Communication Interventions in Support of Polio Eradication Program in Egypt

This PowerPoint presentation was part of a June 2005 joint United Nations Children's Fund (UNICEF)/World Health Organisation (WHO) meeting dedicated to examining communication in the context of the final global push to eradicate polio. At this meeting, country-specific presentations were made by communication practitioners in 16 of the 21 countries which have experienced cases of wild poliovirus in 2004 and/or in 2005 (to June). The total number of global poliovirus cases increased from 784 cases in 2003 to 1,255 cases in 2004, with 1,004 cases reported to August 9 2005 (548 for the same period in 2005). Communication strategies presented at this meeting were primarily focused on:

1. Analysing the results of programmes implemented to June 2005, and
2. Detailing the planned communication programme for the next 6 to 12 month period, designed to support a reversal of the above trend and achievement of the goal of eradicating polio worldwide.

According to this presentation, Egypt (one of 6 polio endemic countries), experienced one case of wild poliovirus in each of 2003 and 2004. No cases have been reported in 2005, although 2 positive environmental samples were reported in January 2005.

National Immunisation Day (NID) performance indicators are reported for the NIDs held in February, March and May of 2005. These results indicate overall good team performance, described as "better mobilisation of volunteers in mega cities, the successful introduction of finger marking and mOPV1 (monovalent Oral Polio Vaccine Type 1) and excellent cold chain, logistics and vaccine handling". Vaccination coverage for the most recent round held in May 2005 was determined to be 98.4%.

Two key communication risk factors are identified as:

• the upcoming presidential election, which will likely overshadow any other events, and
• a notable media shift which is affecting the polio message (a move away from local television to satellite television - see below).

Detailed analysis was provided of the missed children in the most recent NID. The primary reasons given for non-immunisation were: vaccination team did not visit the home (30%); mother busy/traveling/unaware (25%); child born after the NID (20%); and just took routine immunisation (9%). Additional data detailing the geographic location, education and working status of the caretakers of the missed children is also provided. Analysis of this data resulted in a more specific focus on urban populations, particularly mothers aged 25 to 35 who are on the high wealth index, not working for cash, with fair/good education, as well as those with no education.

The strategic direction for 2005 includes the following:

1. Sustaining the strong role of mass media, especially TV, while considering audience media habit shifts.
2. Pushing within the hard-to-reach areas through special community awareness before every NID in high risk areas in greater Cairo.
3. Building capacities for planning and implementing social mobilisation activities
4. Institutionalising social mobilisation within the Ministry of Public Health (MOPH) microplanning process.

Specific measurable communication objectives are also listed, such as "maintaining public knowledge of key indicators related to Polio vaccination and NIDs to above 95%".

The communication programme includes working through advocacy, mass media, community mobilisation and institutional support.

Advocacy includes such components as a "Declaration of Commitment" media event and religious leader initiatives.

Media data indicated a significant change in favourite television channels as evidenced by a decrease of from 78.9% to 31.4% watching local channels, and an increase of from 2.9% to 28.4% watching Satellite Channels. The strategy therefore includes: heavy airing on all local and national channels at prime time; utilising Radio FM (highly listened to); airing on some satellite channels (Dream 1 & 2); and having special episodes on polio inserted in some highly viewed television programmes. An educational television programme is also being planned.

Data is provided showing a significant knowledge change from 2002-2005. An example is the increase in the percentage of population sampled recognising that the minimum age for vaccination is one day - from 45.6% in 2002 to 92% in 2005.

A focus on raising community awareness in 20 high risk areas located in the urban slums of Greater Cairo as well as in Assiute and Minya has involved providing special training to all volunteers; development of a training manual; ongoing reporting and evaluation; home to home visits three days before the NID; a focus on nurseries; and the use of megaphones both 2 days before every NID and on the first day of NIDs.

Finally, activities designed to institutionalise social mobilisation within the MOPH micro-planning process are detailed. The philosophy behind these activities is that social mobilisation plans must be developed at the grassroots levels, with only training, coordination and supervision from higher levels. One tool which has been developed is a detailed yet simple template consisting of only 6 pages, for use in developing social mobilisation microplans at the health unit and district levels.

From June 2005 to December 2005, key goals are to:

1. Maintain the media coverage
   
   • Move to new media channels as indicated by media habits surveys
   • New format for additional TV spots: e.g., educational programmes
2. Complete the implementation of the training plan
   
   • training of 5,638 close supervisors in a total of 117 workshops will be undertaken
   • 1,821 district directors and health office directors from all Egypt will be trained on skills of social mobilisation planning in a total of 70 workshops in various parts of Egypt.
3. Follow up on the utilisation and efficacy of the new forms for social mobilisation planning

In 2006, if no cases are reported in 2005, the challenge will be to phase out from NIDs into a sustained strong routine immunisation programme which will require a new integrated communication plan.

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