Capacity Building in Communications: Polio Eradication Initiative

Background

Since May 1988, when the World Health Assembly (the governing body of the World Health Organization, or WHO) declared its resolve to eradicate polio, much progress has been made toward that goal. Under the global Polio Eradication Initiative, several regions of the world have been declared polio-free. In other areas of the world, the spread of the disease has been severely reduced. By the year 2001, the number of polio endemic countries had been reduced to 10, and hopes are high for total eradication of the wild poliovirus by 2005. These 10 priority countries where there are still "reservoirs" of poliovirus are in Africa and South Asia. Violent conflict and resistance to immunization have made eradication a particularly difficult goal in many of those areas.

From the beginning, the four strategies or "pillars' of polio eradication have been as follows:

• Routine immunization with OPV (oral polio vaccine)
• Supplementary additional doses of OPV, delivered during National Immunization Days (NIDs)
• Mop-up campaigns
• Certification-standard surveillance for all cases of acute flaccid paralysis and wild poliovirus.

It has been widely acknowledged that communications and social mobilization efforts have made an important contribution to effectively implementing those strategies. For example, the Taylor Commission report states: "Social mobilization as utilized by the EPI-Polio has relied on massively utilizing IEC, including mass media, strengthening existing community organization, and involving political and community leaders." The three components were identified as having strong positive effects." The report also cites social mobilization as "the variable with most positive effects in all countries."

Communications in support of worldwide polio eradication, however, was not envisioned as a significant activity. Epidemiological strategies (i.e., the four "pillars"), not programmatic strategies, were the primary focus for the eradication effort. Therefore, provision for capacity building in communications was not made in the early planning stages. In 1996, however, WHO/AFRI hired a Communications Advisor for Africa to support polio eradication through communications and social mobilization. Subsequently, both WHO and UNICEF have created and filled several regional- and national-level communications and social mobilization positions. In addition, many of the Interagency Coordinating Committees (ICCs), which provide coordinated inputs to national Expanded Program on Immunization (EPI) programs and to national Polio Eradication Initiative (PEI) programs, have created Social Mobilization Committees (SMCs) to coordinate national communications planning and implementation.

The need to deploy many people to influence behavior and to foster increased acceptance of immunization services, whether at health facilities, in communities or in homes, has created the need for capacity to be built in communications. Because of the determined international focus on interrupting the transmission of wild poliovirus, however, little attention has been paid to institutionalizing communications capacity nor to evaluating these efforts.

This consultant was asked to review capacity-building efforts in communications related to polio eradication for the period covering 1996 - 2002 by gathering and examining studies and reports and by interviewing key personnel who have been involved in those efforts. As a result of the review, the consultant was to prepare a "draft 15-30 page analytical paper on lessons learned regarding the best strategies for capacity building, including recommendations to the polio/immunization partners." The consultant conducted interviews (by telephone or in person) with individuals from the World Health Organization (in Geneva, as well as in country offices), UNICEF, USAID, the CHANGE Project, the Voice of America and the BASICS II Project. In addition, the consultant reviewed the written and audio-visual materials that are listed in the Bibliography at the end of this paper. The consultant summarized her findings in the present document, and also presented her findings at a June 14, 2002 meeting in New York City titled "Capacity building in communications related to polio eradication" (summarised at the end of this paper)...