Outcomes of Polio Eradication Activities in Uttar Pradesh, India: The Social Mobilization Network (SM Net) and Core Group Polio Project (CGPP)

The Social Mobilization Network (SM Net) was formed in Uttar Pradesh, India, in 2003 to support polio eradication efforts through improved planning, implementation, and monitoring of social mobilisation activities in areas at high risk of polio transmission. This paper examines the vaccination outcomes in districts of SM Net where the CORE Group Polio Project (CGPP) works. In short, the research found that "[v]accination outcomes in CORE Group areas were equal or higher than in non-CORE, non-SM Net areas. This occurred even though SM Net areas are those with more community resistance to polio vaccination and/or are/have harder-to-reach populations than non-SM Net areas."

As detailed here, the SM Net has developed behaviour change communication (BCC) materials, training materials, supervision structure, and pay scale with uniform guidelines; these are implemented consistently across CGPP and United Nations Children's Fund (UNICEF). The Community Mobilization Coordinator (CMC) - who must be 18 years or more, preferably female, and from the same community - interacts with families and community members at the village level. During Supplementary Immunization Activity (SIA) rounds, CMCs assist vaccinators in setting up vaccination booths, organise groups of child mobilisers ("Bulawwa tollies"), and arrange for mosque and/or temple announcements. CMCs also do the following: accompany vaccinator teams to all the houses; work to convince families with an unvaccinated child (called an "X" household) to allow their child to be vaccinated (converting an "X" household to "P" (denoting a house where all eligible children are vaccinated against polio); and, accompany persons of influence (influencers) during follow-up activities. In between the SIA rounds, the CMC carries out activities aimed at increasing oral polio vaccine (OPV) coverage. She visits houses, talking to mothers and other caregivers, hoping to dispel their doubts or rumours about the vaccine. She holds mothers' meetings and conducts "polio classes" at schools that use various methods to get the children interested in becoming a part of the polio campaign - such as poetry and painting competitions on the polio theme.

Also explored in the article are the activities, within the SM Net, of: the Block Mobilization Coordinator (BMC), who oversees social mobilisation activities during (and in between) SIA rounds through supervision and mentoring of the CMCs working in the block; and the District Mobilization Coordinator (DMC), who is in charge of social mobilisation activities in all the CORE blocks of the district.

This study is a secondary analysis of data originally collected for the purpose of programme management. Each month, the CGPP CMC compiles her data and delivers a hard copy report to her supervisor, the BMC. The BMC compiles CMC data and submits it to the DMC who then sends a computerised report to the Sub Regional Coordinator, or SRC (an employee of one of the CGPP partner organisations) and the CGPP Secretariat.

CMC areas are a group of villages within a block that have been purposively selected because they have a higher proportion of families that are resistant to allowing their children to be vaccinated with polio vaccine than non-CMC areas. Therefore, researchers expected - in the absence of additional CGPP social mobilisation efforts - that vaccination performance would be lower, on average, in CMC areas compared to non-CMC areas. However, they found that:

• Booth coverage in CMC areas is clearly higher than in non-CMC areas - a finding that was consistent across all districts in the analysis.
• In all but one instance in one district, the percent of "X" households converted to "P" was higher in CMC areas than in non-CMC areas. In several districts, the percent was even significantly higher in CMC areas vs. non-CMC areas.

In short: "The vaccination outcomes in CGPP program areas met or exceeded the vaccination outcomes in non-program areas - even though program areas were purposively selected because the challenges vaccinating in these areas were greater. This is suggestive of the added-value of CGPP social mobilization efforts....The CGPP model - achieving scale through a partnership of PVOs [private voluntary organisations] and NGOs [non-governmental organisations] under the leadership of an independent Secretariat - appears promising and should be explored further as a model for social mobilization and other health programming efforts. Additional analysis as to what particular social mobilization efforts are associated with better performance on the vaccination indicators included in this analysis is recommended."