"The past 18 months have seen the emergence of a powerful platform to collect and analyze social data, and the birth and subsequent growth of a network of skilled community mobilizers who contribute contextual evidence about the feelings, opinions and other variables responsible for many of the same children being repeatedly missed."
With a focus on Pakistan and Nigeria's most vulnerable communities, this report provides insight about the role that community push-back is playing in the transmission of the polio virus and how the Global Polio Eradication Initiative (GPEI) can mitigate these social risks to reach every missed child.
According to the report, improvement in oral polio vaccine (OPV) coverage is evident everywhere except the Nigerian state of Zamfara and two northwestern areas of Pakistan: the Quetta Block of the Balochistan province and the neighbouring Federally Administered Tribal Areas (FATA). Share of refusals is significantly higher in several challenging areas of northern Nigeria, Pakistan's Quetta Block, and the Katanga province of the Democratic Republic of the Congo (DR Congo), where as many as 3% of all children under the age of 5 years are missed due to caregiver refusal. Conflict is an obstacle, with key areas continuing to struggle with fragile or deteriorating security, threatening programme success, staff morale, and ability to build trust with local communities. Social mobilisers are working to build trust; more than 5,000 mobilisers work in 78% of the high-risk areas of Afghanistan, Nigeria, and Pakistan. Each month they directly engage with over 800,000 households.
While the programme has scaled up to reach more families and children on the doorstep, the report stresses that more needs to be done to reach them in farming areas, in schools, and on the move. Particularly vulnerable, for example, are children growing up with caregivers who cannot read or write or in conservative societies where elders are the primary decision makers. "Caregivers dissatisfied with vaccination team makeup or performance are more likely to refuse vaccination. Consequently, shifting the programme's focus - from districts, sanctuaries and generally geographic criteria to specific communities, groups, households and children united by common social characteristics - is a priority."
"Maintaining an appropriate - accurate and positive - public image of the polio eradication effort is another considerable challenge. Some of the highest-risk programme areas are home to continued negative reports about the polio programme. In others, caregivers place little faith in the media and trust only interpersonal communications from local religious or community leaders and influencers....To combat such perceptions, efforts continue to be made to foster local buy-in and ownership by engaging influential Muslim scholars, Imams, popular celebrities and communities themselves. The need to ensure that polio eradication is not seen as a programme driven by outside interests must often be balanced with the humanitarian needs in a state of emergency, and the urgency and external pressure to achieve results."
The report notes that dedicated social mobilisation networks are "the key component of the operational strategy in highest-risk areas." Rather than coverage, it is urged here that reaching and immunising an unprotected child must be prioritised. "Programme data is critical to ensuring that the highest-risk areas receive appropriate levels of dedicated human resources support....[R]eaching large or widespread populations also requires programme staff to encourage, facilitate and otherwise support house-to-house communications to magnify and spread the goodwill generated by personal interaction on the doorstep.
"New mass media campaigns that build on the power of interpersonal communications are underway in Afghanistan and Pakistan, with the ultimate goal of igniting a broad social movement against polio. Population awareness has already begun to rise in both countries as a result. As the media campaign continues to roll out in a series of planned phases, it must move beyond raising awareness to reinforce on-the-ground efforts of promoting local ownership and engagement."
Recommendations for the communications programme include:
- Act on previous decisions to improve data quality on the global scale.
- Continue to invest in social accountability alongside political accountability.
- Prioritise efforts among highest-risk areas and families.
- Identify new strategies to reach children absent during vaccination-team visits.
- Profile frontline workers and invest in their skills and motivation - "Interpersonal skills training for all frontline workers must be rolled out in each priority country before the end of the year."
- Establish standard operating procedures for all joint teams in the field - "In all countries - including Pakistan, which has already developed such procedures - new guidelines should be launched via joint orientation sessions and monitored to ensure field use."
Email from Susan Mackay to The Communication Initiative on October 26 2012.