Pakistan Polio Communication Review Recommendations Towards Complete Coverage

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Pakistan Polio Communication Review
RecommendationsTowards Complete Coverage

• Pakistan Polio Communication Review Meeting
• Islamabad
• September 17-19, 2007

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PEI In Pakistan 2007 Overview

• Tremendous gains have been made since the start
  of polio eradication activities in 1994
• Average coverage rates at the provincial level
  are gt95 across the country.
• Sub-national variations exist.
• Progressive decrease in cases since 1998.Total
  number of new cases in 2007 to date is 13.
• Geographic and genetic localization of identified
  cases.
• Overall sensitive surveillance system well over
  global certification standards.
• Improving routine EPI coverage but sub-optimal
  coverage in certain areas.

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Social Mobilization and Communication Activities
2007 Overview

• Strong coordination of partners leading to a
  successful national programme.
• Comprehensive national strategy in place.
• Communication activities an integral part of the
  programme.
• mass media, advocacy, IPC, education and
  programme communication materials and other
  social mobilization activities.

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Overall Programme Objective Outstanding
Challenges

• Some areas of sub-optimal coverage remain.
• Reasons for missed children include
• Quality of Operations
• Inaccessibility (area and households)
• Mobile Populations
• Refusals
• Under-utilization of programme data linking SIA
  outcomes with communication activities

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Recommendations
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Recommendation Area Maintaining Achievements

• High Coverage Overall
• Need to sustain acceptance in populations already
  accepting vaccine through message development
  targeted at emerging concerns (i.e. over
  vaccination, multiple campaigns)
• Quantify number and location of missed children
  due to inaccessibility due to security using
  complete denominators
• Good surveillance and regular reviews
• Expand community-based AFP Surveillance
• High level political commitment
• Strengthen translation into action in particular
  in high risk districts and sub-districts of the
  remaining three endemic provinces to demonstrate
  ownership

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Recommendation Area Maintaining Achievements

• Broad-based media campaign achieving high level
  awareness (TV, radio, print media including new
  approaches, e.g. polio true stories)
• Assess impact of the current strategy elements
  to guide allocation of resources and activities
  (such as production/use of posters)
• Strengthen provincial leadership for programme
  communication activities and planning.

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Recommendation Area Focus Strategies in High
Risk Areas

• Strengthen data driven communication strategies
  at sub-district level
• use Control Room and PCM data to identify
  shortfalls in SIA performance and analyze trends.
• Include previous SM/C activities in trend
  analysis to assess impact and develop indicators
  by which to assess future impact.
• Modify SM/C activities to according to impact
• Conduct program activity
• Link impact data from SM/C activities to trends
• Emphasize focus of communication activities on
  sub-district levels in high risk areas
  (UCs/Areas)

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Strategic Approach to Communication Activities

• High number of communication activities are being
  conducted.
• The next phase of the programme requires
  intensification and evidence based strategy which
  should include
• Retrospective desk review of SM/C activities
  related to programme achievements
• Planning and monitoring for impact developing
  indicators
• Modifying SM/C activities

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Strategic Approach to Communication Activities

• Trend analysis to identify reasons and patterns
  of missed children
• Inaccessibility (to area/household)
• Performance of teams (IPC, no team, not
  available)
• Refusals (perceptions, mis-information, demand)
• Impact of previous interventions

Previous Interventions communication
Strategy/Intervention Jirga, press release,
mosque announcements, community meeting, DCHO
Locally appropriate strategy identified (DSO, SO,
CSP, DHCO community)
Implement and measure communication strategy (s)
Implement program activity
Surveillance data
Collect Data
SIA data (control room, PCM) over time
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Examples of Strategic Approaches to SM/C
Activities
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Example 1 No TeamInadequate access for teams
to children under six months.

• Analyze the data to identify the cause of the
  access problem at the sub-district level
• Review current SM/C activities to look for
  evidence of impact (i.e. decrease in proportion
  of no team in PCM, increase in general or under
  6 months coverage)
• Modify SM/C responses and measure new impact
  going forward e.g.
• SM/C involving peri-natal care providers
  (proportion of TBAs/community mid-wives briefed,
  increase in birth registration)
• Engagement with mothers in the community to
  increase awareness of EPI and polio (rate of
  demand for EPI amongst mothers increased)

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District with full access and intensive SM/C
activities
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Example 2 RefusalStrategic Approach

• Review prior programme data to identify trend
• Distinguish persistent or transient refusal
• Identify specific causes of refusal e.g.
• negative media, misconception, fatigue, too much
  OPV, religious objection, demand related
• Analyze relationship between SM/C activities and
  refusal trends (increase in convincing, decrease
  in refusal)
• Modify SM/C activity accordingly and measure
  impact going forward
• Link back to programme data

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Strategic Approach to Communication Activities

• Implement and measure communication strategy (s)
• Provincial level support to support training
  prior to campaign
• Mobilize quality CSP, DSO, DCHO to area during
  campaign
• Conduct jirga meeting (tribe A) in UC 5 inviting
  all religious leaders two days before SIA,
• Conduct jirga (tribe B) in UC 3 with different
  leaders two days before SIA

• Trend analysis to identify reasons and patterns
  of missed children
• Low recording of absent or unavailable children
  by vaccination teams
• Refusals most refusals are located in UC 5 and
  are primarily due to misconception of two local
  religious leaders
• UC 3 had few refusals also due to mis information

• Locally appropriate strategy identified
• Training conducted in presence of high level
  support, focus on IPC and using tally sheets of
  previous rounds in training
• UC 5 and 3 are of two different tribes organize
  jirga with objective of gaining access to
  community

communication Strategy/Intervention Jirga
meeting held in UC 3, attended by 15 community
leaders, one week before the campaign
Surveillance data
SIA data (control room, PCM) over time
Conduct SIA
Conduct SIA
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Recommendation Area Training

• Better use SIA data to identify gaps in
  vaccinator team performance related to
• Access to household
• Quality of recording (NA, Refusals)
• Supervision and Monitoring
• Social Mapping

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Recommendation Area Training

• Building on existing modules and training
  programmes, focus on
• Using previous SIA data relevant to the area of
  the teams being trained
• Analyzing and plotting local realities (e.g.
  areas of low coverage or refusals) using social
  maps
• Strengthen IPC negotiating skills using past SIA
  household case studies
• Build morale by providing programme overview and
  global updates
• Monitor impact of improved trainings

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Recommendation Area Human ResourcesProvincial
Level

• There is a gap in strategic communication
  capacity and leadership at the provincial level.
• Create and fill immediately 3 long-term
  Provincial-level Programme Communication
  Specialist Posts
• Skills should include
• Data analysis and communication strategy
  development with focus on high risk districts
• Experience in communication, ME and polio

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Recommendation Area Human ResourcesProvincial
Level (Continued)

• The post requires an independent critical analyst
  working as part of the provincial team (GoP, WHO,
  UNICEF).
• The specialist should report regularly to the
  Federal level on progress and impact of
  communication strategies.

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Recommendation Area Human ResourcesDistrict
Level

• Ensure that ALL high-risk districts have DHCSOs.
• Positions should be filled immediately
• DHSCOs should be provided regular training on
  communication strategies and fully utilize the
  expertise of the provincial specialist.

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Recommendation Area Follow-up to Communication
Activities

• Hold regular team leader meetings attended by
  partners with report backs on communication by
  the provincial communication specialists.
• Expand mandate of TAG to include substantial
  component of communication
• to include a communication expert on the TAG
• Provincial Communication Specialists to report
  regularly to the TAG

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Summary

• Sustain achievements of the programme
• Intensification phase of communication focused on
  sub-district strategic approach
• Link data with SM/C activities
• Develop and monitor indicators
• Refine and modify approaches accordingly
• Focus training on IPC quality, use of data in
  training and social mapping.
• Increase capacity and leadership for provincial
  and district communication urgently.
• Ensure adequate follow-up through regular
  meetings, reporting and TAG.