Technical Advisory Group on Polio Eradication for the Horn of Africa Countries: 18th Meeting Report

"In view of the ongoing outbreaks and risks, GPEI [Global Polio Eradication Initiative] should continue regular communication and advocacy with the Ministries of Health to ensure all necessary efforts are made until the current outbreaks are stopped."

The 18th meeting of the Horn of Africa Technical Advisory Group (HoA TAG) was held from November 27-29 2018 in Nairobi, Kenya; this report offers details about the discussion. Since the group's last meeting in May 2018 (see Related Summaries, below), the HoA implemented a response to ongoing outbreaks (OBs) of circulating Vaccine Derived Poliovirus Type 2 (cVDPV2) and Type 3 (cVDPV3) in Somalia, Kenya, and Ethiopia. The TAG stresses that several countries across the HoA remain at high risk of development or importation of cVDPVs due to serious gaps in immunity and surveillance.

Within the above context, the 18th HoA TAG meeting was called with the following objectives (with the present summary focused on the portions of the report focused on 2e - communication strategies):

1. To review the cVDPV OB situation in Somalia and Kenya, including the implemented and planned response in those and other HoA countries, and to provide recommendations as required.
2. To review the following with particular reference to Somalia, Kenya, Ethiopia, Yemen, and South Sudan, and to make recommendations concerning: a) The status of the control of the cVDPV 2 and 3 OB-affected countries; b) OB response (OBR) preparedness and risk mitigation strategies in countries with no confirmed circulation; c) Sensitivity of surveillance in countries, particularly with reference to access compromised, high-risk, and mobile populations; d) Plans for strengthening basic immunisation services in the context of polio transition; and e) Communication strategies focusing on building and sustaining demand for immunisation, particularly in high-risk groups.
3. To make recommendations for strengthening surveillance and mitigating risks with respect to other HoA countries.

Country summaries related to communication for development (C4D):

• Ethiopia - Thanks to the support of the communication team, 98% and 86% of parents/caretakers were aware of the July and September 2018 campaign before the vaccination team visited their house. The 3 most common sources of information for the campaign include kebele leader (38% and 30%), megaphone (32% and 38%), and health workers (24% and 25%) for first and second round, respectively. A total of 2,698 Islamic Affairs Supreme Council (IASC) network members have conducted weekly polio social mobilisation activities in 3,666 orientation sites (mosques, madrasas and other public gatherings) and reached an audience of 277,291 individuals. Fourteen bordering woredas received daily polio social mobilisation activities.
• Kenya - C4D/advocacy and social mobilisation were integrated into the national OB response, which was based on evidence generated through formal knowledge, attitudes, and practices (KAP) studies and formative research, as well as the analysis of campaign data. With a focus on the 12 high-risk counties, the strategy used existing community structures and networks to reach the intended populations. Following capacity building, advocacy at national, county, and subcounty levels was initiated. Evidence-informed information, education, and communication (IEC) material for each of the rounds was developed. Use of local radio and television stations, and social media for urban audiences, was a key part of the response, and media engagement by the local leaders helped increase vaccine acceptance and awareness. In addition, a strong community engagement element with different stakeholders (e.g., high-risk populations, religious leaders) increased the vaccine reach and utilisation. The campaigns were supported by national- and county-level champions.
• Somalia - The Somalia programme is using a combination of C4D strategies, including high-level advocacy with all stakeholders, and engagement of trained community mobilisers and members of the National Islamic Advisory Group (NIAG) to inform communities - through house-to-house visits and mosque announcements - and to handle refusals through revisits. Nomadic elders continue to be mapped, oriented, and included in microplans so they can assist in coordinating with vaccination teams to ensure vaccination of nomadic children. Mass media channels such as radio/TV, IEC materials, and short messaging service (SMS) and megaphone announcements are used throughout the country in all campaigns. Special emphasis is given to the sensitisation of nomadic populations, and mobile/cross-border/internally displaced person (IDP) populations, which includes an increase in the number of days for house-to-house mobilisation and community sessions. A communication assessment conducted in high-risk and densely populated districts of south and central regions indicates that overall awareness is higher than 90% in the assessed districts. The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) are sharing regular situational updates and engaging with UN agencies, health cluster members, and the national and international media using different channels (meetings, TV, radio, social media (@WHOSom; @unicefsomalia)).
• South Sudan - Having been trained, the 2,306 community mobilisers visited 1.06 million households from May 2018 to July 2018. During this time, they also conducted 1,789 school orientations, 1,938 mothers' meetings, 1,561 church/mosque announcements, 1,595 community meetings, and 1,261 youth club meetings.
• Sudan - To convey messages and convene people during SIAs, the programme is using key channels for communication, including megaphones, radio (through a network of national-, state-, and community-focused stations), community leaders, religious leaders, and civil society organisations (CSOs).
• Uganda - Community mobilisation and enhanced polio risk communications have been emphasised during SIAs, and communication packages have been developed for stakeholders and health workers to facilitate effective communication and community mobilisation. Meetings are ongoing reaching out to different stakeholders to address the identified hindrances to immunisations.
• Yemen - Communication plans have been established/updated in all high-risk districts/governorates, and IEC material has been revised/updated in light of communication data collected.

The TAG acknowledged the improvement in social data collection by country offices. The TAG also appreciated the comprehensive fact sheet (Polio Communication Profile) developed at the regional level but noted, with concern, that non-OB countries, especially those neighbouring active OBs, did not address or report on relevant C4D components of polio outbreak preparedness and response planning. The TAG points to several lessons learned from the 2013-14 wild polio virus type 1 (WPV1) and 2017-2018 VDPV OBs, such as: the importance of high-quality training at all levels on the use of data for evidence-based communication planning, and the need for a monitoring framework for social and behaviour change activities conducted in the region.

General C4D recommendations:

• The HoA should develop a regional C4D plan focused on common priorities (one voice, one platform) in close coordination with country teams.
• All international partners, including GPEI partners, should strongly support the use of global communication guidance and best practices.
• Country teams should ensure use of data for evidence-based planning and corrective action, including zero dose social profiling, and disaggregate data for special and mobile populations at all levels.
• All OB-affected countries should continue to build capacity to use polio communication profiles to help inform programmatic decisions.

The TAG also offers recommendations for specific HoA countries. To cite only one example, Yemen is advised to: conduct OB simulation and document that relevant C4D components are integrated in national OB preparedness plans; build capacity for OB response and preparedness, especially with regard to improving interpersonal communication (IPC) skills of frontline workers; and develop special OB preparedness, responsive C4D strategies, and communication profiles for security comprised areas.

Taking into consideration the current OB and outbreak response activities (OBRAs) and the follow-up of recommendations, the HoA TAG proposed to convene during May/June 2019 to review implementation of the next phase of OB response and risk reduction measures.