Polio Communication in Nigeria: Interruption and Beyond

1
Polio Communicationin Nigeria Interruption and
Beyond

• Final
• TAG Recommendations
• 29 June 2007

2
2007 TAG Context

• A real opportunity
• Evidence suggests an epidemiological and
  operational opportunity in 2007-08 for
  interruption
• Case trends show significant reduction over 2006
• The media environment is vibrant
• There is significant investment and commitment
  from Federal and State Government and
  International Agencies
• There is a clear recognition of, and desire for,
  increased local State and LGA ownership to
  improve effectiveness.

3
2007 TAG Context cont

• But gains need to be consolidated by
• Making maximum use of communication
• Rationalising social mobilisation and
  communication activities by focusing on high
  impact strategies
• Preparing a solid and thorough multi-year
  Communication Strategy
• Improving the effectiveness of vaccinator teams
  and supervisors through training, supervision and
  monitoring
• Developing resource mobilisation plans at Federal
  and State levels
• Keeping in mind that the situation is still
  fragile and Nigeria and other countries have been
  at this point before only to see cases increase.

4
TAG Review - Intention

• To support improvements and consolidate gains
  made towards Polio eradication in Nigeria over
  the past two years.
• To introduce communication related
  recommendations to accelerate and strengthen
  short term polio action while supporting the
  continued development of sustained communication
  action on polio, routine immunization and other
  primary health care needs.
• To make strategic recommendations backed-up
  wherever possible with specific examples.
• To make each recommendation as specific and clear
  as possible while recognizing that decisions on
  whether and how to operationalise recommendations
  rests with the government, partners and donors
  responsible for implementing the polio programme
  in Nigeria.

5
TAG Review - Scope

• What follows is not a comprehensive review nor a
  fully fledged plan
• It is a set of recommendations designed to
• Support effective social mobilization and
  communication action
• Set a wider dynamic in play through these
  actions
• And help inform and support Nigerian decisions
  and planning related to Polio eradication.

6
Critical Polio Issues

• The specific strategies and ideas that follow are
  intended to address a cluster of critical issues
  identified by the Technical Advisory Group that
  may, if left unaddressed, undermine or reverse
  progress
• Missed Children/Non-Compliant Households
• Improving the accuracy of estimates for the total
  population of under-fives at State, LGA and Ward
  levels.
• Establishing better understanding of the reasons
  behind, and the numbers of, missed and zero dose
  children and non-compliance.
• 2. Vaccinators, Supervisors and Monitors
• Improving the motivation and skill levels of
  vaccination teams.
• Strengthening the capacity of supervisors and
  monitors to support the teams and ensure quality
  control.

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Critical Polio Issues cont

• 3. Ownership at State and LGA and Community
  Levels.
• States have taken an increasingly active and lead
  role in IPDs which should be further expanded and
  supported through enhancing their capacities in
  areas such as analyzing data, producing IEC
  materials and conducting localized media outreach
  in line with the strategic communication plan.
• 4. Coordination and Supervision Amongst all Main
  Parties
• Coordination needs to be strengthened between and
  among government and partners especially though
  not exclusively at the state and LGA levels.
• 5. Data Quality and Utilisation for Communication
• The quality of communication related data
  collection and analysis is a major concern and
  needs to be addressed across a number of fronts
  including training and motivation for vaccinator
  teams, improved monitoring for quality control,
  independent spot monitoring and linking data
  needs more closely to the strategic communication
  plan.

8
Critical Polio Issues cont

• 6. The Implications of a Broader IPD and PHC
  Focus
• IPDs, RI and PHC need to be more strongly linked
  and integrated in order to be able to sustain the
  gains made during the rounds and maintain high
  enough levels of immunity to move from
  interruption to eradication.
• 7. Systemic and Sustainable Capacity Building
• Many of the critical issues mentioned above
  depend on capacity building from State and LGA
  staff to vaccinator teams, supervisors and
  monitors.
• Taken together the recommendations are designed
  to positively address these issues.

9
Recommendations
10
Communication StrategyA Multi-Year/Multi-Stakeho
lder Approach

• Recommendation 1
• That a multi-year/multi-stakeholder communication
  strategy aimed at disrupting polio transmission,
  sustaining polio-free status through
  certification and strengthening routine
  immunisation in Nigeria in the context of primary
  health care be prepared.

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Communication StrategyA Multi-Year/Multi-Stakeho
lder Approach

• Rationale
• There is a well developed communication
  strategy Engaging Communities which provides an
  excellent basis for the elaboration of a
  multi-year strategy.
• However, current SM/C activities appear to be
  year to year, periodic and operationalised mainly
  around campaigns.
• At minimum eradication will take another 5
  years which will require a 6-12 month plan,
  within a 2-year plan, within a 5-year plan
• A more sustained month-by-month approach is
  needed that engages on a permanent basis with
  communities (perhaps primarily via the
  development of the community dialogue model).
• This planning process will need to happen
  without interrupting or drawing resources away
  from ongoing programme effectiveness.

12
Communication StrategyA Multi-Year/Multi-Stakeho
lder Approach

• A multi-year/multi-stakeholder communication
  strategy will
• Be able to look to communication needs over the
  coming year as well as post-interruption needs.
• Provide clearer communication as to the
  relationship between IPDs, routine and other
  immunisation programmes within the Primary Health
  Care system and how these strands fit together
  over time.
• Coordinate longer needs such as providing
  training and consistency to front line
  communication and the development of skills at
  State and LGA levels.
• Establish a year round set of communication
  activities linking IPDs to other health
  communication needs related to strengthening
  Routine Immunisation.
• Better match the communication plan to the
  technical plan.

13
Communication Indicators Coherent and Impact
Related

• Recommendation 2
• That the impact of SM/C activities be measured in
  terms of their own outcomes, and correlated with
  operational (coverage) and epidemiological
  (circulating virus) data using central indicators
  such as
• 75 recall of major messages of key knowledge
  shared through communication action.
• 50 of people have discussed polio/routine with a
  friend/family member in the past week.
• 80 of respondents got 3 of 5 major polio/routine
  facts correct.
• 70 of household respondents stated that the
  vaccinators both a took the time and b were
  courteous and polite in discussing any concerns
  that they may have had about vaccinating their
  child.
• Associate these measures with operational and
  epidemiological performance data at relevant
  level (village, ward or LGA).
• The above should be collected and reviewed
  between every round at agreed time interval and
  correlated with overall programme outcomes.

14
Communication Indicators Coherent and Impact
Related (cont)

• Rationale
• Common impact indicators drive focus and
  coherence what you countis what you do.
• All of above indicators are justifiable from
  literature as having significant role in impact
  though Nigeria will need to review and develop
  indicators specifically related to its own
  communication strategy and associated appropriate
  impact measurement requirements.

15
Communication-Related Data

• Recommendation 3
• That significant improvements be made to the
  quantity and quality of communication-related
  data including
• Better estimates of the overall population of
  under-fives in each state, LGA and ward as well
  as the numbers of missed and zero dose children
  and those in non-compliant households.
• Preparing reporting data using both percentages
  and absolute numbers for coverage to aid in the
  identification of actual numbers of missed and
  zero dose children and non compliant households
  to better plan well-targeted SM/C activities.
• Gathering more in depth qualitative knowledge
  related to non-compliance with the support of
  independent agencies that have the required
  skills and with results fed back into round
  planning.

16
Communication-Related Data contd

• Rationale
• Absolute numbers will give LGAs and States a
  clearer idea of targets and gains and help
  clarify the actual numbers of people being
  immunised.
• Understanding the numbers of children to be
  immunised, whether they are zero dose, missed or
  in non-compliant households is essential to the
  communication strategy for any round in every
  state.
• Improving the depth of qualitative knowledge will
  provide a better feel for people related issues
  and opportunities and provide a necessary
  compliment to quantitative data.
• Existing forms for capturing qualitative data
  especially, though not exclusively, in the
  community dialogues tend to miss important
  information regarding communication issues
  effecting community ownership of the polio
  programme.
• Present tools do not allow States and LGAs to
  collate the qualitative results to what's
  happening in the communities they work in.

17
Independent Monitors

• Recommendation 4
• Strengthen existing monitoring systems and
  capacities with further training, earlier
  deployment and the addition of one or more fully
  independent agencies to conduct in and end
  process monitoring and provide periodic reports
  to the partners in Abuja.
• Rationale
• Quality control remains a very large issue for
  household level data collection, accurately
  transferring data from one level to another and
  ensuring maximum coverage during IPDs.
• Numbers of monitors have been increased
  significantly over recent rounds but their
  training and skills are not consistent.
• Independent (e.g. outside the polio programme
  partners) and fully trained monitors doing proper
  in and end process monitoring would help identify
  gaps and problems and allow specific training and
  other needs to be identified and targeted.

18
Community Dialogues

• Recommendation 5
• That Community Dialogues (CDs) be improved and
  strengthened through
• greater methodological coherence and focus on
  local community
• leadership, agenda setting and facilitation.
  Specifically this will include
• Reviewing and consolidating the approach,
  purpose and practice of CDs.
• Conducting CDs year round focused on community
  determined PHC issues but used to spot emerging
  issues pre-round and evaluation post-round.
• Identification of appropriate local
  facilitators.
• Training facilitators directly. This has
  resource implications as cascade training will
  not be adequate.
• Moving government and technical agency staff to
  support roles and negotiating a larger role for
  Ward Development Committees.
• Continued support and expansion of peer CDs
  for women, religious leaders and other segments
  of the community.
• Following Katsinas lead integrating
  community dialogues with local radio.

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Community Dialogues cont

• Rationale
• Polio, RI and PHC programmes are considerably
  strengthened by local ownership.
• CDs can be an important tool to link and embed
  programmes in local systems and cultures helping
  to support long term healthy behaviour change.
• CDs are significant but under-utilised sources
  of pre and post round information and evaluation.

20
Social Mapping

• Recommendation 6
• That more extensive use be made of social mapping
  strategies.
• Specifically this should include
• Engaging all actors in a community local
  community members to international agency
  personnel in jointly building over time a social
  map of their community incorporating key social
  themes, data, resources, problems and issues
  along with polio, routine and other primary
  health care knowledge.
• Building on the route/social maps now used and
  already being adapted to include some social
  information.
• A strong relationship with the community dialogue
  process.

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Social Mapping cont

• Rationale
• Social Mapping places the specific issues eg
  polio in the context of overall community, LGA,
  State and other resources and opportunities.
• Mapping out the full depth of social resources
  will help identify and track important local
  partners for the IPDs over time.
• Data presently shows that the involvement of some
  CBOs and NGOs is irregular and there is evidence
  to show that in some communities they may be
  getting fatigued.
• Reviewing and updating these on a regular basis
  will enable tracking over time and support
  communication strategies to strengthen and build
  on these relationships and respond to changes
  between rounds.
• Social maps will provide a coherent relatively
  simple platform built on already existing tools
  for accumulating knowledge and taking advantage
  of relationships
• These maps will be an important post polio PHC
  support and tool.

22
Vaccinators and Supervisors Front Line for
Communication

• Recommendation 7
• That vaccinators and supervisors be formally
  recognised as the front line communicators for
  polio, routine and other primary health care
  initiatives and be supported to be more effective
  communicators through
• An improved selection process that stresses
  experience skills the ability to understand and
  relate to household dynamics and personal
  commitment to child health.
• More extensive inter-personal communication
  skills training.
• A support package that increases retention and
  motivation possibilities allowance, transport,
  equipment.
• Tracking of retention rates and identification of
  reasons for low retention.

Rationale As the public interface between the
delivery system and the households the quality of
the communication by vaccinators is vital for
success this aspect of their work has been
overlooked.
23
Data Collection and Analysis

• Recommendation 8
• That data collection be improved so that it is
  accurately captured, organised, analysed and
  submitted upwards or re-submitted downwards in a
  timely fashion.
• In the short term this should include
• Training to vaccinators, supervisors and monitors
  on accurate data collection and proper use of
  forms.
• Training for supervisors and monitors on
  assessing data quality and implementing simple
  quality control measures.
• Data sampling to determine areas of weakness for
  targeting in successive rounds.
• For the longer term Nigeria should
• Explore more advanced technologies for
  collecting, analysing and sharing data - for
  example
• Widening access to computers and internet (to
  LGAs for instance) would enable faster and more
  open distribution of data and reduce the points
  at which data is transferred from one form to
  another by hand.
• Other technologies for collecting data such as
  mobile phone or personal digital assistants
  (PDAs) could also be explored.

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Data Collection and Analysis cont

• Rationale
• A long term goal for immunisation and the wider
  health system is the advancement of health
  information systems. Improving how data is
  gathered from the local level to a central
  organising point and then back to the local level
  for planning is vital.
• Data collection and accuracy has been identified
  as a major problem within Nigerias polio
  programme starting from the house to house
  collection during rounds and then moving up
  through the collection and anlaysis system.
• Without dependable data shared in a timely
  fashion it will be very difficult to know how
  successful the programme is or how to
  strategically focus communication.

25
Strengthening Knowledge Sharing

• Recommendation 9
• Establish a platform for sharing and critically
  reviewing the very significant knowledge being
  generated at LGA, State and Federal levels and
  throughout the full range of partners so for
  example what is learned in Katsina can be easily
  accessed by Jigawa
• Key actions to include
• A monthly update email/print on a key
  developments in past week b major learnings c
  main issues and d new communication programme
  developments Federal level to facilitate.
• A text message network so people from an agreed
  communication support network can both a share
  key developments quickly and b seek guidance on
  particular issues.
• An online knowledge base.
• Financial data sharing.

26
Strengthening Knowledge Sharing cont

• Rationale
• Vitally important knowledge is generated at LGA
  and State level but is not consistently shared.
• Such knowledge could become an essential tool
  resonating with, and therefore significantly
  helpful to, those involved in the on-the-ground
  action.

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Mass Media and Communication Support Unit

• Recommendation 10
• That suitably qualified Nigerian entities
  agency/university/company be contracted
  (possibly by the Social Mobilisation Working
  Group) to provide national mass media and
  communication support and to generate knowledge
  for use by all partners and states that includes
• A regularly updated comprehensive map of the
  Nigerian media landscape with state specific
  breakdowns.
• A listing of the most popular programmes and
  their audiences.
• Continuous monitoring of the impact of mass media
  polio communication programmes at national and
  state level
• Regular communication and information and support
  to partners and government placing content in
  mass media.
• Support and development of suitable partnerships
  with media.
• Rapid assessments, surveys and research as
  needed.
• Rationale
• Mass media plans and the monitoring of campaigns
  will be considerably strengthened by this
  resource.

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IEC State Hubs

• Recommendation 11
• That the capacity of states to produce IEC
  materials specific to their needs and based on
  their communication strategies be increased.
• Specifically this means
• Updating existing (such as HECTIC) and/or
  establishing new IEC production centres in the
  high risk states.
• Rationale
• IEC production technologies are now quite cheap
  and easy to use.
• States presently spend a lot of time producing
  things like hand painted banners and other IEC
  materials for IPDs. This cost in time and
  resources could be reduced by introducing
  relatively inexpensive new technologies.
• As states continue to take on greater leadership
  roles they will need to produce more IEC
  materials tailored to their specific needs.

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Engaging Key Community Groups

• Recommendation 12
• Consolidate, institutionalise and further
  strengthen partnerships with traditional,
  religious, women and youth groups in their role
  in PEI, RI and other PHC initiatives.
• Rationale
• Considerable progress in reaching many more
  under-five children has been made through
  building partnerships such as those with Quranic
  Schools, Ulamas, CAN, Traditional Birth
  Attendants, FOMWAN, the Miyetti Allah Association
  and the Christian Association of Nigeria.

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Thank you over to you