Lessons Learned from Five Country Studies of Communication Support for Polio Eradication and Routine

Summary provided by the presenter

Since the mid-1990s, communication specialists from major international organisations supporting the global Polio Eradication Initiative have met approximately every six months to update each other on activities, share tools and lessons learned, and plan joint activities. In 1999 this group planned and carried out five country studies on communication support for polio eradication and routine immunisation. The objectives of these studies were to:

• Document communication activities
• Disseminate effective tools and approaches
• Make recommendations to officials in each country

The five country studies (in Mozambique, Zambia, DRC [Democratic Republic of the Congo], Mali, and Nigeria) were carried out in October and November 1999 by teams from UNICEF, WHO/AFRO, and USAID (BASICS II and CHANGE projects, and in Nigeria, Johns Hopkins University/PCS). Each country team consisted of four to five persons (approximately half from outside of the country) who spent about two weeks reading documents and interviewing diverse people from ministers to mothers, aiming to answer over 150 questions that would compare the country approach to "best practices".

Findings were summarised in five country reports and a summary report (all are available by clicking here). Major findings were:

• Polio activities were generally very successful (some reaching over 100% coverage in NIDs (National Immunization Days), while routine coverage was stagnant or falling in most countries.
• There were massive mobilisation and communication efforts for polio NIDs with a wide array of organisational partners, but minimal efforts for routine immunisation or surveillance (primarily health talks and posters). Although the public in most countries lack basic knowledge on immunisation, the team found Zambians to have good knowledge and motivation to have children immunised due to education given in health clinics, schools, churches, and communities. One community passed a resolution fining immunisation defaulters.
• In most countries, there was limited promotion of routine immunisation in polio communications, and some of the opportunities taken actually caused confusion.
• There was a lot of centralised, top-down planning and execution of polio communications, resulting in some materials being inappropriate for major regions and audiences, and some being distributed late or not at all. However, Zambia and some other countries did leave some scope for local initiatives.
• What worked well: interpersonal communication and involving local leaders and networks; interagency and intersectoral collaboration; engaging public officials and media, using a mix of media.
• Areas needed improvement: carrying out and using research for programme and materials design; making communications more strategic (not just giving people information but systematically defining desired behaviours and analysing and addressing barriers and motivations); local involvement in communications planning (except in Zambia); more lead time for planning and arrival of funds; supervision, monitoring and evaluation of communications; funding, management and quality of routine immunisation services; treatment of families by health staff.

Some major recommendations based on these studies were:

• Country programmes should use research-based national umbrella strategies that provide basic technical content and message consistency but that also encourage local adaptation and planning.
• Routine immunisation programmes should strive to use ideas that worked in polio eradication: interagency coordination; involvement of multiple sectors; focus on interpersonal communication, local leaders and networks; effective advocacy, including personal accountability of public officials; and strong partnerships with the media.

In addition, new initiatives are needed to:

• Engage people at all levels around routine immunisation, in part through better collection and use of information on all levels.
• Promote a client focus within health services, improving both attitudes and interpersonal skills.
• Promote the concept that immunising children is a shared responsibility of health services, communities, and parents.
• Increase programme resources and improve management.
• Prepare, implement, monitor, and evaluate research-based communication plans that are fully coordinated with service delivery and community participation.
• Build and institutionalise communications capacity.

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