Interim Guidelines for Frontline Workers on Safe Implementation of House-to House Vaccination Campaigns (25 June 2020) in the Context of COVID-19

The purpose of this document from the Global Polio Eradication Initiative (GPEI) is to provide supplemental guidance to national and sub-national programme managers who are supporting frontline workers for the safe implementation of house-to-house polio immunisation campaigns in the context of the COVID-19 pandemic. It assumes that the country team has already consulted existing technical guidance materials that outline the process for undertaking a risk assessment and decision-making process to initiate supplementary immunisation activities (SIAs).

The planning for house-to-house polio campaigns within the context of COVID-19 requires additional logistics specific for ensuring the safety of both the health workers and the community while conducting the activity. GPEI stresses that these additional requirements, including estimates for personal protective equipment (PPE), should be factored into the campaign microplanning. In addition to PPE, communication for eradication (C4E) is important to ensure community ownership in the context of COVID-19 and to prevent stigma. It is this C4E dimension that is the focus of the present summary.

Among the considerations for selecting members of the vaccination team (vaccinator, recorder, community mobiliser, etc.) is the requirement that all members should be selected from the same locality/community. At the start of training, the morale of the frontline workers should be addressed to motivate them, as they may have doubts about circulating and moving around in communities. During training, in addition to ensuring an understanding of COVID-19 transmission and infection prevention using demonstration techniques, health education content should be designed following the interpersonal communication approach outlined in Annex 4 of the document (see below). Guidelines for supervisors are also provided in preparation for door-to-door visits.

During campaign implementation, among the C4E-related guidelines are:

• Vaccinator: Reassure the caregiver that the polio immunisation process is safe and convey the importance of having all children under the age of 5 immunised.
• Recorder: Consider noting any COVID-19-related information, including rumours, that may indicate issues with public acceptance; document and share any findings with the supervisor during the evening meeting.
• Community mobiliser: Share any local COVID-19 messages and other health-related information, making an attempt to resolve polio-vaccine-related refusals.

Among the 5 annexes is a decision-making framework example, covering topics such as community acceptance, and Annex 4, which provides support to trainers on interpersonal communication (IPC). Some key points:

• IPC is designed to ensure two-way communication; frontline workers are advised to use  listening skills and ask open-ended questions to make the parents and caregivers of children feel comfortable and motivated to engage in an exchange of ideas.
• IPC can be persuasive in addressing a strongly held practice, attitude, or belief.
• IPC provides an opportunity to model a recommended practice or behaviour in a realistic setting such as an individual's home or community, showing people like them engaging in desired activities.
• Showing empathy and understanding helps frontline workers treat people with respect and kindness regardless of who they are. Being understanding allows caregivers to express themselves, to be comfortable and honest, and to discuss their concerns. This can create a positive environment for them to trust health facilities and take the care they need for themselves and their children.
• If people have too much information, they may become fearful and mistrust health recommendations. They may ignore lifesaving advice, they might refuse help from health workers, and they may mistreat people who seem to be sick even when cured.
• A chart outlining key communication skills at the doorstep offers suggestions for fronline workers, such as: Review guiding messages on polio ahead of time so you can answer parental queries confidently; make sure you have all the appropriate tools and materials with you, including your tally sheet; look interested, honest, and reliable; be culturally sensitive and well groomed; and do not do multiple things at the same time - that is, focus on the client.