CORE Group Polio Project: Annual Report FY19

"The road to polio eradication has been longer and harder than we expected at the outset and it is presently difficult to see the end of the journey. In this context, the CORE Group Polio Project draws upon years of experience, knowledge and skill to keep pressing on..." - Lee Losey, Deputy Director and Technical Lead, CGPP

This annual report from the CORE Group Polio Project (CGPP) examines the activities and contributions made in fiscal year (FY) 2019 to polio eradication and diseases surveillance in India, Ethiopia, South Sudan, Nigeria, Kenya, Somalia, and Uganda.

Overall, in brief, CGPP's 19,000-plus frontline workers reached 2.1 million households with health education messages on immunistion and acute flaccid paralysis (AFP) surveillance. Frontline workers and CGPP staff supported the vaccination of 4,037,044 children during supplemental immunisation campaigns. The CGPP trained 13,611 frontline and health workers to strengthen the health systems that provide routine immunisation, supplemental immunisation activities (SIAs), and community-based surveillance. At the regional and global level, CGPP continued to engage with polio eradication leaders to ensure that the civil society and community perspectives championed by this project have a voice in global, regional, and national policymaking.

The report features country reports organised around the CGPP's objectives, which are to:

1. Build effective partnerships with private voluntary organisations (PVOs), non-governmental organisations (NGOs), and international, national, and regional agencies involved in polio eradication - example from South Sudan: During the first quarter of FY19, CGPP South Sudan collaborated with 5 national NGOs to implement project activities in 4 states, 36 counties, and 236 payams. CGPP South Sudan works closely with the Ministry of Health (MoH), the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), and other partners. In February 2019, the CGPP Deputy Director presented to a regional joint cross-border health conference on One Health in Lodwar, Kenya (Turkana County), for which CGPP supported the attendance of 4 state MoH officials from Kapoeta East County.
2. Support PVO/NGO efforts to strengthen national and regional immunisation systems to achieve polio eradication - example from India - CGPP India contributed to national, state, district, and sub-district level meetings, including the Immunization Action Group (IAG) and task force meetings at state, district, and block levels. Furthermore, in FY19, 911 community mobilisers reached 399,328 families, including 301,428 children under age 5. Community mobilisation coordinators (CMCs) facilitated 27,594 meetings (including meetings with parents, Village Health Sanitation and Nutrition Committees, and barbers) and held 250,385 one on-one interactions with mothers and fathers, influencers, and religious leaders. The coverage in project areas remains dramatically higher than the overall state level coverage of 72.8% in Uttar Pradesh (UP). The percentage of children 12-23 months who were fully immunised also remained high at 87.4%, and the percentage of zero dose (never vaccinated children) remains at 0% in CGPP implementation areas.
3. Support PVO/NGO efforts to strengthen AFP case detection and reporting and detection of other infectious diseases - example from Uganda - CGPP partners focused building a strong network of key informants, sensitising communities to signs and symptoms of AFP and conducting AFP surveillance, and providing strong supportive supervision, mentorship, and review meetings to strengthen the capacity of village health teams (VHTs), health workers, and health facilities. VHTs used their planned house-to-house visits as access points for active case search. They provided communities with messaging on AFP surveillance and immunisation during regular health education sessions conducted during community meetings and on market days. In FY19, they reached 605,992 people with social mobilisation activities and messages related to AFP surveillance and immunisations.
4. Support PVO/NGO involvement in national and regional planning and implementation of supplemental polio immunisation - example from Nigeria - As a result of intense CGPP social mobilisation and behaviour change communication activities, noncompliance and vaccine rejection due to concerns about oral polio vaccine (OPV) safety, religious beliefs, child sickness, and parental refusals have decreased significantly across the CGPP focal states. Nearly all (99.9%) of children one year and younger in project areas received at least 7 doses of OPV through campaigns and routine immunisation. Employing the strategy of directly observed oral polio vaccination (DOPV) was a contributing factor to reaching eligible children in non-compliant households. Religious beliefs remain the most prominent reason for noncompliance in many focal communities, despite consistent social mobilisation efforts. CGPP Nigeria expanded the use of the Iftar strategy (through which male heads of households were engaged following evening prayers held during Ramadan, and male religious leaders and other male gatekeepers were trained to deliver supportive immunisation messages) to all 5 focal states in FY19: 93% of missed children (3,063 of 3,294 children) from non-compliant households were vaccinated.
5. Support timely documentation and use of information to continuously improve the quality of polio eradication and other health-related activities - example from Ethiopia - CGPP Ethiopia presented at 12 international and regional conferences and developed 9 peer-reviewed articles, 6 for a special edition of The Ethiopian Journal of Health Development and 3 for a special supplement of the American Journal of Tropical Medicine and Hygiene (AJTMH). To improve programme impact, CGPP Ethiopia collected qualitative data from 24 health facilities. The Secretariat (CORE Group, plus Catholic Relief Services (CRS) and World Vision, or WV) conducted 24 in-depth interviews, 115 observations and 118 exit interviews in the Somali and Benishangul/Gumuz regions. Findings will be released in FY20. The Secretariat prepared and distributed 1,200 flip books in local languages, nearly 3,000 pages of reporting formats, and 286 social mobilisation materials.
6. Support PVO/NGO participation in national and/or regional polio eradication certification activities - example from the Horn of Africa (HOA): Kenya and Somalia - CGPP has established a cross-border health initiative, with committees meeting monthly to strengthen coordination along and across borders to better serve transboundary nomadic populations. CGPP HOA presented on this initiative to the Africa Regional Certification Commission (ARCC) and supported a 2-day workshop for the Kenya MOH and partners to review the ARCC recommendations. As part of the broader polio transition plan, CGPP will continue to leverage existing partnerships and relationships, community networks and connections, and cross-border health structures for implementation of the Global Health Security Agenda (GHSA), focusing on community-based preparedness and response to diseases of pandemic impact.

The annual report also includes a gender analysis, which notes that, while vaccination coverage remains comparable among girls and boys in CGPP programme areas, gender norms related to roles, behavioural expectations, and decision-making do impact vaccination access and programme implementation. The CGPP endeavours to empower women to be leaders and decision-makers in their families and communities and to promote equity in access to polio immunisation. Female community volunteers, who are selected by their communities, report gains in confidence, community respect, and recognition from their work, which they also say gives them a broader life purpose. Volunteers gain new skills and capacities through training opportunities and supportive supervision. The CGPP also engages men in focal communities to build understanding and help with the empowerment of women. This is done through couples' communication, education of men about issues impacting women and children, male peer educators, men's/fathers' groups, and the engagement of male religious and traditional leaders.

Highlights of global/headquarter contributions and achievements - with a focus on representation (advocating for stronger partnerships), monitoring and evaluation (determining impact and assessing achievements), and communications (sharing results, ideas, best practices, and lessons learned) - conclude the report.