Leveraging CSO Contributions to Advance Polio Transition and Integration Efforts in the African Region

"All four organizations...were able to make impactful contributions to polio transition and integration efforts in their respective countries, despite varying country contexts and significant contextual challenges."

While still experiencing outbreaks of the non-wild variant of poliovirus, known as circulating vaccine-derived poliovirus (cVDPV), the African region was declared free of wild poliovirus (WPV) in August 2020. This achievement was a result of decades of work by a coalition of international health bodies, national and local governments, community volunteers, and civil society. With the goal of elevating the civil society voice to the polio endgame, from 2021-2022, the United Nations (UN) Foundation provided support to selected civil society organisations (CSOs) to implement advocacy interventions to enhance polio transition and integration efforts in their African countries. This UN Foundation report documents these CSO contributions and outlines opportunities going forward for robust civil society involvement in polio integration and transition.

The premise of this work on the part of the UN Foundation is that polio transition and integration needs to happen at the country level and to serve the needs of local populations. To that end, the following CSO qualities can be brought to bear in this process:

• Strong comprehension of community needs and opinions and ability to tailor messages to specific communities and identify context-appropriate solutions to challenges;
• Trust and credibility in the community, with access to community stakeholders such as healthcare workers, parents and caregivers, local governments, and influential leaders;
• Ability to move governments to action and hold them accountable; and
• Strong networks to amplify messages and increase impact of interventions.

Notably, CSOs are not homogenous and have varying capabilities and mandates. Therefore, specific CSO collaboration for polio transition and integration needs to be tailored to their individual strengths.

A few selected examples of the impact of the 4 CSOs' interventions supported by UN Foundation grants are provided here; the table on page 7 of the report lists a full overview of all activities implemented, and Annex 3 provides information on each activity. In brief:

• In Ethiopia, the Consortium of Christian Relief and Development Association (CCRDA) helped elevate awareness and sense of urgency for polio transition. At the start of CCRDA's project, government authorities were dealing with COVID-19 pandemic response, as well as facing war and instability and dealing with an outbreak of cVDPV, which left very little time for polio integration and transition planning. However, after a series of advocacy activities and meetings convened by CCRDA with government officials and UN partners, polio transition planning activities were given increased attention by key stakeholders. Through elevating these issues to the highest levels, CCRDA was able to help Ethiopia establish a Polio Transition Task Team, finalise the updated national polio transition plan (2022-2025), and establish and train subnational level teams to coordinate polio integration and transition activities at localised levels.
• In Democratic Republic of Congo (DRC), VillageReach advocated for domestic allocation of funds by partnering with national and sub-national parliamentarians to build their awareness on the importance of polio transition and the role parliamentarians have in helping to secure domestic funding. VillageReach also used their networks to build more pressure for local governments to allocate budget lines to polio and immunisation. They trained 18 CSOs and journalists across three provinces (Equateur, Kinshasa, and Kwilu) to support advocacy efforts. One key result of this effort was the development of a provincial edict for Kinshasa that would secure annual budgeting of immunisation and polio eradication activities at the provincial level.
• In South Sudan, Impact Health Organization (IHO) helped elevate awareness and sense of urgency for polio transition and advocated for domestic financing. At the start of IHO's project, the South Sudan polio transition plan, drafted in 2017, had not yet been updated, and no funds had been allocated by the government for its implementation. IHO created a network of CSOs to build pressure on the government to prioritise this issue. They convened meetings with government authorities and key polio partners, and they supported the country to extend the current plan and discuss the need to advocate for more government funding for polio and immunisation.
• In Nigeria, Vaccine Network for Disease Control (VNDC) worked to integrate polio into other health services. VNDC pilot tested the Whole Family Approach (WFA) programme in selected primary health care (PHC) centres in Nigeria. They developed a scorecard to gauge the level of preparedness of health facilities in the effective integration of polio vaccination and routine immunisation with COVID-19 vaccination. They also fostered partnerships with 5 local women-owned CSOs to help strengthen health facilities at all levels and contribute to their readiness for WFA testing. In order to address vaccine hesitancy, VNDC selected and trained 6 local CSOs to facilitate their collaboration with social mobilisation and community development committees at the village and ward administrative levels. VNDC worked with participants from the 6 CSOs and built their capacity on polio assets and the WFA. The session was attended by 12 CSO representatives, in addition to community members. Participants were trained on proper integration of polio vaccination messages into their local-level activities.

Throughout the period of these projects, the UN Foundation's CSO Polio Integration and Transition Working Group met monthly and served as a place for the CSOs to exchange experiences, hold each other accountable, and compile best practices that could be repeated in other countries and contexts.

This work uncovered challenges to consider for polio transition planning and implementation at the country level, including lack of awareness and/or urgency for polio transition, constraints on health system capacity, COVID-19 and competing health priorities, changes in political leadership, and civic instability and prolonged conflicts. The key takeaway is that with planning, preparation, and persistence, progress can be made even within challenging circumstances.

It is notable that none of these countries is close to achieving the 90% polio immunisation coverage goal set by the World Health Assembly. This fact indicates the need for effective communication strategies to generate vaccine demand and for political and administrative leadership to ensure that polio essential functions are incorporated into national systems. Developing these strategies and tailoring messages to community needs is a role CSOs can support.

Based on the experiences from the 4 CSOs covered in this report, the UN Foundation offers recommendations (one example provided for each key group, below):

• Individual CSOs and/or networks of CSOs working at country level on issues related to immunisation, surveillance, and outbreak response should be included in polio transition processes - e.g., CSOs can convene meetings with other CSOs and polio stakeholders to coordinate actions and share information.
• Governments and World Health Organization (WHO) and United Nations Children's Fund (UNICEF) country offices in polio transition countries in the African Region can, e.g., work with local CSO networks and harness the advantages that they can bring to transition goals.
• Global and regional partners, including WHO and UNICEF global & regional offices, Global Polio Eradication Initiative (GPEI) partners, and other coordination groups on polio and immunisation, such as the Polio Partners Group (PPG) and Immunization Agenda 2030 (IA2030), can, e.g., hold country partners accountable for targeted and intentional inclusion of civil society.

Editor's note: Click on the video below to watch "The Road to a Polio-Free Future: Integration and Transition of Polio Experiences and Assets in Ethiopia". Produced by the CCRDA and the CORE Group Polio Project (CGPP) in Ethiopia, this 15-minute documentary explores the process of integration and transition of polio experiences and assets in Ethiopia.

Click here for the 33-page report in PDF format (French).