CORE Group Polio Project Annual Report FY17

CORE Inc. is an international development organisation that has endeavoured since 1997 to advance the field of community and maternal health by advocating for in-country collaboration between global partners, local non-governmental organisations (NGOs), and government ministries of health. This annual report explores the work of the CORE Group Polio Project (CGPP), sharing country reports from Ethiopia, Horn of Africa, India, Nigeria, and South Sudan. The present summary highlights some of the communication-related activities of each focus country during fiscal year (FY) 2017.

The primary focus of the project is the achievement of high population immunity through the promotion of high-quality campaigns, routine immunisation (RI), and community-based surveillance (CBS). The backbone of this effort is achieved by community mobilisers trained and supervised by NGOs who form the CGPP civil society coalition of approximately 30 local NGOs and ten international NGOs (iNGOs). Overall objectives include:

1. Building effective partnerships with private voluntary organisations (PVOs), NGOs, and international, national, and regional agencies involved in polio eradication;
2. Supporting PVO/NGO efforts to strengthen acute flaccid paralysis (AFP) case detection (and reporting and detection of other infectious diseases);
3. Supporting PVO/NGO efforts to strengthen national and regional immunisation systems to achieve polio eradication;
4. Supporting PVO/NGO involvement in national and regional planning and implementation of supplemental polio immunisation;
5. Supporting timely documentation and use of information to continuously improve the quality of polio eradication (and other health-related activities); and
6. Supporting PVO/NGO participation in national and/or regional polio eradication certification activities.

The country reports are organised according to the six objectives above. Brief highlights:

• Ethiopia - In FY17, CGPP Ethiopia and its 11 implementing partners trained 13,781 community volunteers and health workers (including on interpersonal communication, or IPC) to reach 1.8 million people along its porous borders with routine and supplementary immunisation, AFP surveillance, and health information. CGPP Ethiopia also contributed to the development of a polio transition plan for the entire country. CGPP conducted Expanded Programme on Immunization (EPI) Mainstreaming through religious training in Siti Zone Erer woreda from July 3-6 2017 to increase the participation of the religious community in immunisation and surveillance activities. In addition, CGPP Ethiopia conducted a sensitisation workshop for 257 religious and political leaders. Community volunteers (CVs), health development army leaders (HDALs), and health extension workers (HEWs) were trained to conduct surveillance, as well as house-to-house health education sessions and social mobilisation activities during routine and supplementary immunisation campaigns. Partner NGOs provided support, including social mobilisation materials (megaphones, dry cells, and banners). In FY17, the Secretariat also implemented a mobile device and web-based surveillance data collection and online submission system called m-Health. Collaborative activities among cross-border districts are also described. CGPP Ethiopia is developing a comprehensive polio legacy plan to strengthen community-based surveillance and immunisation activities and transition resources to the government. To that end, supportive documents have been developed to articulate elements such as best practices and lessons learned and the communication and advocacy strategy.
• Horn of Africa - In Somalia, 148 community health volunteers (CHVs) and 21 community mobilisers (CMs) reached more than 165,000 children through supplementary and routine immunisation campaigns and active AFP case detection. During the reporting period, CHVs in Somalia conducted 24,271 house-to-house visits, reaching 97,436 people, and conducted 1,343 visits to border health facilities. CMs conducted community dialogue sessions with 22,742 pregnant and nursing mothers and 14,538 men on the importance of RI. In Kenya, CORE Group reached 178,599 under-fives along 138 crossing border points with 400 CHVs and 80 CMs.
• India - Since the inception of CGPP, the number of wild poliovirus (WPV) cases in India has dropped from a high of 1,934 in 1998 to zero in 2017. According to the final 2017 survey, 100% of children had received at least one dose of the polio antigen either during the supplementary immunisation activity (SIA) campaign or during RI. Sample activity: Through the Barber Initiative, CGPP has built the capacity of barbers to impart knowledge about immunisation with fathers (the main decision makers in families), initiate discussions about the importance of polio immunisation, and sensitise men to immunize their children during immunisation campaigns. (Barbers are an integral part of any Indian community; they not only provide services, but also act as important meeting places, where men participate in conversations about family life, village politics, cricket, and many other issues. They, therefore, represent an opportunity to reach large numbers of men with behaviour change communication related to polio vaccination.)
• Nigeria (see also Appendix A, on the CGPP: Nigeria RI programme) - Working in the highest-risk areas, 2,383 CGPP Nigeria-trained CHVs reached nearly half a million children under five years old in FY17 and reported 281 cases of AFP through CBS. Vaccine refusal or non-compliance and poor access to vaccination in the most insecure areas of the country pose a serious threat to Nigeria. CGPP Nigeria continued its work to reach unprotected, trapped children in areas impacted by the Boko Haram insurgency. The progress of CGPP Nigeria was closely tied to the work of volunteer CMs (VCMs) in promoting participation in campaigns and RI. They used IPC sessions with mothers to convey health education on vaccine-preventable diseases, maternal health, hygiene, and the dangers of polio disease to reduce vaccine hesitancy. Prior to Immunization Plus Days (IPDs), VCMs also conducted house-to-house visits to engage mothers on polio immunisation. They also mobilised families for RI outreach/fixed sessions and ensured that all households were visited by the vaccination teams during the IPD or mop-up sessions. These household visits were conducted with guidance and collaboration from local, religious, and traditional leaders to reduce or minimise vaccine hesitancy, non-compliance, or outright vaccine rejection. VCMs worked closely with their communities to ensure that parents understood the importance of repeated doses of polio vaccination beyond the initial birth dose. If any child in the VCM settlement was missed due to absence, the VCM returned to the home, thus improving overall coverage rates. A compound meeting or community dialogue was conducted to resolve cases of non-compliance. CGPP introduced a new strategy called Iftar to engage fathers, who are the heads of households in CGPP focal areas, during the Ramadan period. To encourage the acceptance of vaccination, CORE Group was reaching men at community mosques when Muslim men congregate for dusk prayer. Before the meetings, a list line of all non-compliant households was comprised. Following these meetings, 90% of the non-compliance cases, or a total of 905 children, were immediately immunised. The Male Peer Educators strategy was piloted in Kaduna state and has been expanded to Yobe state. This initiative trained prominent men in the community with information about the importance of vaccination. In turn, these men acted as influencers in their communities by supporting other heads of households to vaccinate their children. To address the most recent rumours that CVs were vaccinating children with Monkey Pox, Northern Traditional Leaders Committee on Primary Health Care (NTLC) countered with media messages to reinforce the importance of vaccinations. Community influencers such as religious leaders, community leaders, elders, decision makers, youth, and women leaders were engaged to dispel rumours and myths.
• South Sudan - At the request of the national EPI Technical Working Group (EPI TWG) CGPP began conducting post-campaign evaluations in 2014. In FY17, CORE Group identified, trained and deployed more than 550 data collectors who assessed the quality of the country's four annual SIAs. Data collected by monitors contributed to developing and planning campaigns that resulted in increased numbers of children who received oral polio vaccine (OPV) for the first time.

The report also shares some specific impact data. For example, in Nigeria, the 2017 survey showed increased knowledge about the polio vaccine across states; 86% of households understood when a newborn required his or her first oral polio dose, compared to 68% reported during the 2015 midterm survey. The final survey showed a 31% vaccination card retention rate, compared to the 19% survey results in 2014 and to the current national rate of 29%. Furthermore, survey results showed improved relationships of caregivers with CGPP CVs, at 72% in 2017 over 54% at 2014, and caregivers with health workers, at 24.4% at baseline compared to 29% at endline.

In reflecting on the CGPP's year, Lee Losey, Deputy Director and Technical Lead, writes: "The project has increased the national, regional, and global visibility of the coalition through publications and participation in a number of planning and oversight meetings....As we near the end of polio eradication the project has begun to develop transition plans and engaged various constituencies both internally and externally in discussions on how to document and utilize the human resources, strategies, and lessons learned for the benefit of other global health concerns. In summation, the project has matured, achieved, and contributed to polio eradication, continues to contribute and will likely be felt in the global health arena long after we see the last case of polio in the world."