Religious Leaders as Partners in Polio Eradication NWFP/FATA

This PowerPoint was one of the communication presentations made at a technical consultation on polio eradication in Afghanistan and Pakistan, held in Egypt from February 3-4, 2008. The objectives of the meeting included:

1. Reviewing progress towards polio eradication in the two countries, with a focus on 2007.
2. Discussing planned activities for 2008.
3. Making recommendations to enable the programme to address constraints facing the two national programmes.

The two-day meeting consisted of a programme of presentations and discussion looking at the epidemiological situation and programme activities in both countries, with a strong emphasis on programme communication.

The presentation begins with a background on Pakistan's North-West Frontier Province (NWFP) and the Federally Administered Tribal Areas (FATA) and reviews the reasons for working with religious leaders, the impact of this work, and recommendations for the future.

NWFP/FATA has a population of 29 million with 5.6 million under 5 years of age and a further 300,000 Afghan refugees. There is a 1,200 km border with Afghanistan and significant population movement between the two countries. There is considerable difference between various tribal and religious groups combined with a highly conservative society involving women only minimally in immunisation. There are significant and increasing misconceptions regarding vaccination - most of these have a religious origin. Many areas have become inaccessible due to political unrest.

In this context it was important to involve religious leaders because many religious leaders have appeared to be unsupportive. There has been intensive circulation of Fatwas against oral polio vaccine (OPV) amongst a population where Fatwas are very influential. Religious leaders are themselves very influential with their followers, have the capacity to counter negative Fatwas, and can be persuaded to support OPV if approached appropriately.

Gaining the support of religious leaders was approached systematically, beginning with developing a proper understanding of the situation and the magnitude of issues related to misperceptions and refusals, reviewing available social mobilisation resources, and knowing the religious and tribal sects involved. This initial step was followed by arranging planning meetings amongst the Polio Eradication Initiative (PEI) partners and then following these up with meetings with religious leaders. These meetings were designed to generate (and their success was measured by) high profile declarations and Fatwas which can be disseminated in the media.

Fatwas supporting polio immunisation have been effective in diminishing the effect of previous negative Fatwas and rumours.

The process of engaging religious leaders in NWFP/FATA has resulted in:

1. A decrease in refusals due to religious misconception.
2. Coverage of religious refusal families has increased; out of 19,154 religious refusals, 17% were covered in the October 2007 round compared to 13% out of 31,101 in August.
3. Coverage of refusals due to misconception increased to 50% in the October 2007 round compared to 37% in August.
4. More inaccessible areas became accessible and the total of inaccessible children in the tribal agencies fell to 866 in December 2007 from 24,951 in October and 68,000 in August.
5. There were more Days of Tranquility related to PEI.
6. The number of positive newspaper articles increased, and during the October-November 2007 supplementary immunisation activities (SIAs) there were 102 news items; 99 of them were positive and only 3 were negative.

According to this presentation, the success of this initiative to engage religious leaders leads to the conclusion that most religious leaders were not against vaccination and that well-planned and ongoing communication with them can keep them supportive and active in the campaigns. Furthermore, involving religious leaders has been a strong tool in convincing refusal families, and the Fatwas and media events have been instrumental in preventing refusals from growing and keeping media coverage positive.

Click here to download the full PowerPoint presentation.