Technical Advisory Group on Polio Eradication for the Horn of Africa Countries: 16th Meeting Report

"The TAG congratulates the HOA countries for implementing most of the recommendations from the 15th HOA TAG and for progress in building strong C4D [communication for development] networks in many countries and integrating C4D into the response....In recognizing the progress, the TAG highlights that the work is not complete and complacency must be avoided as long as risk of active transmission remains."

The Horn of Africa Technical Advisory Group (HOA TAG) was established to review the situation and progress of poliomyelitis (polio) eradication in countries of the Horn of Africa, identify areas of concern, and issue technical recommendations on appropriate strategies to ensure the interruption of wild poliovirus transmission (WPV) in the HOA and neighbouring countries. The HOA TAG meets annually; this is the report from their 16th meeting, held May 11-12 2017 in Nairobi, Kenya.

The report describes the epidemiological situation, which, in short, is that the likely continuing transmission of WPV and circulating vaccine-derived poliovirus type 2 (cVDPV2) in Nigeria and the Lake Chad region remains a threat to all HOA countries. There are many factors contributing to the high risk of polio virus importation and spread, such as the continued conflict and insecurity in Sudan, South Sudan, Somalia, and Yemen that have left an estimated 730,000 children inaccessible for immunisation.

In this context, the TAG deems it crucial that HOA countries utilise mechanisms such as polio outbreak simulation exercises (POSEs) to develop robust outbreak response plans and thereby strengthen preparedness and response capacity for polio events and outbreaks. The TAG encourages countries to establish cross-border coordination meetings at the level of border localities between neighbouring countries (e.g., South Sudan and Kenya; South Sudan and Ethiopia).

"Given the continuing risk, it is of utmost importance to maintain and further strengthen communication capacity, including crisis communication across HOA countries." Communication training for outbreak preparedness and response should, according to the TAG, be conducted annually to address high staff turnover in MOH [Ministry of Health] and UN [United Nations] partners. As recorded in the last TAG (Editor's note: the 15th meeting report does not seem to be available online), the overall social environment remains conducive to polio campaigns, as evidenced by high campaign awareness across HOA countries (See Figure 9 on page 12). However, children are still being missed due to both operational and social reasons. TAG explains that the challenge for countries in or emerging from conflict is keeping the C4D networks in play amid dwindling resources. While innovations around mobile populations are "laudable", "they need to be built upon from a C4D perspective". Furthermore, in thinking about transitioning beyond the GPEI, the TAG indicates that "strategies should engage more concretely with the imperative of maintaining hard-won C4D assets and for leveraging RI [routine immunisation] and resources for other health emergencies."

The report (Annex B) provides country summaries; here are highlights of C4D activities in each:

• Kenya's C4D strategy focuses on polio within overall child health promotion (including RI) as a positive social norm. The national outbreak response plan is updated and includes a communication component. The country's communication and social mobilisation strategy is updated to include risk communication guidelines. The Supplementary Immunisation Activity (SIA) communication products and vaccination teams' trainings developed for the 2017 polio SIAs were informed by reasons for missed children from 2016 polio SIAs and the 2016 measles/rubella campaign. Refusals are at an all-time low of 2%. Two strategies - namely, the School Strategy and the Immunization Champions Strategy - have been transitioned to support RI with funding from GAVI as part of the communication-related interventions.
• The Somalia programme is using a combination of C4D strategies, including high-level advocacy with stakeholders, ministries, religious leaders, schools, radio, megaphone announcements, and house-to-house community mobilisation. Special emphasis is placed on the sensitisation of mobile nomadic populations. Specially trained mobilisers are set to reach and sensitise these populations with the support of duly trained nomadic elders. Polio information, education, and communication (IEC) materials were also produced, with a special focus on polio surveillance. Frequently asked questions (FAQ) leaflets and posters were produced and dispatched to all 3 zones, in addition to the usual printed material on polio vaccination (posters, banners, mobilisers' aprons).
• In Ethiopia, C4D is well addressed in the revised polio preparedness and response plan. No refusal was reported during SIAs in 2016. Lack of awareness as a reason for non-vaccination for SIAs remains 2% or less during the year.
• The information and education centre at Yemen's MOH has developed its 2017-2020 strategic plan to support the Expanded Programme on Immunization (EPI)'s activities and to advocate for polio eradication. With the help of the United Nation's Children's Fund (UNICEF), the MOH was able to face the rumours emerging before the National Immunisation Days (NIDs) in February 2017. Prompt response and actions were taken involving medical personnel, since the rumours were medically based; communication focused on the safety of vaccines. Moreover, the information and education programme is concentrating its efforts on involving local authorities and community leaders in areas with refusals and in hard-to-reach areas. In 2017 and after the refusal of vaccine entrance to the country, the MOH and its partners were successfully able to advocate for the importance of vaccination and polio eradication.
• Sudan EPI/Polio is using multiple strategies, including high-level advocacy with stakeholders, ministries, religious leaders, schools, radio, megaphone announcements, and house-to-house community mobilisation. The programme prepared a communication component for the national outbreak response plan, which included updated social mapping of high-risk populations and analysis of reasons for missed children. This was discussed and updated during the POSE conducted in Sudan, March 5-8 2017.
• Communication activities in South Sudan continue to receive technical support from UNICEF C4D, and there is a functional social mobilisation working group (SMWG) that ensures SM activities are consistently carried out.
• In Tanzania, social mobilisation on immunisation services is done using combined methods, including advocacy with stakeholders, politicians, and religious leaders and using radio, megaphone announcements, and house-to-house community mobilisation.
• There has been enhanced polio risk communication during Uganda's SIAs. An equity assessment was conducted to address identification of high-risk populations: urban economically poor settlements, migrants, ethnic minorities, some religious sects (especially Muslims, Bisaka sect and Triple 6, upcoming town settlements, fishing communities, refugee communities, remote rural, and island and mountainous communities). An assessment of communication staff's capacities was done: 3 UNICEF C4D staff members completed the UNICEF-NYU [New York University] Behavioral and Communication Strategies for Global Epidemics course in 2015, 2016, and 2017.
• Communication and social mobilisation activities are ongoing in Eritrea.

Prior to country-specific recommendations for Somalia, Ethiopia, Kenya, South Sudan, Yemen, and Sudan), the report offers overall recommendations, some of which are communication-related:

• Ensure use of updated social mapping, the analysis of high-risk populations, and the reasons for missed children, in the preparation of evidence-based communication plans, according to various accessibility profiles.
• Complete capacity building of frontline workers and ensure rigorous monitoring of outputs and outcomes.
• Reinforce and monitor outreach strategies for mobile populations and activities, specifically in border areas.