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The complexity of social mobilization in health communication: Topdown and bottomup experiences in p

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Top-down and bottom-up experiences in polio eradication. Rafael Obregon and ... was effective' in overturning resistance and dispelling anti-OPV attitudes ... – PowerPoint PPT presentation

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Title: The complexity of social mobilization in health communication: Topdown and bottomup experiences in p


1
The complexity of social mobilization in health
communicationTop-down and bottom-up experiences
in polio eradication
  • Rafael Obregon and Silvio Waisbord

2
Outline
  • SM in the PEI
  • Goal and research questions
  • Conceptual framework
  • Analysis and discussion
  • Conclusion

3
Social 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.

6
Activist 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?

8
Four 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

9
1. 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).

11
Activist 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.

12
Activist 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

13
Activist 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.

14
Two 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.

15
Lessons 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.

16
2. 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.

18
3. 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

19
Shift 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

20
4. 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.

21
Conclusions
  • 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.

22
Conclusions
  • 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.

23
Conclusions
  • 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.

25
The complexity of social mobilization in health
communicationTop-down and bottom-up experiences
in polio eradication
  • Rafael Obregon and Silvio Waisbord
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