Strategies for Addressing Rumours and Building Community Acceptance for Immunisation (Balochistan)

This PowerPoint presentation was prepared for a September 2007 United Nations Children's Fund (UNICEF)-hosted meeting dedicated to examining polio communication efforts in Pakistan. In support of the final global push towards polio eradication, state-specific presentations were given by in-country communication and health practitioners working in Pakistan's polio-endemic states (Sindh, Balochistan, and the Northwest Frontier Province). These were assessed by an external panel of experts in the fields of development communication, mass media, epidemiology, and anthropology, who provided communication programme recommendations based on data presented by the country teams, as well as data gathered on field visits to the endemic states. Communication strategies presented at this meeting were primarily focused on:

1. Analysing the results of programmes implemented through September 2007
2. Detailing activities on national and sub-national levels, specific to social mobilisation, community engagement, underserved areas, media, and political advocacy strategies
3. Suggesting communication strategy and programme refinements for the next 6- to 12-month period, designed to support Pakistan's polio eradication efforts

This presentation gives an overview of geographic distribution of wild poliovirus (WPV) cases to date in the Balochistan province of Pakistan, with a special focus on refusals and rumours related to polio vaccination, the communication strategy for dealing with these issues at both the provincial and district levels, and social mobilisation activities at the community level.


According to this presentation, there have been two WPV cases in Balochistan to date in 2007. These cases are geographically restricted to the Nsirabad and Jaffarabad districts on the Eastern border of the province. Districts with the highest number of Union Council (UCs) areas affected by vaccine refusal include Killah Abdullah and Killah Saifullah. An analysis of the causes of these refusals in Killah Abdullah is presented, and includes reasons such as religious perceptions (35%), fatigue with frequent rounds (25%), rumours and misconceptions regarding vaccine safety and composition (18%), and additional demand (17%).


Post-campaign monitoring (PCM) data is illustrated, and reflects that coverage of children under 5 years of age has significantly improved during the first quarter of 2007, especially in the high risk areas. In addition, improved coverage of children under 6 months of age during the first quarter of 2007 is reported in the majority of the high risk districts in the northern region.


Strategies for addressing immunisation refusals and rumours are discussed in detail, at the provincial, district, UC, and community level. Some of the specific activities that have been initiated include:

• Polio walks and cycle rallies
• Interactive vehicle announcements
• Public appearances of high dignitaries to inaugurate vaccination activities
• Directives from the Chief Secretary's office to the district-level
• Use of electronic and print media (e.g. television and radio shows, Polio True Stories, BBC Pashto, discussions in local languages)

A few challenges still facing Balochistan's PEI are mentioned, including:

1. Magazines and print media publishing anti-polio vaccination messages
2. Teachers creating misconceptions regarding the vaccine
3. Community fatigue

Many ideas for improving on the future polio communication strategy were suggested by the Balochistan team. Among these were:

• Increase focus on interpersonal communication (IPC) skills
• Enhance visibility if the Polio Eradication Intiative (PEI) campaign
• Provide increased support to expanded routine programme on immunisation
• Utilise social mobilisers more effectively and provide refresher trainings
• Develop social mapping at the district level

In particular, the presenters discussed that social mobilisation at the community level should focus on:

• Regular meetings with community elders during and between vaccination rounds
• Human resources support at the community level
• Addressing immunisation refusals
• Training of communicators in IPC to respond to the particular audiences
• Results-oriented social mobilisation activities

For the full PowerPoint presentation, please contact Kiyuri Naicker at knaicker@comminit.com