Communication Strategies for Polio Eradication

1. Afghanistan Polio Communication Review RecommendationsAfghanistan polio communication review meetingKabul September 25 to 27 2007 Communication Strategies for Polio Eradication

2. Background and Progress to 2007 • Enormous gains have been made against difficult and constantly evolving conditions since polio eradication activities began in 1994. • In 1999 there were 45 cases; this has been reduced to 10 cases as of September 2007. • Circulation has been restricted since 2004 primarily to the South and East with only three sub-clusters (1 P3 and 2 P1). • Good overall AFP surveillance established, with some concerns regarding accessibility. • Overall good coverage in accessible areas. Gaps remain due to security. • A national PEI system through which government works with donors and partners such as UNICEF, WHO and a range of NGO’s has delivered good results in difficult circumstances over the past decade. • Urgent need to review communication strategies in this last push towards eradication

3. Communication and Social Mobilisation Activities • Strong political commitment exhibited • Presidential Task Force, Polio Eradication National Steering Committee, Polio Action Group • Activation of IEC department for polio eradication • SIA inauguration ceremonies at national and provincial levels • Involvement of religious and community leaders • Branding and national awareness campaign • Enhancement of social mobilization activities in high risk areas • Development and use of social mobilization materials • Stronger focus on cross-border immunization activities

4. Communication Challenges • Gaps in communication strategy at national and provincial levels • Insufficient human resource capacity to implement polio SM/C strategies • Limited programme data related to communication and limited use of existing data • Lack of communication baseline data • Poor levels of monitoring and supervision especially (but not exclusively) in high risk areas • Gaps in inter-sectoral collaboration at sub-national level

5. Communication Challenges • Continued and increasing security restrictions impeding access to many areas in the South and East • Cross border population movement (internal and external) • Difficulties accessing households and reaching child caregivers directly

6. Recommendations

7. Strategic Approach to Communication Activities • Analyze to identify reasons & patterns of missed children: • Inaccessibility (to area/household) • Performance of teams (fighting, IPC) • Refusals (perceptions, mis-information, demand) • Impact of previous interventions Previous Communication Interventions: Training of CHW, Meeting with Mullahs, Community Leaders, Courtyard women Locally appropriate strategy identified (DC, CHW/CHS, Elders, Mullah, Teachers, women’s groups) Implement and measure communication strategy (s) Implement program activity Surveillance data EPI SIA data (control room, PCA)over time Collect Data

8. Communication Strategy • Develop a comprehensive communication strategy for national and provincial levels using data to identify high impact activities (Oct 2007) • Ensure development of indicators and updated social mobilization microplans at district and sub-district levels to address local challenges (Nov 2007) • Focus on high risk districts: Eastern and Southern region, areas with recent WPV, high insecurity/inaccessible/refusal, low-coverage • National media programme: ongoing (TV, radio, billboards, posters) • Baseline data is urgently required: immediate need for KAPB (Nov 2007) • Utilize Pashtu news services for polio message delivery: BBC, Azadi (immediate)

9. Polio Communication: National Level Capacity Polio Action Group: • Improve inter-sectoral involvement and coordination at the national level (Ministry of Women’s Affairs, Education, Religious Affairs, Rural Rehab and Dev, Def) • Translate this commitment into action at the provincial and district level Implementing NGOs: • Specify polio activities (SIA/Surv) as part of one of the 7 components of BPHS and ensure allocation of adequate resources • Hold a national meeting with NGO representatives (contracting and non-contracting ) to ensure their buy-in. Disseminate decision to provincial/district level (Nov 2007) • Update NGO contract upon renewal to include provision of polio activities (2008) • Formally incorporate polio component into CHW training (Nov 2007) • Incorporate NGO representation within national and provincial level polio committees (Oct 2007)

10. Polio Communication: National Level Capacity Strengthen IEC department within MoPH • Assign a polio communication focal point (IEC)(Oct 2007) • Regular refresher training of MoPH/NGO communication staff (Nov 2007) • Immediately recruit a qualified full-time polio communication officer to provide support in implementation at the national level (International post through partner agencies) (Nov 2007)

11. Polio Communication:Provincial LevelCapacity • Ensure all high risk provinces have an assigned polio communication focal point (Nov 2007) • Work in concert with provincial health team and report back to the national IEC polio focal point • Responsible for leadership, coordination and monitoring of SM/C activities • Receive immediate and regular communication training by IEC polio focal point supported by partner agencies (Dec 2007) • Establish provincial inter-sectoral polio communication committees for high risk provinces: (Dec 2007) • Membership: Include other line departments, NGOs • ToR: Review and oversee provincial communication strategy and plan and monitor implementation at district level

12. Polio Communication: District Level Capacity • Ensure all high risk districts have a district communication coordinator working in concert with polio district team (Dec 2007) • Trained by and report to the provincial communication focal point • ToR: • Develop SM/C micro-plans appropriate to the local challenges • Coordinate and monitor communication activities

13. Polio Communication: District Level Capacity Currently identified network categories: Elders, Mullahs, Teachers, CHW • Enhance community involvement: • Community Development Council/ Shura • Local inauguration ceremony for key polio related events (community leaders/mullahs) • Enhance involvement of women (immediate) • Women’s courtyard: develop materials, strategy and indicators • Female CHW : reaching homes and dissemination messages through service delivery (next SIA) Training: SM/C training materials recently developed and distributed • Review and update training materials with focus on local adaptation (Nov 2007)

14. What does this look like?

15. Polio Focal Point IEC Department Polio Communication Officer Nat’l Inter sectoral Committee Training: Revise IPC module Provincial Polio Communication Focal Point Prov Health Team Provinicial Inter sectoral Committee District Communication Coordinator NGO/Community NGO, CDC, Shura,Schools, mosques etc NGO/CHWs:Health Facility CORE TEAM 6 Community Activists per CHS Women Courtyard Elders Mullah Imams Teachers CHWs Data Family

16. Monitoring Process • Ensure the use of updated social mobilization campaign monitoring tools in all provinces (Next SIA) • Ensure communication monitoring data is collected and analyzed regularly and used to modify activities (Next SIA)

17. Security Tremendous efforts being made at district levels (e.g. focused district strategy (FDS), access negotiators) • Recent successes especially in accessing 2 high risk districts and obtaining support for polio from local communities • Active fighting still ongoing and some clusters within districts are either inaccessible or difficult to verify quality and performance.

18. Security • Need to map inaccessible populations/areas at sub-district levels (Immediate) • Intensify Coordination at higher level between GoA, ISAF, and other parties involved (Next SIA, ongoing) • Assess and expand successful strategies: e.g. access negotiators (Immediate) • Pilot using community monitoring to assess the quality of campaigns in hard to reach areas: require adequate training (Dec 2007) • Using alternative social networks at community levels to gain access (On-going)

19. Cross Border Issues and Mobile Populations Efforts are being made in tracking and vaccinating mobile and border-crossing populations Good collaboration between Pakistan and Afghanistan and synchronizing SIAs: • Continue regular meetings between provincial level teams • Ensure better coordination at local level to implement agreed-upon decisions regarding vaccination strategies for border-crossing populations • Coordinate sharing of common communication materials, messages, and initiatives in border areas (Nov 2007) • Ensure appropriate location, visibility and shelter for vaccination posts (especially permanent ones) (Next SIA)

20. Follow-up to communication activities • Hold regular (every 2 months) national-level meetings attended by provincial communication focal points to review progress. (Nov 2007) • Expand mandate of TAG to include substantial component of communication: • Include communication expert on the TAG • include updates by the national polio focal point regarding progress in the high risk provinces (Sept 2007) • A time-bound action plan should be developed by the MoPH and partners to ensure implementation of these recommendations (Oct 2007)

21. Summary • Incredible strides have been made against great odds and it is critical to sustain the achievements of the program as we move into this final phase of eradicating polio. • Communication has to play a central role in what comes next. • The recommendations focus on quickly building polio communication capacity through: • Strengthening current communication structures and capacity • Reinforcing the current focus on high risk districts and locally tailored strategies • Utilizing program data to focus on the highest impact activities • Monitoring and follow-up for all SM/C activities • And enhancing cooperation with Pakistan to ensure that the areas of circulation are covered.

22. Thank You