Title: The complexity of social mobilization in health communication: Topdown and bottomup experiences in p
1The complexity of social mobilization in health
communicationTop-down and bottom-up experiences
in polio eradication
- Rafael Obregon and Silvio Waisbord
2Outline
- SM in the PEI
- Goal and research questions
- Conceptual framework
- Analysis and discussion
- Conclusion
3Social mobilization in the PEI
- Critical component
- Responsibility of SM
- committees
- Conducted through delivery of OPV, media
campaigns, house-to-house identification of
unimmunized children, community education, case
surveillance. - Reliant on local associations
4- Goal
- To examine factors that account for the
successes and setbacks of SM in PEI - Key questions
- Impact of SM for polio eradication
- Assess levels of complexity of SM and effects for
health communication practice - Implications for similar global initiatives
5- What is Social Mobilization?
- The process of inter-sectoral coalition building
and actionto raise awareness about specific
issues, raise demand, support service delivery,
and strengthen and facilitate local
participation.
6Activist and pragmatist perspectives on SM
- Activist - SM as community participation and
empowerment - Bottom-up approach communities express demands,
define goals, and make key decisions - Pragmatist SM as means to strengthen health
services and achieve goals - SM adds significant human and funding resources
to strengthen services and accomplish program
goals.
7- SM committees performed various tasks
delivering OPV, managing the cold chain,
training/staffing vaccination teams, conducting
advocacy - PEI suggests that tension between activist and
pragmatic SM may be inevitable in global health
programs - SM as strategy necessary to overcome system
weakness, deliver services, raise funding, etc,
but - how is activist SM possible in the context of
global initiatives?
8Four critical dimensions of SM
- Competing understandings of SM
- The media as social and political institution
(rather than transmission belt) - Interpersonal communication as dialogue and
engagement (rather than information and
persuasion) - Gender and communication
91. Competing understandings of SM
- Pragmatic SM
- Participation of local actors in service delivery
and communication - Impact of community mobilizers in changing
attitudes and behaviors towards OPV among
parents. - Four high-risk districts in India
- Reduction of number of cases
- 116 (2001), 49 (2002)
- Increase in booth coverage 2001-2003
- Districts with SM from 50 to 75
- Overall coverage from 19 to 35
10- Perception of polio risk for children without OPV
- Communities with SM with more than 11 higher
risk perception - Communities with SM less likely to refuse OPV
compared to communities without SM - 79 of resistant houses accepted OPV after visits
by SM teams (Aligargh district, India) - Districts with SM more likely to believe that OPV
protected children, view polio as serious health
problem, and believe OPV was safe - (Pakistan, 2005).
11Activist SM
- Aims to wrestle decision-making power from
national and global bodies - SM characterized by negotiation and reframing of
methods and objectives of the PEI.
12Activist SM
- 1st scenario adaptation of polio eradication to
local demands - CORE and SWS in Varanasi to provide integrated
health services and education. - Positioning polio eradication as social program
correlated with increased coverage and conversion
13Activist SM
- 2nd scenario opposition to PEI
- SM as contentious action to challenge global
goals - Opposition in communities with poor health
services, high levels of social marginalization,
high distrust of government programs, deep
grievances about - unmet needs.
14Two forms of oppositional SM
- Political protest political collective
movements that openly defied polio immunization
(e.g., Northern Nigeria 2003) - Mix of causes political, cultural, distrust of
government programs, geopolitical. - Passive resistance rejection of vaccination
teams at household levels (e.g. Indias Uttar
Pradesh and Bihar) - Causes lack of understanding about many rounds,
view of PEI as someone elses program.
15Lessons from oppositional SM
- Dont assume that global goals are unanimously
adopted by communities worldwide - SM around PEI as platform for the expression of
deep-seated conflict, dissatisfaction with
official health services, distrust of
national/global powers - SM is a messy, unpredictable process building
trust is crucial.
162. The media as key social and political
institution
- Lesson need to reconceptualize the role of the
media in global health programs - Limitations of approaching the media as a set of
channels for top-down dissemination of
information. - Instead, the media are complex social and
political institution and tied to local and
national interests
17- PEI suggests that the media is a multilayered
field that refracts the influence of several
actors (owners, journalists, governments,
audiences) - Example Role of the media in the spread of
rumors about OPV safety - Recognition of this complexity led to reduction
of negative coverage of polio campaigns (India,
Nigeria) though engaging the media.
183. IPC as dialogue and engagement
- Intensification of IPC to address refusal, and
missed children, and thus convert households. - Local dialogues, engagement of religious/political
leaders, incorporation of women in vaccination
teams, better training of teams in IPC
19Shift from information dissemination to engagement
- Building social norms in communities where
vaccination isnt widely accepted. - Example of two-step flow of information and
role of opinion leaders/personal trusted sources - Lack of data on why IPC seemingly was effective
in overturning resistance and dispelling anti-OPV
attitudes
204. Gender and communication
- Polio eradication as entry point to facilitate
womens participation. - Response to local opposition.
- Introduction of female vaccinator teams in
Pakistan and expansion of womens spaces for
dialogue in India.
21Conclusions
- 1. SM shouldnt be approached as top-down
informational strategy - SM is complex, open-ended process, thus results
cant be predicted. - Participation puts in motion uncertain dynamics
and demands. - Need to take into consideration local needs
before, rather than only as a reaction, to
developments on the ground.
22Conclusions
- 2. Implementing centralized strategies is not
synonymous with SM. - Bottom-up micro-planning and strong local
commitment essential to SM. - Need to decentralize decisions (about strategies,
funding, staffing) to maximize effectiveness and
sustainability.
23Conclusions
- 3. Insufficiency of informational approaches to
SM and communication. - Local associations as social/political
organizations rather than transmitters of
information in support of pre-established goals.
24- PEI shows that both activist and pragmatist
SM are concrete possibilities for any global
health initiative. - We cant assume that mobilized communities will
espouse or reject global goals - democratization, local conflicts, local
demands, and persistent problems of health
services have turned SM into a complex form of
communication in support of health goals.
25The complexity of social mobilization in health
communicationTop-down and bottom-up experiences
in polio eradication
- Rafael Obregon and Silvio Waisbord