Transcript Slide 1

Pakistan Polio Communication
Review Recommendations
Towards Complete Coverage
Pakistan Polio Communication Review
Meeting
Islamabad
September 17-19, 2007
PEI In Pakistan: 2007 Overview

Tremendous gains have been made since the start
of polio eradication activities in 1994 :

Average coverage rates at the provincial level are
>95% across the country.
– Sub-national variations exist.




Progressive decrease in cases since 1998.Total
number of new cases in 2007 to date is 13.
Geographic and genetic localization of identified
cases.
Overall sensitive surveillance system well over
global certification standards.
Improving routine EPI coverage but sub-optimal
coverage in certain areas.
Social Mobilization and
Communication Activities: 2007
Overview

Strong coordination of partners leading to a
successful national programme.
 Comprehensive national strategy in place.
 Communication activities an integral part of the
programme.
– mass media, advocacy, IPC, education and
programme communication materials and other
social mobilization activities.
Overall Programme Objective:
Outstanding Challenges
Some areas of sub-optimal coverage remain.
 Reasons for missed children include:
–
–
–
–

Quality of Operations
Inaccessibility (area and households)
Mobile Populations
Refusals
Under-utilization of programme data linking
SIA outcomes with communication activities
Recommendations
Recommendation Area: Maintaining
Achievements

High Coverage Overall
– Need to sustain acceptance in populations already accepting
vaccine through message development targeted at emerging
concerns (i.e. over vaccination, multiple campaigns)
– Quantify number and location of missed children due to
inaccessibility due to security using complete denominators

Good surveillance and regular reviews
– Expand community-based AFP Surveillance

High level political commitment
– Strengthen translation into action in particular in high risk
districts and sub-districts of the remaining three endemic
provinces to demonstrate ownership
Recommendation Area: Maintaining
Achievements

Broad-based media campaign achieving high level
awareness (TV, radio, print media including new
approaches, e.g. polio true stories)
– Assess impact of the current strategy elements to
guide allocation of resources and activities (such as
production/use of posters)

Strengthen provincial leadership for programme
communication activities and planning.
Recommendation Area: Focus
Strategies in High Risk Areas

Strengthen data driven communication
strategies at sub-district level:
– use Control Room and PCM data to identify shortfalls in SIA
–
–
–
–

performance and analyze trends.
Include previous SM/C activities in trend analysis to assess
impact and develop indicators by which to assess future
impact.
Modify SM/C activities to according to impact
Conduct program activity
Link impact data from SM/C activities to trends
Emphasize focus of communication activities on
sub-district levels in high risk areas (UCs/Areas)
Strategic Approach to
Communication Activities
High number of communication activities are being
conducted.
The next phase of the programme requires
intensification and evidence based strategy which
should include:
– Retrospective desk review of SM/C activities related to
programme achievements
– Planning and monitoring for impact; developing
indicators
– Modifying SM/C activities
Strategic Approach to
Communication Activities
Previous
Interventions:
communication
Strategy/Intervent
ion:
Jirga, press release,
mosque
announcements,
community meeting,
DCHO
Surveillance
data
SIA data
Trend
analysis to
identify
reasons and
patterns of
missed
children:
•Inaccessibility (to
area/household)
time
over
(DSO, SO, CSP,
DHCO &
community)
Implement and
measure
communication
strategy (s)
Implement
program
activity
•Performance of teams (IPC,
no team, not available)
•Refusals (perceptions, misinformation, demand)
(control room,
PCM)
Locally
appropriate
strategy
identified
•Impact of previous
interventions
Collect Data
Examples of Strategic
Approaches to SM/C Activities
Example 1: “No Team”



Inadequate access for teams to children under six
months.
Analyze the data to identify the cause of the access problem at
the sub-district level
Review current SM/C activities to look for evidence of impact
(i.e. decrease in proportion of ‘no team’ in PCM, increase in
general or under 6 months coverage)
Modify SM/C responses and measure new impact going forward
e.g.:
– SM/C involving peri-natal care providers (proportion of
TBAs/community mid-wives briefed, increase in birth registration)
– Engagement with mothers in the community to increase awareness of EPI
and polio (rate of demand for EPI amongst mothers increased)
District with full access and intensive
SM/C activities
Example 2: Refusal
Strategic Approach

Review prior programme data to identify trend
– Distinguish persistent or transient refusal
– Identify specific causes of refusal e.g.


negative media, misconception, fatigue, too much OPV,
religious objection, demand related
Analyze relationship between SM/C activities and
refusal trends (increase in convincing, decrease in
refusal)
 Modify SM/C activity accordingly and measure
impact going forward
 Link back to programme data
Strategic Approach to Communication
Activities
communication
Strategy/Intervent
ion:
Jirga meeting held in
UC 3, attended by 15
community leaders,
one week before the
campaign
Surveillance
data
Trend
analysis to
identify
reasons and
patterns of
missed
children:
•Low recording of
absent or unavailable
children by vaccination
teams
SIA data
(control room,
PCM)
time
over
Locally appropriate
strategy identified
•Training conducted
in presence of high
level support, focus
on IPC and using
tally sheets of
previous rounds in
training
•UC 5 and 3 are of
two different tribes
organize jirga with
objective of gaining
access to community
Implement and
measure
communication
strategy (s)
•Provincial level
support to support
training prior to
campaign
•Mobilize quality CSP,
DSO, DCHO to area
during campaign
•Conduct jirga meeting
(tribe A) in UC 5
inviting all religious
leaders two days before
SIA,
•Conduct jirga (tribe B)
in UC 3 with different
leaders two days before
SIA
•Refusals: most refusals
are located in UC 5 and
are primarily due to
misconception of two
local religious leaders
Conduct SIA
•UC 3 had few refusals
also due to mis
information
Conduct SIA
Recommendation Area: Training
 Better
use SIA data to identify gaps in
vaccinator team performance related to:
– Access to household
– Quality of recording (NA, Refusals)
– Supervision and Monitoring
– Social Mapping
Recommendation Area: Training

Building on existing modules and training
programmes, focus on:
– Using previous SIA data relevant to the area of the
teams being trained
– Analyzing and plotting local realities (e.g. areas of low
coverage or refusals) using social maps
– Strengthen IPC negotiating skills using past SIA
household case studies
– Build morale by providing programme overview and
global updates

Monitor impact of improved trainings
Recommendation Area: Human Resources
Provincial Level
There is a gap in strategic communication capacity
and leadership at the provincial level.
 Create and fill immediately 3 long-term
Provincial-level Programme Communication
Specialist Posts
 Skills should include:
– Data analysis and communication strategy development
with focus on high risk districts
– Experience in communication, M&E and polio
Recommendation Area: Human Resources
Provincial Level (Continued)

The post requires an independent critical analyst
working as part of the provincial team (GoP,
WHO, UNICEF).

The specialist should report regularly to the
Federal level on progress and impact of
communication strategies.
Recommendation Area: Human Resources
District Level

Ensure that ALL high-risk districts have
DHCSOs.
– Positions should be filled immediately
– DHSCOs should be provided regular training
on communication strategies and fully utilize
the expertise of the provincial specialist.
Recommendation Area: Follow-up to
Communication Activities

Hold regular team leader meetings attended by
partners with report backs on communication by
the provincial communication specialists.

Expand mandate of TAG to include substantial
component of communication:
– to include a communication expert on the TAG
– Provincial Communication Specialists to report
regularly to the TAG
Summary

Sustain achievements of the programme
 Intensification phase of communication focused on
sub-district strategic approach
– Link data with SM/C activities
– Develop and monitor indicators
– Refine and modify approaches accordingly

Focus training on IPC quality, use of data in training
and social mapping.
 Increase capacity and leadership for provincial and
district communication urgently.
 Ensure adequate follow-up through regular meetings,
reporting and TAG.