Role of Social Mobilization in Tackling the Resistance to Polio Eradication Program in Underserved Communities of Aligarh, India

This paper describes a cross-sectional study conducted to assess the impact of social mobilisation on families in Aligarh, India who are resistant to giving polio drops to their children. Considering that there is a history of Muslim resistance to the oral polio vaccine (OPV) due to mistrust and rumour, it was deemed significant that the Aligarh Muslim University led on this study; medical interns from this institution were trained as social mobilisers by the United Nations Children's Fund (UNICEF) and Rotary International trainers.

The introductory section of the paper provides a history of polio eradication efforts in India (editor's note: at the time of this writing, India's name had been struck off from the list of endemic countries; on March 27, 2014, the World Health Organization (WHO) certified India as polio-free). India became a partner for Global Polio Eradication in 1988; National and SubNational Immunization Days (NIDs and SNIDs) were initiated in 1995. (NIDs are popularly called Pulse Polio Immunization, or PPI). As explained here, even though the Government of India stepped up the frequency of mass immunisation from 1999-2000, "the most backward and underserved communities with little or no access to mass media were probably not reached by these activities. It was also noted that communication between health specialist, national planners and community was poor." Furthermore, "[d]oubts were raised about government motives in repeated rounds. Doubts left unanswered led to rumors such as polio drops cause infertility, are useless and paralysis may occur in spite of its administration or it causes polio..." This situation led to the conclusion that polio eradication could not succeed without the participation of the community - hence the efforts to break the barrier of resistance by social mobilisation.

For this study, the participating medical interns from Aligarh Muslim University were trained to carry out Team A and Team B activities. In both teams, there was at least one female medical intern; her presence made accessing the houses easier because most of the male family members were working at the time of the visit. (It would be inappropriate for a man to visit a woman at home with no male present). The interns were trained keeping in mind the demographic, socio-economic, cultural, and religious factors of the communities.

As part of this study, one round of polio drop administration during September 2012 was selected randomly from a total of 6 rounds of the PPI campaign carried out in the year 2012 in Aligarh, India. Trained members of the Team A first greeted the families, took note of their grievances, and asked about any apprehension regarding polio drops. They imparted correct health education in an effort to convince the family members that polio drops were safe and that receiving them did not contradict any religious or cultural sentiments. Many people visited by the interns asked for other basic amenities like sanitation, drinking water, health services, and electricity. "Team members discussed their problems with the district authorities and requested to instruct the person concerned to take appropriate action at the earliest. This helped a lot in reducing the resistance in the families."

The total number of resistant families identified during the house-to-house outreach activity of Team A was 309. A large number of houses (70.9%) were converted to P houses (houses where children had polio vaccination). Ninety houses (29.1%) remained resistant even after the activity of Team A. These resistant houses were again visited by Team B members. Out of these 90 houses, polio drops were administered in 70 (78.9%) houses. Nineteen (21.1%) houses remained extremely resistant.

In conclusion: "All efforts should be made to impart correct health education regarding importance of polio drops and routine immunization. There is a need to carry out polio eradication campaign more vigorously through information, education and communication (IEC) activities. District authorities should focus on issues related to basic amenities of the community. Communication strategies such as mobilizing social networks and community leaders, creating political will, increasing knowledge and changing attitudes, overcoming gender barriers and, above all, reaching out to the poorest and the most marginalized population of the community."