Follow-up Consultation on the Task Force on Immunization (TFI) Recommendation for Communication for the Expanded Programme on Immunization-Polio

In 2007, the Task Force on Immunization (TFI) for the Expanded Programme on Immunization-Polio (EPI) recommended more data-driven and more evidence-based communication in the fight to eradicate polio in Africa. This recommendation resulted in the April 2008 Dakar (Senegal) 'Follow up Consultation' of 30 programme communication specialists, as well as epidemiologists from countries across West and Central Africa - Niger, Democratic Republic of Congo (DRC), Chad, Nigeria, Cote d’Ivoire, Central Africa Republic, and Liberia - and various United Nations (UN) agencies and international organisations, such as the World Health Organization (WHO), IMMUNISATIONbasics (Washington), The Communication Initiative (Canada), and The International Red Cross (Geneva). One purpose of this meeting was a participatory selection of communication indicators for measuring the impact of communication interventions in the eradication of polio.

The facilitators outlined a potential framework for standardised polio and routine immunisation (RI) communication indicators that could be collected from the countries in the region and adapted to help guide country programmes. Baseline communication data were requested as a first step in 2 key areas: communication planning and communication plan implementation. This document's template of communication indicators would then be used and adapted to set targets for measuring progress and contributing to polio and immunisation impact. Some examples of the indicators of communication planning include:

polio high risk districts (HRDs)

 

1. number of HRDs in the country;
2. % that have a communication strategy specific to each of the HRDs;
3. % of priority districts (with the most polio under-immunised children) that have at least 2 communication activities conducted per campaign district-wide; and
4. % of polio HRDs with specific communication strategy to address under-immunised (e.g. < 3 doses) for polio vaccination.

Routine Immunisation HRDs

 

1. number of HRDs;
2. existence of RI strategy for increasing coverage in these HRDs/ populations;
3. % of annual district micro plans in RI HRDs that include RI communication strategy;
4. how many of these districts with high numbers of un-immunised are considered to be priority districts;
5. % of priority districts (with the most un-immunised children) that have at least 2 communication activities conducted monthly, district-wide; and
6. % of HRDs with specific communication strategy to reduce RI drop-outs.

Presentations that followed the discussion of communication indicators included:

 

1. A focus on why large-scale community-based-communication programmes are necessary. Reasons given were:

    

   • "Because child survival results depend on adoption of key behaviours at the household and community level, not just in zones of convergence but across entire countries - 90 per cent coverage is necessary.
   • Large-scale behaviour change in key practices can reduce child mortality by 40 per cent (Lancet).
     
   • Key behaviours include exclusive breast feeding, hand washing, using an insecticide-treated net, treating diarrhoea with [oral rehydration salts]ORS, caring for pneumonia."

    

2. Communication functions to address gaps in service delivery to the "never-reached" and "drop-out" populations were listed as:

    

   • "Improve health worker inter-personal communication skills.
     
   • Increase use of vaccination cards as health information tools (e.g. return dates).
     
   • Improve community and caregiver awareness of vaccination services and schedule.
     
   • Negotiate with communities on outreach and vaccination sessions."

    

    

3. Questions guiding the development of polio communication indicators include: Are key programme messages being heard and are they resonating with caregivers, health professionals, and community leaders across a range of cultural, religious, ethnic, urban, and rural differences?

    

4. The 5 communication indicators presented seek to:
   
   
   • Facilitate discussion within countries seeking to strengthen their own indicators.
     
   • Utilise data collected from campaigns, surveillance, and programme research effectively from national to lowest administrative level.
     
   • Guide planning, monitoring and resource allocation.
     
   • Ensure a flexible approach focused on needs of high risk areas while maintaining high general awareness.
     
   • Establish trend data related to strategies and activities.
     
   • View communication as an ‘internal’ tool for improving operations and maintaining morale etc., as well as an ‘external’ tool for building ownership, demand, and immunisation seeking behaviour.

A subsequent presentation highlighted the assets of using data in communication programmes, and presented the different types and groups of communication indicators, illustrated by examples, as well as the importance of linking these indicators with epidemiological data and social data in order to develop specific indicators relevant to the situation that the programme is facing. This presentation pointed out that communication indicators must be relevant, feasible, specific, simple and understandable, and verifiable. An example illustrating the use of data related the amount of funds put into a project to the number of religious leaders attending the project, then the number of those leaders that incorporated an EPI message in their sermon, and finally the impact of the input and output measured in increased attendance at vaccination sites.

The following presentations are available through the UNICEF West and Central Africa website:

1. Regional Strategy: Programme Communication for Child Survival in West and Central Africa - Neil Ford, UNICEF WCARO
2. Objectives, expected outcomes and methodology - Paryss Kouta, UNICEF WCARO
3. Progress in Polio Eradication Initiative and Routine strengthening update in Africa - Mbaye Salla, WHO Afro
4. TFI 2006-2007 recommendations and implementation strategy in WCARO - Paryss Kouta, UNICEF WCARO
5. Communication Data collection and use (Polio and Routine Immunisation), lesson learnt from Immunisation basics - Lora Shimp, IMMUNISATION. Basics
6. Measuring communication’ contribution in Polio/EPI: lessons learnt from Afghanistan, India and Pakistan - Liliane Boualam, WHO HQs Geneva
7. Key criteria/principles to determine/select communication indicators - Grâce Kagondu, WHO Nigeria
8. Nigeria presentation on communication indicators during SIAs/IPDs and REW (Reaching Every Ward) interventions: process, lesson learnt and way forward - Grâce Kagondu, WHO Nigeria
9. Niger presentation on communication indicators during NIDs and RED interventions: process, lesson learnt and way forward - Dejean Mariama Niger EPI Division
10. DRC presentation on communication indicators during SIAs and RED interventions : process, lesson learnt and way forward - Mariam Kanakomo and DRC Team
11. Chad presentation on communication indicators during SIAs and RED interventions: process, lesson learnt and way forward [version française] - Achta Abderamane and Chad Team
12. Reviewing and updating countries’ communication indicators - Paryss Kouta, UNICEF WCARO