Building Communication Skills: Training Community Mobilizers for Polio Eradication in Uttar Pradesh

This 32-page document examines United Nations Children's Fund (UNICEF) India's experience in working with local community members as front-line communicators to promote and maintain positive immunisation behaviour. This organisation has developed strategies to build the interpersonal communication (IPC) skills of community-level workers - also known as community mobilisation coordinators (CMCs) - in Uttar Pradesh (U.P.) who are working to eradicate polio. The initiative, which kicked into high gear in 2002 (following a polio outbreak that infected over 1600 children across India), centres around training modules designed to equip CMCs with the skills to communicate effectively with families, mobilise their communities in response to the threat from polio, and effectively track on the immunisation status of all eligible children in their community. As detailed here, the approach to IPC training has evolved and intensified over the past 4 years in response to the changing epidemiology of the disease, and as knowledge and understanding of polio's social determinants has sharpened.

Author Gitanjali Chaturvedi of UNICEF India argues that, by engaging community volunteers in high risk areas vulnerable to outbreaks of polio, it is possible to reach out to underserved communities. CMCs are able to leverage the support of local professionals and influential people who, in turn, are crucial in clarifying misconceptions about polio, tackling fear and resistance and mobilising people to vaccinate their children at a "vaccination booth." Experience over the years has shown that the CMC should be ideally a woman over 21 years of age, literate and respected within the community. (More than 90% of community mobilisers are women working outside of the home for the first time, and the vast majority are Muslim.) Though raising the technical competency of CMCs is central, the approach is also designed to instill CMCs and community members with a strong sense of social service and voluntary action.

This report follows the evolution in UNICEF's approach to IPC skills development chronologically, while also examining these changes within the context of adult learning principles, which emphasise the experiences of the trainees. In brief, CMC training involves:

• Interactive sessions such as group discussion and role play interspersed with knowledge dissemination through lectures and testing knowledge retention by quiz and a post-training questionnaire
• A combination of different learning/communication tools designed in part by CMCs themselves. For instance, the 13 questions incorporated in an interactive flip book, which is intended to be used in conducting IPC with families, are those supplied by CMCs and asked most frequently by families during house-to-house counselling
• An emphasis on building knowledge levels through regular refresher training rather than making it a one-time, content-intensive module
• An action-oriented approach which introduces the volunteers to the realities of working in the field, in part through the participation of supervisors working in the field to engage problem solving in the field
• A requirement that trainees reside on site during the sessions
• A requirement that the CMC build networks at the local level by identifying influencers who can support her in mobilising families to bring eligible children to the booth, plan and organise booth day, and organise bulawa tolis - children over 10 years of age visit homes with children under 5 on booth day.

The document also provides quantitative and qualitative data on the effectiveness of IPC training in western U.P. As the UNICEF-initiated Social Mobilization Network (SMNet) expanded and the Intensified Pulse Polio Immunization (IPPI) campaign grew, the role and number of CMCs expanded. As a result, according to the author, community participation was increased, more children were immunised, and fewer families refused Oral Polio Vaccine (OPV) in areas where CMCs were working. A study carried out in 2005-2006 among a sample of approximately 60 new inductees and 60 old CMCs who had been active in at least one round of pulse polio and were receiving refresher training revealed that "knowledge levels of most CMCs had gone up tremendously. They were aware of the basic techniques of how to conduct IPC with families and how to plan for booth day. A small percentage of CMCs were still uncomfortable using IPC tools such as the flip book. Most CMCs maintained thorough records of children under five. Community participation and levels of motivation among all CMCs were extremely high. All CMCs displayed high awareness of their roles and how they were to fulfill them. Added to this was the conviction amongst all CMCs that polio can be eradicated. Such conviction, dedication and zeal can help in winning the final battle against polio."

UNICEF has developed various ways to enhance the planning skills of CMCs. Tools such as a resource map, the grid approach, child survey, and record keeping are designed to enable these volunteers to map their areas, list all eligible children, track expectant mothers, and list potential partners. These efforts are regularly updated in what the author characterises as an organised fashion. The rapid and sustained expansion of the SMNet has increased the need for regular and frequent human resource development.

The author suggests that the experience of working with community mobilisers has shown the benefits of decentralising training that is closely linked with supportive supervision in the field. Other recommendations include:

• Intersperse knowledge with practical examples (games, role play and case study).
• Increase field exposure for trainees so that they learn by doing - this is a strategy for increasing knowledge and allowing skills to develop more rapidly. In turn, the author claims, confidence builds more quickly and there are more sustained and effective partnerships at the local level.
• Seek continual feedback and input from the trainees themselves to keep trainings fresh, relevant and useful.
• Repeat and reinforce the training, update knowledge and encourage the trainee to determine the content of the training.
• Consider including an interpersonal counselling module, like the one built into this programme. This module highlights effective social mobilisation (persistently engage the community, identify with problems faced by families, and involve them by assigning them responsibilities for ensuring children are immunised).
• Consider introducing professional trainers; in UNICEF India's experience, these Sub Regional Training Coordinators (SRTCs) "made CMC training more dynamic and shifted the focus considerably from a content-based learning programme to on-the-job training with learning from field experiences."

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