PEI Communication: Progress & Challenges - Afghanistan

1. PEI Communication: Progress & Challenges - Afghanistan TAG 1- 2 June 2009, Cairo

2. Presentation Outline • Implementation of last TAG Recommendations • Evidence-based communication - what does the data tell us? • Strategic shifts & communication objectives • A dynamic mix of communication interventions • Outcome • Challenges • Way forward

3. Communication Recommendations

4. What Does Data Tell Us? Social & Epidemiological Analysis

5. Social Data – KAP Study Jan 2008 If we want caregivers to get children immunised with OPV, what do they need to know, feel and believe? Is awareness enough?

6. Knowledge Gaps Low knowledge of specifics, regarding polio as a disease or OPV 39.1% 65% 53.6%

7. Perception Low perceived threat—few people believe polio is an untreatable disease, which indicates low threat perception Low perceived OPV efficacy, which might be linked to poor knowledge 43% 18.6%

8. Missed Children Distribution 2009 – Children Absent or Silent Refusal? Central North NE Badakhshan East West SE South

9. Communication Variables & Communication Objectives

10. Communication Variables to Increase Demand Knowledge of intervention Barriers Threat (susc / sev) Child gets OPV Intent to immunize child Perceived norms Perceived personal efficacy Perceived efficacy of intervention

11. Communication objectives Raise awareness and fill specific knowledge gaps about polio and routine immunisation Improve access to children in HRAs with targeted, data-driven community mobilisation Communicate with and through women to reach newborns, sleeping & sick children with OPV Address campaign fatigue and improve motivation of families and vaccinators Reduce % share of ‘absent children’ among children missed in SIAs Integrate communication planning and implementation into the SIA micro planning. Build IPC skills of vaccinators, especially in HRAs Improve cross-border communication – social mapping, common messaging and reaching mobile populations Improve communication data collection management & utilisation

12. A Dynamic Mix ofCommunication Interventions Focus - High Risk Districts

13. Community Mobilisation Supporting ‘Option Three’ Southern Region: Kandahar – Panjwai, Maiwand, Shahwalikot, spinboldak, Daman, Kandahar urban Hilmand – Nade Ali, Nauzad, Musa Qala, Sangin, Kajaki, Washer, Garamsir & Bust Urozgan – Tirinkot, Dehrewood, Shahedehesas Eastern Region: Ningarhar - Jalalabad Laghman – Mehterlam Kunar – some border clusters Western Region: Farah – Bakwa, Balabaluk,

14. Local Inaugurations at Sub-district Level Local level ownership & community engagement:

15. ‘Cluster Jirgas’ with Elders and Mullah Local level advocacy: using credible voices to influence families

16. Address Campaign Fatigue:District & Sub-district Motivational events Cricket, football and volleyball matches held in Kandahar, Khox and Nangarhar & Laghman – generating good coverage in local media Special Events: Above – Cricket Match for the May NID in Jalalabad Right – Cricket Match in Khost

17. Communication With Women, By Women Visibility events TV Teachers Mullah Visibility events Teachers TV Community Elders Women Courtyard CHWs Posters and Banners Radio CHWs Women Courtyard Mullah Community Elders Posters and Banners FAMILIES Radio

18. Women Courtyard discussion session in Jalalabad, Nangarhar Jan 2009

19. Female Mobilizer in a house in Kandahar Nov. NIDs 08

20. Courtyard Women Accompany male Vaccinator Teams in Metherlam, Laghman

21. Risk Communication: perceived susceptibility & severity of threat

22. Post-campaign Community Mobilisation Reviews – Ongoing Process Cluster focal points’ review meeting March 2009: Mawlawi Nazeer, Cluster focal point of B3 during reporting of his cluster

23. Improved Communication Data Management • Communication indicators added to PCA and ICM checklists • Data collection tools standardised • Training provided to national and provincial communication Focal Points in data entry, analysis and report generation using Epiinfo – STOP Team Volunteer

24. Cross Border Communication High visibility to border vaccination posts Use of local Pashto media channels – BBC Pashto Service, local and community media channels, Shamshaad TV Community based social mapping of border clusters in ER to identify spheres of influence & channels of communication to access them better

26. Process & Outcome Indicators:

27. Coordination in ER: Number and % of CM undertaking Joint house visits with vaccinators during Jan 2009 NID 100% 87% 86%

28. Source of information to families in ER: PCA Data

29. Missed Children Reduced in CM Districts during Jan 2009 NID Inaccessible due to insecurity Districts with Social Mobilization

30. Result indicator in SR: Comparison of Refusal in CM districts by rounds Oct 08 – Jan 09Data Source PCM Zero refusals New Families Repatriated from Pakistan

31. Impact of Women Courtyard on routine immunization coverage ER – visits to health centres

32. Women Courtyard in SR • 787 meetings attended by 6,578 women* • Women discussed with women & shared information about polio immunisation - 12,136 neighbourhood houses mobilized • Space created for women to dialogue with women on survival and health of children – including of course polio and routine imunisation • 68 refusal and not interested families ‘converted’ during mobilization • Courtyard Women accompanying male vaccinator teams in ER to open access into homes * Q 3 & Q 4 of 2008

33. Media Outreach • National Media: • Regular briefings • Polio Express brought out by MoPH • PSAs produced and broadcast in the field • Partnership with BBC World Trust: Produce and broadcast episodes in the highly popular TV drama serial ‘New Home, New Life • Local media: • Local radio, community radio, local TV channels For e.g. Azadi radio, Equal Access community radio, BBC Pashto service, Shamshad TV

34. Challenges • IPC Skills of vaccinators need continuous strengthening • High turnover of trained vaccinators – limits training gains • Ongoing training of monitors to collect communication data • Communication data collection and transmission from sub-district and provincial level • Inadequate documentation in the field of innovations & lessons learned • Difficulties in conducting micro surveys, KAPs and similar resarch due to modest technical capacity and ongoing insecurity • Develop relevant partnrships to reach mobile and nomadic populations

35. Next Steps • Strengthen partnerships including with NGOs, YICC (youth), pvt media and women’s groups in KDH, Hilmand and Farah • Strengthened monitoring of Integrated community mobilisation in HRAs (SR, ER & WR) • Implement Research Plan • Hold national Polio Communication Review in October 2009 • Long term IPC capacity building of vaccinators • Strengthen communication data management and standardise reporting

36. Research Plan • Micro survey to track ‘absent children’ : members in order to analyse trends among 'missed children', esp 'absent' or 'not at home’ • Post training evaluation- Interviews- Field observations- Interviews with families- Role play

37. Thank you