of whether rounds are intensified.
Lastly, intensification of rounds should occur gradually to minimise community fatigue and resistance, and should be accompanied by an appropriate communication plan that envisages crafting key messages for mobilisers, a media and IEC strategy, advocacy through religious leaders, and most importantly, engagement of local influencers.
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