RELIGIOUS LEADERS AS PARTNERS IN POLIO ERADICATION NWFP/FATA

1. RELIGIOUS LEADERS AS PARTNERS IN POLIO ERADICATION NWFP/FATA

2. BACKGROUND • The total population of NWF/FATA is 29 millions, <5 Y target 5.6 millions, including 0.3 million Afghan refugees. • NWFP has long border (1200 KM) between Pakistan/Afghanistan with significant population movements across the border. 3.The NWFP/FATA community has different religious/tribal sects/groups. 4.It is a highly conservative community with minimal involvement of female in immunization. 5.There were misconceptions mostly religious regarding vaccination.

3. Background (cont) 6. Many areas became inaccessible because of political unrest. 7. In 2006 misconception about vaccination and refusals based on religious misunderstanding was increasing. 8. There were considerable negative propaganda by some religious dominated media about safety of OPV . 9. Peshawar High Court was considering a case made about safety of OPV.

4. Why involve religious Leaders: • Intensive circulation of negative religious Fatwas against OPV. • People have strong belief on the Fatwas. • Religious leaders are influential specifically amongst their followers. • Religious leaders appeared to be non supportive.

5. To address the situation: • Step I: proper understanding the situation: • Issues related to misconception. • Available resources for SM. • The religious tribal sects. • Magnitude of refusals. 2. Step-II: arrange a meeting jointly with MoH, SoH, Dean of PMC, Acting WR, National and Provincial EPI managers, UNICEF and WHO staff, at July 2006 to be used as a back ground for future meetings with the religious leaders which leads to issuing of the 2nd September 2006 Fatwa..

6. Dr. Wahdan visit in July 2006 to prepare for the 2nd Sep 06 Fatwa issued by the Senior Doctors & Ulemas in Peshawar Medical College

7. To address the situation(Cont): Step -III: well prepared meetings identifying participants with suitable place and proper Fatwas prepared. Media forum established with media declaration supporting OPV vaccinations and EPI. Step 1V: successful meetings done involving main religious leaders ended with Fatwas in favor of polio vaccination and EPI.

8. Provincial SIAs 18th June 07 InaugurationIn Swat Dar Ululoom Hanafia

9. On 28 July 2007 , the Grand meeting was conducted with religious and Tribal Leaders .

10. No Imam of Haqania is campaigning against polio programme or EPI.

11. Maulana Sher Ali Shah has disseminated the positive messages by himself and through his followers. No new negative article was published byZarb –E- Momin magazine.

12. The religious Leaders in North and South Wazirstan supports the planned campaigns

13. The Religious Leaders while giving OPV to the children in the refusal village (Haripur district) of the lawyer who registered a case against PEI - January 2007 campaign ( all 76 <5 children of refusal families vaccinated)

14. Use of Hajji pictures is very effective to convince refusal

15. Maullana Sheikh Ul Hadees issued a Fatwa that facilitated the vaccination of the most hard refusals

16. Fatwas diminished the effect of negative Fatwas and rumors

18. IMPACT • Refusals due to religious misconception decreased. • Coverage of refusals due to religious misunderstanding increased. Out of (19154) religious refusals 17% were covered in October 07 round compared to 13% out of (31101) covered in August 07 round. Coverage of refusals due to misconception increased to 50% in Oct 07 round compared to 37% in August round. • Inaccessible areas became accessible. Total inaccessible children in the tribal agencies reduced to 866 in Dec 07 round compared to 24,951 children in October 07 round and 68000 in Aug 07 round.. • More days of Tranquility (PEI brings peace into tribal areas ) 5. More positive newspapers articles; October - November SIAs 2007, there were 102 news items, 99 of them were positive and only 3 news items were negative

19. More days of Tranquility(PEI brings peace to tribal areas ) • Negotiations with Militants for days of tranquility in Bara and Tirah of Khyber succeeded. • The militant local Jirga of Bajour agreed on days of tranquility more over provided local supervisors and vaccination teams. • The Militant leader of South Wazirstan ordered his field commanders to protect the supervisors and the vaccination teams during polio campaigns and the measles catch up campaign. • Multiple local Jirgas in Mohmand stopped the cross-firing , protected the teams and solved the issue of mass demand refusal.

20. Conclusions • Most of the religious leaders are not against vaccination. • Proper communication with Religious Leaders can keep them on board to facilitate PEI/EPI activities. • Involvement of Religious leaders in SIAs activities is a strong tool to convince refusal families and refusal prevention. • Fatwas was effective in convincing considerable number of refusal families. • NWFP team successful to stop rumors in news papers (no more running after rumors in news papers)

21. Recommendations • Enhance the communication/involvement of religious leaders. • Continue to keep Ulemas informed about PEI/EPI and seek their support. • Maintain public awareness though community level meetings, Jirgas and gatherings/SIAs inaugurations led by religious leaders and campaign inaugurations at Madrasas. • Intensify utilization of Fatwas by all tiers of PEI field staff and to consider each sect. • Coordination with religious leaders to use their communication tools (at D/A ) i.e. FM Radio, Magazines and News Papers in favor of the Polio Campaigns.

22. Thank you