Polio Communications Quarterly Update - June 2011

From the United Nations Children's Fund (UNICEF), this quarterly update prepared for the Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative (GPEI) focuses on global communication indicators for the effort to eradicate the disease through the oral polio vaccine (OPV). As detailed here, the GPEI communication indicators are designed to help key stakeholders assess and monitor progress towards milestones outlined in the 2010-2012 Strategic Plan. They provide insights into how well the high-risk countries are performing in the areas of communications and social mobilisation, measuring performance against a core set of indicators and targets. Using insights and data from the field, this report seeks to go below top-level management data to explore areas of particular excellence and developing concern - for example, examining vaccination refusals more closely in order to capture and comprehend additional social reasons for missed children, beyond refusals. The report stresses that, "[d]espite meeting a milestone, work may still remain to meet the needs of the country-specific context; classification of risk has therefore been determined using both a quantitative as well as a qualitative lens."

The report includes detailed country updates for the following countries: Afghanistan, India, Nigeria, Pakistan, Angola, Chad, and the Democratic Republic of the Congo (DRC). It also includes communication data profiles for all of those countries, as well as for South Sudan. The below excerpt from the report offers background, context, and a brief summary of these country-specific updates.

An excerpt from the report follows:

"The past six months represents a period of unprecedented scale up of communication and social mobilization programmes in support of polio eradication. Core staffing for polio communications has almost doubled or trebled in the eight priority countries since last year, and in some countries, for example, in Pakistan, hundreds of social mobilizers are being hired to address social mobilization needs in the highest risk areas...

...Now teams are working towards building the necessary monitoring systems to collect the required data both at national local level in key high-risk areas. This is no small task given that data-driven systems are not the norm in communication programmes. The indicators are also being tested for their relevance and ability to inform programme adjustments and management decisions...

...A specialized database [PolioInfo] has been developed for the GPEI global communication indicators using the DevInfo platform. An evolution of UNICEF's ChildInfo database system, DevInfo is a powerful tool for organizing, analyzing and presenting data in a uniform and accessible way to facilitate comparisons within and across countries. The presentation of data in a visual format - through mapping and compound indicator analysis - facilitates easy identification of correlations, problems and high risk areas. The ability to access the database - and subsequently the country data profiles - online in future will yield a powerful tool for engaging countries and partners in monitoring and understanding performance.

Understanding refusals and additional social barriers to vaccination
Understanding the reasons why children are missed during immunization campaigns is vital to improve coverage and reach the most difficult to access. This data is potentially the most interesting and powerful resource to guide polio communication programmes....High risk areas in Afghanistan, DR Congo and Nigeria continue to miss over 10% of children during campaigns, also called supplementary immunisation activities (SIAs). Areas of Pakistan miss as many as 5-7%, and this does not take into account areas that are consistently inaccessible due to insecurity. India too must take care not to overlook complacency in the high risk states of UP [Uttar Pradesh] and Bihar, as routine monitoring data (not independent monitoring) shows coverage slipping slightly since February, from 98% to 95% in Bihar, and from 93% to 92% in UP.

...In all countries, the partners should consider how monitoring classifications can better delineate between operational and social reasons for missed children [the cultural, religious, political and economic reasons that may contribute to a covert resistance to vaccinate]. India is the only country that clearly distinguishes reasons for missed children as those that can be 'converted' by communications efforts and those that are more reliant on improving the quality of operations. This approach helps the communications programme focus its efforts, monitor impact and manage expectations...

Campaign awareness: Translating awareness into higher demand
Only India, Nigeria and DRC have reached the optimal target of at least 90% caregivers being aware of polio campaigns. Yet in these three countries, a high level of awareness leads to very different outcomes. India enjoys an optimal mix of high awareness (90%) and low refusal levels (both overt and covert). Nigeria and DRC, on the other hand, enjoy high levels of awareness, together with the highest rates of refusal....The programme in both Nigeria and DRC face complex social contexts, where reasons for refusal are often woven into political statements, demand for other services, or cultural and religious beliefs. As India has shown, translating awareness into behaviour change in these environments will require intensive community engagement and trust...

Pakistan and Afghanistan have the lowest levels of campaign awareness, together with the highest proportions of children missed because they are not at home during the visit of the vaccination teams....Chad is showing national awareness of polio campaigns at 84% but in some areas...awareness is worryingly low, at only 65%. It is in these areas also where the highest proportions of children are missed. In Angola national awareness is at 83% for the last round....In Sudan, awareness almost meets the target of 90%...

Sources of information: Establishing targets and monitoring efficacy
In Angola the main source of information on polio campaigns is currently mass media, which reflects the relative investment of resources in this intervention area. However, interpersonal communication (IPC) as a main source of information has doubled since February....In Pakistan too, the main source of information is mass media...

In India, the intensive social mobilization strategy has proven highly effective. Community organizations such as the Anganwadi Workers (AWW) and Social Mobilization Network (SMNet) may be the factors that maintain high social commitment in UP and Bihar...

Nigeria is another excellent example of the polio communication strategy functioning well with the main source of information about polio campaigns coming through social mobilization, thus reflecting the strategic investments in this area over several years. DRC has the highest IPC figures among the 8 priority countries, with a staggering 97% of caregivers receiving their information through this method. But DRC, too, has high levels of refusal...

...In just two campaign rounds, IPC shows an increasing trend in areas [of Afghanistan] where communication activities are taking place. Still, mass media dominates as the main source of information. In a context where social reasons account for almost a quarter of all missed children, more intensive IPC will be critical to overcome these barriers.

Using data: Substantial challenges remain
...[T]the concept of social data is causing some confusion in the field, where inexperienced teams do not always know what kind of data is needed, how to collect it, or how to use it to guide programmes. These indicators will continue to be problematic until greater technical capacity is developed at national and sub national level..."

Capacity: Staff and skills are required
...Many of the priority countries continue to face recruitment challenges....In many countries, communication staff are new to polio eradication, and new to the countries they are working in. Orienting them to their context and to the particular complexities of polio eradication, including the more rigorous evidence-based approach required to achieve the goal, will continue to be a work in progress."

Funding: Disbursement to the field is still a challenge
...In general, campaigns are being supported by communication interventions in all countries, but serious concerns are flagged in Pakistan where only 40% of High Risk Areas received funds on time, and in South Sudan where only 50% of funds were received on time. Consequently, urgent improvements are needed in this area..."