The Last Lap - Strategy for Polio Eradication in Bihar

This PowerPoint presentation was part of a March 2007 United Nations Children's Fund (UNICEF)-hosted meeting dedicated to examining polio communication efforts, in the context of the final global push towards polio eradication. State-specific presentations for India's polio-endemic states (Uttar Pradesh and Bihar) were given by in-country communication and health practitioners. These were assessed by an external Technical Advisory Group (TAG) panel of experts who provided communication strategy recommendations based on evidence presented and data gathered on field-visits to endemic states. Communication strategies presented at this meeting were primarily focused on:

1. Analysing the results of programmes implemented to March 2007.
2. Detailing activities on national and sub-national levels, specific to social mobilisation, community engagement, underserved areas and media and political advocacy strategies.
3. Suggesting a planned communication programme for the next 6- to 12-month period, designed to support India's polio eradication efforts in the event of a resurgence of cases or population/programme fatigue.

This presentation outlines initiatives taken by the government of Bihar, the Bihar social mobilisation and underserved strategy, monitoring and evaluation data, and communication issues and challenges that are in need of strategic and technical support.

The government of Bihar has implemented at least six very specific strategies to improve communications, including video conferencing by Chief Minister with the District Magistrate before rounds and state level reviews with Civil Surgeons and Medical Officers. Data from recent supplementary immunisation activities (SIAs) reflects the increased participation of district administration in the programme.

According to a meeting of the India Expert Advisory Group (IEAG) in December 2006, Bihar completed its most effective immunisation rounds in that year. This, coupled with the understanding that the post-epidemic community is more immunised due to exposure to the virus led the IEAG to conclude that Bihar is provided with a good opportunity for eradication if programme quality is sustained at a high level.

Specifically, the following opportunities for improvements in Bihar's programme were presented:

1. Expanding community access to other routine services and improving routine immunisation (RI) coverage.
2. Engaging the Panchayat Network for mobilisation and monitoring.
3. Capacity building of District Management Units into programme support and monitoring.
4. Increased recruitment to fill vacancies.
5. Strengthening the roles of accredited social health activists (ASHAs) and Anganwadi workers (AWWs) in RI.
6. Assuring coverage of both mobile and hard-to-reach populations.

A brief history of polio immunisation in Bihar from 1978 to 2007 followed, beginning with the introduction of oral polio vaccine (OPV) in RI and culminating in the communications and social mobilisation networks lead the by the UNICEF team.

The data profile of wild poliovirus (WPV) cases in Bihar reflects a steady increase from 2003 (18 cases) to 2006 (61 cases). According to SIA indicator data a high number of houses are still missed (referred to as "X" houses) during these rounds. The vast majority of these cases (>75%) are due to families being out of village at the time.

Bihar's polio communication strategy was then contextualised according to: what the team has learnt from the virus and SIAs; the structure and distribution of the polio unit; and the communication support provided by other advocacy and activities.

A detailed look at social mobilisation (SocMob) activities is given, outlining over 18,000 events that were organised prior to the February 2007 SIA round in Bihar. The underserved strategy, in particular, has focused on engagement of Muslim and local influencers. Mobilisation at transit points, with support from groups such as the National Cadet Core and the government of Bihar, has proven particularly effective during large festivals.

Monitoring and evaluation data illustrated the effectiveness of having Block Mobilisation Coordinators in place in the high-risk states, and a significant increase in coverage of mobile populations during special events.

The following major challenges are currently affecting polio communications in Bihar:

• Accelerated rounds with short intervals between them.
• System and community fatigue.
• Effectively reaching hard-to-reach populations.
• Cross-border transmission with Nepal.
• Underserved minority/marginalised populations.
• Sporadic negative media reporting.

To address these challenges, many actions have been undertaken, including the following:

• Recruitment of full-time polio media and training consultants.
• Increasing support for effective cross-border rounds and transit sites to stop virus importation.
• Advocacy and revitalising partnerships.
• Social Mobilisation Network (SMNet) expansion and strengthening.

In conclusion, the Bihar team requested strategic and technical support from the TAG panel on the following issues:

1. How to address community and system fatigue?
2. How to address concerns among community regarding repeated vaccinations and frequent activities?
3. How to go about expanding the SMNet?
4. How to assure adequate indicators and monitoring systems?
5. How to go about recruiting qualified staff for open positions?

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