"Pressure from above (government and traditional leadership) is essential to the programme but ultimately it will need to combine this with pressure from below in which passively compliant and non-compliant communities move not just to accept polio vaccine if offered at the door but to view it as an important and valued health service for their children."
This report provides a consolidated summary of the major findings and recommendations of a 4-day polio communication review that was undertaken in 4 states of Nigeria (Sokoto, Kano, Katsina, and Kaduna) by 4 teams. During the September 2012 review, which was called by The Director of the National Primary Healthcare Development Agency (NPHCDA) and coordinated by the Nigerian Social Mobilization Working Group (NSMWG), 12 panellists explored 4 thematic areas:
- Assessing the impact of communication approaches to engage religious and traditional leaders to prevent missing children when trying to administer the oral polio vaccine (OPV) and to resolve non-compliance;
- Assessing the impact/effectiveness of the community engagement approaches being undertaken to reduce missed children and improve community acceptance of the OPV;
- Assessing the impact of communication approaches to reach high-risk groups, including nomads; and
- Improving communication planning based on effective data analysis.
Speaking generally, the thematic teams found that the programme has several strengths to build from, the most prominent being: the reinvigorated engagement of traditional leaders; strong (if still uneven) government support; a surge in partner agency staff capacity; a range of international and civil society organisations (CSOs) engaged in polio activities; and new research, data resources, and tools for tracking impact and mapping households ready or nearly ready for implementation. At the same time, all teams identified the need for better planning, coordination, and capacity building. They were concerned at the way the programme is weaker across all these areas the closer it gets to the ward level and below. A central finding from this review is that - while it is still important to focus on government at national, state, and Local Government Association (LGA) levels, improved national- and state-level planning, and high-level traditional leadership support - there needs to be a new focus on community-level engagement. "The programme will not be able to reach the non-compliant or build support amongst specific and sometimes insular groups such as the Fulani unless it engages those people in their own communities to identify and resolve the local concerns that lead to missed children."
The teams found that the programme remains vulnerable to rumour and misinformation, and communication has a major role to play in reducing this vulnerability. Suggested areas of improvement with regard to community engagement in this regard include:
- Partner coordination and programme harmonisation - e.g., meet jointly with organisations deploying community health worker/volunteer outreach networks.
- Information, education, and communication (IEC) materials, which should be "developed in a manner consistent with proven behavior change communication methodologies. Messaging and content must be data-driven and thoroughly pre-tested to ensure acceptability in the target community, with a particular emphasis on local language and/or low-literacy content."
- Mobilisation networks, including Volunteer Community Mobilisers (VCM) - e.g., "VCM materials and messaging seem to be focused on the 'what', not the 'why'. For example, 'wash your hands' versus 'wash your hands because it prevents spread of germs that will make you sick.' Although the VCMs do seem to understand the need for the actions they are promoting, their presentations to the community do not include that element."
- Data use, monitoring and evaluation, which should involve programme partners jointly determining and tracking key indicators and developing guidelines on the type and frequency of formative data collection, as well as strengthening data analysis capacity.
The report presents 4 interrelated areas that the teams identified as being critical reduce the number of missed children by strengthening the programme at the community level:
- "Update/refine the national communication plan so that it reflects the present surge in resources and capacity and represents agreement between the partners on short and medium term objectives, high risk strategies, milestones, major activities and budget needs.
- Institutionalise regular assessment of progress against planned milestones through national quarterly reports and regular independent reviews.
- Concentrate on strengthening communication planning, implementation and monitoring and assessment at the local level in high risk areas."
- "Develop and operationalize standard operational procedures / protocols including membership for coordination and communication at all levels with special attention paid to key nodes of programme planning national, state, LGA and Ward. As the programme is weakest at the local level it is important to ensure that partners are systematically included at the local level i.e. below Ward level.
- Establish a monthly calendar of events at Federal and high risk state level to be maintained and shared with partners.
- Ensure that minutes of meetings are prepared including attendance and shared vertically and horizontally across the programme."
- Data and Monitoring
- "That key partners prepare and sign on to a standard agreement for collecting and sharing all data...to ensure automatic and full access to information at all levels.
- That the systematic analysis and presentation of social data being done at the Abuja level be reviewed and adapted to provide more consistent support to state / LGA working groups to guide, monitor and evaluate ward level plans and activities."
- Supervision and capacity building
- "Ensure that there is a chain of supervisory staff with communication responsibilities at all levels (national, state, LGA and Ward) and fill any gaps in this supervisory chain as quickly as possible.
- Recognising that many people in supervisory positions will be new, provide them with immediate and ongoing technical support and appropriate management training.
- A plan for training and capacity building should be developed and built into the revised national communication strategy that includes plans for improved coordination and strengthened data and monitoring approaches in the areas of capturing and utilizing data, constructing state and LGA / Ward level plans and monitoring and reporting on progress."
Emails from Chris Morry to The Communication Initiative on September 26 2012 and November 9 2012.