International Communication Review of Polio Activities in Pakistan (Sindh)

This PowerPoint presentation was prepared for a September 2007 United Nations Children's Fund (UNICEF)-hosted meeting dedicated to examining polio communication efforts in Pakistan. In support of the final global push towards polio eradication, state-specific presentations were given by in-country communication and health practitioners working in Pakistan’s polio-endemic states (Sindh, Balochistan and the Northwest Frontier Province). These were assessed by an external panel of experts in the fields of development communication, mass media, epidemiology, and anthropology, who provided communication programme recommendations based on data presented by the country teams, as well as data gathered on field visits to the endemic states. Communication strategies presented at this meeting were primarily focused on:

1. Analysing the results of programmes implemented through September 2007
2. Detailing activities on national and sub-national levels, specific to social mobilisation, community engagement, underserved areas, media, and political advocacy strategies
3. Suggesting communication strategy and programme refinements for the next 6- to 12-month period, designed to support Pakistan's polio eradication efforts

This presentation gives an overview of the polio situation and the demographics of the population to be immunised against polio in Pakistan's Sindh province. It describes surveillance strategies and statistics, routine immunisation (RI), polio-specific communication, and social mobilisation strategies in the region. Finally, achievements, challenges, and the perceived way forward for Sindh’s polio communication programme are discussed.


The province of Sindh has a total population of 39.3 million people spread over 23 districts, with access to 1,716 health facilities and 1,204 immunisation centres. Surveillance data indicates the number of acute flaccid paralysis (AFP) cases reported to date in 2007 is 733, with a non-polio AFP rate of 6.09. The majority of these cases (65%) occur in children 4 years of age or younger. Trends from 1998 to 2007 indicate that Sindh has surpassed international standards for key surveillance indicators (i.e. non-polio AFP rates - percentage of reported AFP cases collected within 14 days of onset) consistently for the last six years. Polio case trends indicate a steady decline in cases tracked from the implementation of aggressive immunisation activities in 2003 - from 29 during that year to 6 to date in 2007. These cases remain localised to four districts in the province.


Detailed case profiles are presented for each of the six wild poliovirus (WPV) cases reported this year. The programme's response to these cases included immediate house-to-house campaigns in the affected districts and vaccination of 1.4 million children with monovalent oral polio vaccine type 1 (mOPV1). Sindh's expanded programme on immunisation (EPI) has also included vaccinating young children against measles, diphtheria, pertussis and tetanus (DPT-3), tuberculosis (BCG vaccine), and tetanus toxoid (TT). Coverage trends from 2001 to 2007 for these vaccines are detailed in this presentation.


In an effort to strengthen routine immunisation, the province of Sindh has emphasised micro-planning, advocacy seminars, and enhanced data collection during vaccination campaigns. The team observes that AFP surveillance is the core base for routine surveillance of other vaccine-preventable diseases, and that polio campaigns should be used as vehicles to advocate routine immunisation.


Sindh has witnessed strong government support towards the Polio Eradication Initiative (PEI) and increased involvement of Rotary International in 2007. The advocacy strategy remains focused on local activities, such as involvement of community leaders and nomadic populations, and sustained political commitment by district Nazims. At the Union Council (UC) level, increased visibility of religious leaders has been witnessed in support of vaccination campaigns. This was achieved in part through activities such as a series of seminars with all renowned Ulemas in the province to counter misconceptions regarding polio vaccination. Inter-provincial cross-border meetings are also seen to be an important part of Sindh's polio communication activities, and allow for the review of coverage performance of the border districts in Pakistan's three remaining polio-endemic provinces following immunisation activities.


Media coverage and involvement in Sindh in 2007 has included the following:

• Media seminars
• Training of media personnel on polio reporting
• Engagement of cable operators to broadcast local language polio messages
• Use of traditional media (street theatre, festivals, etc.)
• Regular press briefings on campaign issues
• Messaging regarding the importance of repeated vaccination on radio, television, and mobile phones

Some of these media activities are geared specifically towards families refusing to immunise their children against polio. Social mobilisation strategies have also been implemented in Sindh around this issue of refusal, and include the involvement of familiar paediatricians and an increased emphasis on social-mapping and microplanning. Efforts have also been made to increase the commitment of general practitioners, paediatricians, and private hospital administrators to the PEI and EPI programmes.


The team mentioned the following points among Sindh's immunisation programme achievements:

• Immunisation messages were distributed in three major languages to primary schools.
• Quarterly inter-provincial cross-border meetings were initiated.
• 26 EPI centres were established at border points around the province.
• Meetings and seminars were conducted on PEI issues for health care professionals.

The key challenges for Sindh's PEI programme in 2007 include the following:

1. Ongoing promotion of immunisation on the development agenda
2. Building demand for routine immunisation
3. Improving vaccinator team morale
4. Minimising refusals

The future strategy described by the team will include a focus of communication and social mobilisation on the high-risk union councils, and especially within nomadic populations. Sustaining political commitment at the district and higher levels is also seen as essential. Finally, the team asked the following two questions of the expert panel:

1. How to sustain high-level media coverage over a long period of time, with limited or no funds?
2. How to sustain the high level commitment at all levels within the available resources?

For the full PowerPoint presentation, please contact Kiyuri Naicker at knaicker@comminit.com