Transcript Maintaining involvement of political leaders in PEI

Political Commitment
& OWNERSHIP
for PEI/EPI
Punjab-2008
Punjab
• Demographic background:
– > half the population of Pakistan.
– Projected population for 2008 ~ 96 million.
– wide diversity of geographical, cultural characteristics, and
literacy rates.
• Political set up:
– Established political set up and civil administration.
– Decentralized to the district level
– Unique challenge: 2 managers in each district (EDO/ DoH)
- no clear TOR, may lead to conflicting interest .
Political commitment
• Leaders to use their personal involvement, power, and
influence, to ensure that PEI / EPI is a top priority and extend
their full support to achieve polio eradication
• Essential:
– Currently ..to:
• Ensure that they continue extending their support to PEI
for highest quality campaign activities
• Guard against false sense of over confidence.
– After being polio free..to:
• Keep the interest ,commitment and motivation when
polio is not visible as a public health problem
– Sustain high vaccination coverage
– Sustain rigorous AFP surveillance.
Issues took into consideration…
• Multiple Centers of influence:
– Federal: slim influence at the provincial level.
– Provincial: (policy making and planning, little involvement
in implementation and monitoring at district level)
– District: the main operational units/ key players….totally
independent
• Political / establishment:
– Nazim, DCO
• Managerial:
– EDO, DSV, DoH, DDHOs,
• Others:
– Unions.
– Religious leaders (different religious set up almost
in each district)
– Community leaders / opinion leaders
– NGOs /CBOs
Issues took into consideration..(cont)
• Types of influential powers:
• Formal (official- authorized influence)
• Informal (unofficial - un-authorized influence)
These multiple centers of influence, sometimes
competing with each other creating power gap,
represents a real challenge to the issue of political
commitment.
Governor/CM/CS –
Minister of Health
Conflicts (in-built).
Competing priorities
Less oversight by
provincial authorities
Rapid turn over
Single line budget
Still to be further
motivated
•Local Politics
•Departmental
Associations
•Fatigue
Frequent NIDs- News
articles
fading interest
Competing priorities (H.R)
Sec. Health
/DG/DHS (EPI)
DCO \ Nazim
EDO(H)/DOH
• Rumors
DDHOs/Tehsil Nazims
Vaccination Teams/LHWs
Community
• Local Values
•Traditions
• Religious
misbelieves
Performance and
motivation of field
staff
Capacity building,
Monitoring, supportive
supervision ,
incentives
Sustained social
mobilization
Political
commitment
and ownership
Community
awareness and
acceptance
Who to address
– Provincial leadership:
• Political leaders and civil administration (Governor,
Chief Minister, Health Minister, Chief Secretary,
Secretary Health, DG, EPI manager).
– District decision makers / opinion leaders/others:
• Political and civil administration
• Opinion leaders : (religious, political, media, line depts)
• Traditional healers, private practitioners
• Community & Community leaders
• NGOs / Unions
• Field staff (better monitoring , supervision and support)
Building/Maintaining Political
Commitment
– Trust building and Mutual respect
– Avoid contradicting messages…Joint management team
approach.
– Avoid bypassing immediate officials
– Avoid creating parallel system
– Re-enforce ownership continuously
– Low profile constant communication about polio\EPI
– Maximize utilization of the support of :
• ISB, EMRO, H.Q.
– Use the appropriate local channels of communication
– Maximize utilization of all communication channels.
– Appropriate approach for specific issues.
•
– meetings (the most effective tool)
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Pre-campaign meeting: Chaired by H.M / S.H
District Polio Eradication committee meeting: Chaired by DCO/Nazim
Monthly Provincial Surveillance review meeting:
Monthly District Surveillance Committee Meeting:
Expert Review Committee meeting (ERC)
Evening meetings (during campaign days):
Regular feed back.
Regular visits and meetings with district level political leaders.
High profile visits
Recognition (polio free flags, certificates..etc)
Telephone calls from program leaders (EMRO/ISB) to high
district politicians in special circumstances.
Different Approaches for leaders at
different levels
• Chief Minister
• Very busy and direct approach difficult.
High profile visits very helpful
• Support is through NID inauguration
and communication to CS and local
government
• Governor
• High profile visits
• Regular feed back
• Frequently inaugurate NID
• Health Minister
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Periodic direct approach
Regular feed back
Frequently inaugurates NID
Chairs pre campaign meetings
Chief Minister, Health Minister and Secretary
Health inaugurating NID
Different Approaches for leaders at different
levels(cont.)
• Chief Secretary
• Secretary Health
• Invitation to global meeting at H.Q.
• High profile visits
• Periodic direct communication and
feedback
• Passes clear instruction to local
government to ensure their
involvement
• Instructions to Police department for
their maximum support and
involvement in NIDs.
• Periodic direct approach and feedback
• Chairs NID campaign meetings
• Gives clear instructions to health
department to ensure quality NID
implementation
• Personal participation
Cheif Secretary chairs pre campaign meeting with all DCOs / EDOs
Different Approaches for Different Officials
(cont.)
• Nazim
• DCO
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Regular direct communication and telephone communication
DCCO to call all UC Nazims before, during and after the
campaign
Inaugurates the NID in his district
Passes clear instruction to district government officials
Public statements for media
Regular direct communication and telephone communication
Leading PEI activities in the district
Chairs DPEC meetings
Gives clear guidance to health department to ensure quality NID
implementation in the district
Allocate required resources from other line departments
Polio Walk in the
district
WITH INNOVATIVE STYLES & PARTICIPATION FROM ALL
SECTORS
Advocacy Meeting with Mosque Imams &
Religious Leaders from all districts
Different Approaches for Different
Officials (cont.)
• EDO
• DOH
• Regular direct communication with STC
• Periodic meetings/telephone calls at provincial level
• Pre campaign meeting chaired by H.M, S.H and DG
Health.
• Regular direct communication with STC and SO
• Fully involved in training, monitoring for PEI
• Supervises district EPI staff to ensure quality NID
implementation in the district
EVENING MEETINGS IN THE DISTRICT.
SPECIAL ADVOCACY
INTERVENTIONS TO
OVERCOME
SPECIFIC CHALLENGES
Maintaining Commitment in Difficult
Situations
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Outbreaks
Security problematic areas
Refusals
Anti vaccine rumors.
Special issues: accident to one vaccinator
(important to appreciate the workers and also to
maintain the commitment)
• Unexplained change of attitudes of political
leader.
• Competing programs
ADVOCACY MEETING
Security Compromised Areas.
Activities Done.
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Advocacy meetings with
local notables / tribal elders
through district
government.
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Social mobilization through
local teams moving house
to house-CCSPs.
Monitoring Political Commitment
Quantifiable indicators:
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Statements made by leaders
CS to chair special meetings with DCOs
Letters from CS to DCOs
Participation of district decision makers in the provincial
review/preparatory meetings
Leading Polio walks & inaugurations
District Polio Eradication Committee meetings
DCO\Nazim personally involved & allocate resources
Mosque announcements
Refusals
Monitoring Political Commitment cont’d
• Subjective indicators:
– Accessibility to decision makers
– How leaders are knowledgeable about polio
– Response of leaders to rumors
– Response of leaders to the recommendations
Composite indicator:
– Attempt to use all the aspects of political commitment
collectively using the judgment of the field staff.
Emerging challenges
• Fatigue:
– Increasing fatigue at all levels
– A real problem when it affects a high level leader
• Competing priorities:
– Punjab Health Sector Reform Program
– MCH programmes
– Other preventive programmes (T.B dots, Roll back malaria, anti
hepatitis programme, avian flue…etc)
• Increasing anti vaccine propaganda
• Enhanced resistance among medical community
• Polio is not seen as a major public health problem
• Fading interest among some key decision makers (unexplained change
of attitude)
What is next
• Re enforce high level advocacy
• Involve PEI staff to assist in other priority public health
problems
• Concrete scientific approaches to face the anti vaccine
propaganda (proactive standardized message at different
levels)
• Continue maintaining good performance of field staff
• Continue maximizing utilization of S.M tools
Ownership level 2008
• Government of Punjab maintained high level of
program ownership
– Rapid immediate very high quality case response. 2/3
of the operational costs to WHO and 1/3 managed
within the district local resources.
– Vaccination of nomads in 6 districts in response to
cases in NWFP and Balochistan: all costs managed
within local district resources.
– In spite of the existing political \ security situation
C.M, H.M, and S.H inaugurated Jan 2008 NID
We always remember….
• Maintaining political commitment and ownership is a
continuous cumulative process
• Political leadership has brought Punjab (and Pakistan) to the
brink of polio eradication. But if this leadership and
commitment weakens now, we may not achieve the goal of
eradication.
• Maintaining political commitment, interest and ownership
in the coming period is of prime importance to improve
routine EPI and guard against the impact of importation of
wild polio virus….
THANK YOU