The Importance of Why: How Polio Communications Helps Reach Every Child

The historic effort to eradicate polio around the world has seen the engagement of 20 million volunteers, health workers, lab technicians, vaccinators, and mobilisers dedicated to the common goal of preventing childhood paralysis. In this presentation from the United States Agency for International Development (USAID), one of the partners in the Global Polio Eradication Initiative (GPEI), Amanda Quintana and Ellyn W Ogden explore the role that data-driven communication has played in the endeavour.

They begin by asking why USAID invested in polio communications. Through field visits, USAID uncovered issues such as weak leadership and coordination, lack of local engagement, and a disconnect between the GPEI and the people. Communications staff did not have: a standardised field guide, indicators, accountability for results, data analysis and triangulation, enough trained people, or supervision. To convince people that there was a problem here, it was necessary to challenge underlying assumptions, such as the belief that the operating environment is not germane, that social issues (gender, culture, religion) are not relevant, and that communications can't be measured the same way surveillance is.

As Quintana and Ogden explain, the GPEI's original 3-pronged communication strategy, articulated in 1996, involved:

1. Carrying out advocacy among decision-makers at different levels (global, regional, national, state, and district) to obtain political and financial commitments and to persuade others to rally behind polio eradication;
2. Mobilising caregivers, communities, leaders, and organisations to participate in vaccination days; and
3. Informing caretakers about vaccination dates and places to ensure compliance.

A subsequent slide looks at the evolution of polio communication in different time periods (1988-2002, 2002-2006, 2006-2009, and 2009-present) in the categories of relevance, messages, source, social context, monitoring and evaluation (M&E), management/leadership, coordination, and research. The side-by-side, bullet point comparison makes it clear how far we have come to the present day, when communication is recognised as essential.

However, the same children are chronically missed. Why? Factors include: operational challenges, insecurity and attacks on health workers, difficulty reaching newborns, underserved populations and refugees, microplanning challenges, hostile media myths and rumours, and supervision challenges. Communications and community engagement solutions have been developed in the areas of: migrant workers and people in transit, better use of technology, accountability and political leaders' commitment, cross-border coordination, effective communications and social mobilisation, and independent monitoring.

Quintana and Ogden argue that good data drive quality programming. Stratifying information is collected from the national to household level and in categories such as clusters, complacency, trust, and accountability. This information is used to shape tactics involving: child tracking and household tracking; youth engagement; mass media; journalist groups; interpersonal communication; communication networks; negotiation in insecure areas; mosque announcements; celebrities; polio survivors; full engagement of local, religious, and traditional leaders; non-governmental organisations (NGOs), Islamic advisory councils; health camps; advocacy; training to persuade; and information, education, and communication (IEC)/branding.

In this context, USAID's leadership in polio communications has included:

• Linking communications and operations
• Establishing communication networks in India, Pakistan, Afghanistan, and Nigeria
• Introducing standard communication indicators:
  • Profile of missed children (location, age, sex, and social data)
  • Sources of information about polio (TV, radio, religious leaders)
  • Knowledge about polio immunisation (minimum age, health status)
  • Reasons for missed children (refusals, home not visited by vaccinators)
  • Reasons for refusals (fear of side effects, religious issues, too many rounds)
• Initiating external communication reviews: India, Afghanistan, Pakistan, Nigeria
• Supporting operational and qualitative comparative analysis (QCA) research in Nigeria and Ukraine
• Supporting strategic, evidence-based use of mass media, interpersonal communication, community mobilisation, print materials

Quintana and Ogden conclude by suggesting that polio communication saves time, saves money, and saves lives.

Editor's note: The above is a summary of a presentation delivered by Amanda Quintana at Shifting Norms, Changing Behaviour, Amplifying Voice: What Works? The 2018 International Social and Behavior Change Communication (SBCC) Summit featuring Entertainment Education, held April 16-20 2018 in Nusa Dua, Indonesia.

Click here for the 28-slide presentation in PDF format.