Nigeria: Addressing Communication Challenges

This report from the United Nations Children's Fund (UNICEF) details polio communication strategies undertaken in Nigeria, the only polio-endemic country in Africa, as part of the effort to eradicate polio worldwide. As noted here, there is reason for concern: As of November 25 2011, Nigeria had recorded 43 cases of wild poliovirus (WPV) in 8 States, compared to 14 cases in 7 States for the same period in 2010. The report attributes this surge in polio cases to "[c]ontinued community resistance to the programme....Caregiver refusals, or non-compliance, to immunize their children still make up a significant proportion of the total number of children missed during campaigns, and refusals are on the rise in some high-risk States." In response, in 2011, Nigeria conducted 8 national and sub-national Immunization Plus Days (IPDs).

The report details sustained high awareness of polio immunisation. According to independent monitoring data, the level of prior awareness of caregivers about polio campaigns (IPDs) is 98% in all rounds of 2011. According to the September 2011 IPD independent monitoring data, 45% of the caregivers were informed about IPDs by town announcers, followed by radio/TV (23%) and traditional/religious leaders (19%). Community dialogues involving men and compound meetings with women have been intensified so that caregivers' high awareness level can be effectively turned into a positive decision about polio immunisation. Nationally, the level of awareness about polio immunisation has increased from 65% (2009 Knowledge, Attitudes, and Practices (KAP) survey) to 75% (2010 KAP), with a wide variation among States. The milestone target is to bring the awareness level to 85% by the end of 2011. Efforts are underway to increase awareness through: community dialogues; compound and town hall meetings; Majigi film shows; the use of information, education, and communication (IEC) materials; and mass media.

As detailed here, the scale-up of participatory and community-based communication initiatives has been recommended in order to take awareness into practice. To that end, UNICEF piloted a few community-based communication initiatives in 3 northern States, including: (i) Dattawa & Abokai (respected elderly women and youth) in Zamfara; (ii) Household Adoption Strategy in Kebbi; (iii) and Neighbor to Neighbor (N2N) in Sokoto - whereby trained volunteers serve as "champions" for their neighbours, families, and friends by conducting informal conversations in community settings. One reason given for holding individual conversations was to encourage open conversations, as people are more likely to query rumours and vocalise doubts on a one-to-one basis. These efforts "showed encouraging results by reducing missed children and non-compliance through active community participation." The implementation of the intensified ward communication strategy is described as a key part of the push to pursue data-driven communication activities and interventions which empower communities to take action to reduce missed children and non-compliance.

To address the issue of resistance to polio immunisation, local government and polio eradication partners organise regular community dialogues with the support of traditional leaders. UNICEF also initiated an interpersonal communication training to strengthen the capacity of health educators, supervisors, and ward focal persons to convince communities to be immunised against polio. Also, through the Journalists against Polio networks, media professionals are joining the effort to both raise awareness and spark behaviour change. For example, radio programmes with appropriate messages and health-related FAQs are periodically on air. Finally, a national and state-level campaign to raise awareness and advocate for action around polio eradication - the Polio Free Torch campaign - was launched on September 24 2011 to reinforce advocacy efforts, using a symbolic torch to mobilise wide support for Nigeria's commitment to eradicate polio by the London, United Kingdom, 2012 Olympics. (Please see Related Summaries, below, for access to more information about this campaign.)

Challenges have included:

• Lack of commitment of health workers, perhaps due to ineffective interpersonal communication (IPC) skills training as part of the IPDs training packages. In 2011, the contribution of health workers as a source of information and influence has been found to be below 5% in all rounds. In response, UNICEF has started IPC Skills training in high-risk States.
• The 2011 national election and security situation, which has led both the government at different levels and the mass media to be focused not on polio but, rather, on the elections. There was also an August 26 2011 bomb attack that left several UNICEF and World Health Organization (WHO) staff dead or injured. "However, UNICEF was able to rapidly recover from this incident with renewed commitment to polio eradication in Nigeria."