Reaching Every Child: Communication for Polio Eradication in India

Monday, 10th of September 2012

• REACHING EVERY CHILD: COMMUNICATION FOR POLIO ERADICATION IN INDIA

Author: Ellyn W. Ogden, Rina Dey

Affiliation:United States Agency for International Development (Ogden); CORE Group Polio Project India (Dey)

Publication Date: March 29, 2011

Summary: 

"Every aspect of polio eradication has a communication component: Campaigns, surveillance, advocacy and fundraising, new vaccine introduction and certification..."

Ellyn Ogden Polio Presentation

This presentation from a meeting hosted by The Communication Initiative on March 29 2011 ("Social and Behavioural Change Research Results: Strategic Implications") in Geneva, Switzerland explores the evolution of polio communication in north India. The United States Agency for International Development (USAID) funds polio communication because, as described here, it: is critical for success, improves quality, is cost-effective, increases local capacity, and sparks civil society and community participation, which has many beneficial spin-offs.

Opening slides provide context in the form of graphs and charts illustrating the polio situation in India from the late 1980s through to 2010/2011. Historical details are provided to give context for these figures; for example, in 1995, the polio eradication programme was launched in a campaign mode with two National Immunization Days (booth-based), and in 1999, a house-to-house (following booth day) strategy was introduced. In 2001, community resistance grew in Western Uttar Pradesh (UP); Muslim mothers reported the highest rates of hearing rumours/concerns about the oral polio vaccine (OPV) - e.g., some believed that polio immunisation would lead to impotency or was part of a family planning programme. In response, in 2002, a communication response was initiated. The United Nations Children's Fund (UNICEF) and CORE deployed hundreds of volunteers from schools, nursing schools, and non-governmental organisations (NGOs) in high-risk areas of UP to tackle resistance to OPV. Then, in 2003, a mass media campaign was launched involving India's "most popular superstars." Also that year, a unifying look was developed for all of the campaign's communications (in Hindi/Urdu); reportedly, these products were extensively pre-tested and focused on notifying people of the date(s) of the next supplementary immunisation activities (SIAs). From 2003-2006, UNICEF and CORE set up a system whereby community mobilisation coordinators (CMCs) were deployed based on epidemiological and operational criteria to ensure that polio communication reached communities most at risk. This involved training community mobilisers in interpersonal communication (IPC) skills to carry out both one-on-one interactions and group meetings.

Amongst the impact data provided from this component of polio communication in north India:

The percentage of parents in UP who recalled social communication public service announcements (PSAs), August 2006, was 51% (compared to 20% who recalled immunisation PSAs, 20% who recalled HIV/AIDS PSAs, 16% who recalled family planning PSAs, 5% who recalled general health PSAs, 5% who recalled education/literacy PSAs, and so on).

Slide 24 shows that CMC areas reported higher booth coverage as compared to non-CMC areas (Jan 2005-Feb 2006). There were also fewer missed children in CMC areas (in UP, Feb 2005-July 2006).

In 2006, the underserved strategy began with the deployment of underserved coordinators to: foster intensive engagement with Muslim leaders in priority districts in UP, Bihar, and West Bengal; identify local influencers, students, and Imams who can work with the teams to influence family decisions; secure positive fatwas and local information, education, and communication (IEC) materials; and create caste-specific influencers and materials. Evidence of impact: 9 million people were exposed to polio messages during religious congregations in 2010, compared to 5 million in 2009.

In response to data indicating that Wild Polio Virus (WPV) in the UP was up in 2009 (with 75% of cases below 2 years of age), CMCs began visiting each pregnant woman followed by congratulation card at birth. CMCs, to this day, still track polio immunisation status of children under the age of 5. They use mapping and registers, and also provide the immunisation status of each child to vaccination teams.

Another challenge for polio communication is people on the move: migrants. Strategies have included waterproof boards/hoarding, posters for brick kilns and construction sites, and transit teams - all with the message of: wherever you go, make sure your child receives OPV. More than 4,000 barbers, shopkeepers, etc. were engaged as informers to reach migrant groups. CMCs also conduct IPC sessions with migrant families to stress the importance of polio and routine immunisation (RI). Based on findings that RI status in UP was low due to some mothers' beliefs, CMCs focused more on importance of RI during IPC sessions and mother meetings, using pictorial IEC materials. Also, special RI sessions and health camps were organised.

2010 saw a revised communication package. One slide here shows the main sources of information on Polio from a 2010 knowledge, attitudes, and practices (KAP) survey; one finding was that 50% of people reported seeing polio posters or banners prior to the immunisation round. A key strategy outlined here is that posters/banners can be used for more than date announcements; they can include behaviour change messages (e.g., give your child OPV every time it is offered until s/he is 5 years old). Acknowledging the need to proactively engage the media with positive news, the polio programme in north India has sensitised over 400 journalists on polio messages in UP and Bihar, trained 100 TV and radio producers and broadcasters across India, and developed a media kit. Results: Bihar and UP have interrupted transmission of both WPV1 and WPV3 from the majority of districts, and the 107 block plan has been developed to overcome the remaining challenges in the blocks of UP and Bihar that are at the epicentre of the virus. This communication Package for the 107 involves establishing the link between polio and hygiene.

Amongst the lessons learned:

Capacity building - Skills need to start at the beginning with good social mapping, understanding the local operating environment, and cover the range of communication needs (IPC, IEC, mass media). Increased use of role play and participatory techniques have helped internalise skills. IEC/tools development/job aids have evolved for general and specific issues, are increasingly integrated, and are being used strategically

Advocacy dominated the first few years, but wasn't enough over a long period; political advocacy becomes very important.

Monitoring and evaluation (M&E) - Messages needed to evolve based on data. Indicators are needed at all levels to track process and impact. Independent monitoring is essential for validation; external reviews are important for validating progress and identifying gaps. Peer review journals are important for disseminating results.