11

Polio CommunicationPolio Communicationin Nigeria: Interruption and in Nigeria: Interruption and

BeyondBeyond

FinalFinal

TAG RecommendationsTAG Recommendations

29 June 200729 June 2007

22

2007 TAG Context2007 TAG Context

A real opportunity…A real opportunity…

Evidence suggests an epidemiological and operational opportunity in Evidence suggests an epidemiological and operational opportunity in 2007-08 for interruption;2007-08 for interruption;

Case trends show significant reduction over 2006;Case trends show significant reduction over 2006; The media environment is vibrant;The media environment is vibrant; There is significant investment and commitment from Federal and State There is significant investment and commitment from Federal and State

Government and International Agencies;Government and International Agencies; There is a clear recognition of, and desire for, increased local [State There is a clear recognition of, and desire for, increased local [State

and LGA] ownership to improve effectiveness.and LGA] ownership to improve effectiveness.

33

2007 TAG Context 2007 TAG Context con’tcon’t

But gains need to be consolidated by…But gains need to be consolidated by…

Making maximum use of communication;Making maximum use of communication; Rationalising social mobilisation and communication activities by Rationalising social mobilisation and communication activities by

focusing on high impact strategies;focusing on high impact strategies; Preparing a solid and thorough multi-year Communication Strategy;Preparing a solid and thorough multi-year Communication Strategy; Improving the effectiveness of vaccinator teams and supervisors Improving the effectiveness of vaccinator teams and supervisors

through training, supervision and monitoring;through training, supervision and monitoring; Developing resource mobilisation plans at Federal and State levels;Developing resource mobilisation plans at Federal and State levels; Keeping in mind that the situation is still fragile and Nigeria and other Keeping in mind that the situation is still fragile and Nigeria and other

countries have been at this point before only to see cases increase.countries have been at this point before only to see cases increase.

44

TAG Review - IntentionTAG Review - Intention To support improvements and consolidate gains made towards To support improvements and consolidate gains made towards

Polio eradication in Nigeria over the past two years.Polio eradication in Nigeria over the past two years.

To introduce communication related recommendations to accelerate To introduce communication related recommendations to accelerate and strengthen short term polio action and strengthen short term polio action whilewhile supporting the supporting the continued development of sustained communication action on polio, continued development of sustained communication action on polio, routine immunization and other primary health care needs.routine immunization and other primary health care needs.

To make strategic recommendations backed-up wherever possible To make strategic recommendations backed-up wherever possible with specific examples.with specific examples.

To make each recommendation as specific and clear as possible To make each recommendation as specific and clear as possible while recognizing that decisions on whether and how to while recognizing that decisions on whether and how to operationalise recommendations rests with the government, operationalise recommendations rests with the government, partners and donors responsible for implementing the polio partners and donors responsible for implementing the polio programme in Nigeria.programme in Nigeria.

55

TAG Review - ScopeTAG Review - Scope

What follows is not a comprehensive review nor a fully What follows is not a comprehensive review nor a fully fledged plan…fledged plan…

It is a set of recommendations designed to:It is a set of recommendations designed to: Support effective social mobilization and communication action;Support effective social mobilization and communication action; Set a wider dynamic in play through these actions;Set a wider dynamic in play through these actions; And help inform and support Nigerian decisions and planning And help inform and support Nigerian decisions and planning

related to Polio eradication. related to Polio eradication.

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Critical Polio IssuesCritical Polio Issues

The specific strategies and ideas that follow are intended to The specific strategies and ideas that follow are intended to address a cluster of critical issues identified by the address a cluster of critical issues identified by the Technical Advisory Group that may, if left unaddressed, Technical Advisory Group that may, if left unaddressed, undermine or reverse progress:undermine or reverse progress:

1.1. Missed Children/Non-Compliant HouseholdsMissed Children/Non-Compliant Households Improving the accuracy of estimates for the total population of Improving the accuracy of estimates for the total population of

under-fives at State, LGA and Ward levels.under-fives at State, LGA and Ward levels. Establishing better understanding of the reasons behind, and Establishing better understanding of the reasons behind, and

the numbers of, missed and zero dose children and non-the numbers of, missed and zero dose children and non-compliance.compliance.

2. Vaccinators, Supervisors and Monitors2. Vaccinators, Supervisors and Monitors Improving the motivation and skill levels of vaccination teams.Improving the motivation and skill levels of vaccination teams. Strengthening the capacity of supervisors and monitors to Strengthening the capacity of supervisors and monitors to

support the teams and ensure quality control.support the teams and ensure quality control.

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Critical Polio IssuesCritical Polio Issues con’tcon’t

3. Ownership at State and LGA and Community Levels.3. Ownership at State and LGA and Community Levels. States have taken an increasingly active and lead role in IPDs States have taken an increasingly active and lead role in IPDs

which should be further expanded and supported through which should be further expanded and supported through enhancing their capacities in areas such as analyzing data, enhancing their capacities in areas such as analyzing data, producing IEC materials and conducting localized media outreach in producing IEC materials and conducting localized media outreach in line with the strategic communication plan.line with the strategic communication plan.

4. Coordination and Supervision Amongst all Main Parties4. Coordination and Supervision Amongst all Main Parties Coordination needs to be strengthened between and among Coordination needs to be strengthened between and among

government and partners especially though not exclusively at the government and partners especially though not exclusively at the state and LGA levels.state and LGA levels.

5. Data Quality and Utilisation for Communication5. Data Quality and Utilisation for Communication The quality of communication related data collection and analysis is The quality of communication related data collection and analysis is

a major concern and needs to be addressed across a number of a major concern and needs to be addressed across a number of fronts including training and motivation for vaccinator teams, fronts including training and motivation for vaccinator teams, improved monitoring for quality control, independent spot monitoring improved monitoring for quality control, independent spot monitoring and linking data needs more closely to the strategic communication and linking data needs more closely to the strategic communication plan. plan.

88

Critical Polio IssuesCritical Polio Issues con’tcon’t

6. The Implications of a Broader IPD and PHC Focus6. The Implications of a Broader IPD and PHC Focus IPDs, RI and PHC need to be more strongly linked and IPDs, RI and PHC need to be more strongly linked and

integrated in order to be able to sustain the gains made during integrated in order to be able to sustain the gains made during the rounds and maintain high enough levels of immunity to move the rounds and maintain high enough levels of immunity to move from interruption to eradication. from interruption to eradication.

7. Systemic and Sustainable Capacity Building7. Systemic and Sustainable Capacity Building Many of the critical issues mentioned above depend on capacity Many of the critical issues mentioned above depend on capacity

building from State and LGA staff to vaccinator teams, building from State and LGA staff to vaccinator teams, supervisors and monitors. supervisors and monitors.

Taken together the recommendations are designed to Taken together the recommendations are designed to positively address these issues.positively address these issues.

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RecommendationsRecommendations

1010

Communication Strategy:Communication Strategy:A Multi-Year/Multi-Stakeholder ApproachA Multi-Year/Multi-Stakeholder Approach

Recommendation 1:Recommendation 1:

That a multi-year/multi-stakeholder communication strategy That a multi-year/multi-stakeholder communication strategy aimed at disrupting polio transmission, sustaining polio-free aimed at disrupting polio transmission, sustaining polio-free status through certification and strengthening routine status through certification and strengthening routine immunisation in Nigeria in the context of primary health immunisation in Nigeria in the context of primary health care be prepared.care be prepared.

1111

Communication Strategy:Communication Strategy:A Multi-Year/Multi-Stakeholder A Multi-Year/Multi-Stakeholder

ApproachApproach

RationaleRationale

There is a well developed communication strategy ‘Engaging There is a well developed communication strategy ‘Engaging Communities’ which provides an excellent basis for the elaboration Communities’ which provides an excellent basis for the elaboration of a multi-year strategy.of a multi-year strategy. However, current SM/C activities appear to be year to year, However, current SM/C activities appear to be year to year, periodic and operationalised mainly around campaigns.periodic and operationalised mainly around campaigns. At minimum eradication will take another 5 years which will At minimum eradication will take another 5 years which will require a 6-12 month plan, within a 2-year plan, within a 5-year require a 6-12 month plan, within a 2-year plan, within a 5-year planplan A more sustained month-by-month approach is needed that A more sustained month-by-month approach is needed that engages on a permanent basis with communities (perhaps engages on a permanent basis with communities (perhaps primarily via the development of the community dialogue model).primarily via the development of the community dialogue model). This planning process will need to happen without interrupting or This planning process will need to happen without interrupting or drawing resources away from ongoing programme effectiveness.drawing resources away from ongoing programme effectiveness.

1212

Communication Strategy:Communication Strategy:A Multi-Year/Multi-Stakeholder A Multi-Year/Multi-Stakeholder

ApproachApproach

A multi-year/multi-stakeholder communication strategy will:A multi-year/multi-stakeholder communication strategy will: Be able to look to communication needs over the coming year Be able to look to communication needs over the coming year as as

well as well as post-interruption needs.post-interruption needs. Provide clearer communication as to the relationship between IPDs, Provide clearer communication as to the relationship between IPDs,

routine and other immunisation programmes within the Primary routine and other immunisation programmes within the Primary Health Care system and how these strands fit together over time.Health Care system and how these strands fit together over time.

Coordinate longer needs such as providing training and consistency Coordinate longer needs such as providing training and consistency to front line communication and the development of skills at State to front line communication and the development of skills at State and LGA levels.and LGA levels.

Establish a year round set of communication activities linking IPDs Establish a year round set of communication activities linking IPDs to other health communication needs related to strengthening to other health communication needs related to strengthening Routine Immunisation.Routine Immunisation.

Better match the communication plan to the technical plan.Better match the communication plan to the technical plan.

1313

Communication Indicators: Communication Indicators: Coherent and Impact RelatedCoherent and Impact Related

Recommendation 2:

That the impact of SM/C activities be measured in terms of their own outcomes, and correlated with operational (coverage) and epidemiological (circulating virus) data using central indicators such as:

75% recall of major messages of key knowledge shared through communication action.

50% of people have discussed polio/routine with a friend/family member in the past week.

80% of respondents got 3 of 5 major polio/routine facts correct. 70% of household respondents stated that the vaccinators both [a] took the

time and [b] were courteous and polite in discussing any concerns that they may have had about vaccinating their child.

Associate these measures with operational and epidemiological performance data at relevant level (village, ward or LGA).

The above should be collected and reviewed between every round at agreed time interval and correlated with overall programme outcomes.

1414

Communication Indicators: Communication Indicators: Coherent and Impact Related (con’t)Coherent and Impact Related (con’t)

RationaleRationale

Common impact indicators drive focus and coherence – what you Common impact indicators drive focus and coherence – what you count…is what you do.count…is what you do.

All of above indicators are justifiable from literature as having All of above indicators are justifiable from literature as having significant role in impact though Nigeria will need to review and significant role in impact though Nigeria will need to review and develop indicators specifically related to its own communication develop indicators specifically related to its own communication strategy and associated appropriate impact measurement strategy and associated appropriate impact measurement requirements.requirements.

1515

Communication-Related DataCommunication-Related DataRecommendation 3:Recommendation 3:

That significant improvements be made to the quantity and quality of That significant improvements be made to the quantity and quality of communication-related data including:communication-related data including:

Better estimates of the overall population of under-fives in each state, Better estimates of the overall population of under-fives in each state, LGA and ward as well as the numbers of missed and zero dose LGA and ward as well as the numbers of missed and zero dose children and those in non-compliant households.children and those in non-compliant households.

Preparing reporting data using both percentages and absolute numbers Preparing reporting data using both percentages and absolute numbers for coverage to aid in the identification of actual numbers of missed and for coverage to aid in the identification of actual numbers of missed and zero dose children and non compliant households to better plan well-zero dose children and non compliant households to better plan well-targeted SM/C activities.targeted SM/C activities.

Gathering more in depth qualitative knowledge related to “non-Gathering more in depth qualitative knowledge related to “non-compliance” – with the support of independent agencies that have the compliance” – with the support of independent agencies that have the required skills required skills andand with results fed back into round planning. with results fed back into round planning.

1616

Communication-Related Data Communication-Related Data cont’dcont’d

Rationale:Rationale:

Absolute numbers will give LGAs and States a clearer idea of targets Absolute numbers will give LGAs and States a clearer idea of targets and gains and help clarify the actual numbers of people being and gains and help clarify the actual numbers of people being immunised.immunised.

Understanding the numbers of children to be immunised, whether they Understanding the numbers of children to be immunised, whether they are zero dose, missed or in non-compliant households is essential to are zero dose, missed or in non-compliant households is essential to the communication strategy for any round in every state.the communication strategy for any round in every state.

Improving the depth of qualitative knowledge will provide a better ‘feel’ Improving the depth of qualitative knowledge will provide a better ‘feel’ for people related issues and opportunities and provide a necessary for people related issues and opportunities and provide a necessary compliment to quantitative data. compliment to quantitative data.

Existing forms for capturing qualitative data especially, though not Existing forms for capturing qualitative data especially, though not exclusively, in the community dialogues tend to miss important exclusively, in the community dialogues tend to miss important information regarding communication issues effecting community information regarding communication issues effecting community ownership of the polio programme.ownership of the polio programme.

Present tools do not allow States and LGAs to collate the qualitative Present tools do not allow States and LGAs to collate the qualitative results to what's happening in the communities they work in.results to what's happening in the communities they work in.

1717

Independent MonitorsIndependent Monitors

Recommendation 4:Recommendation 4:

Strengthen existing monitoring systems and capacities with further training, earlier Strengthen existing monitoring systems and capacities with further training, earlier deployment and the addition of one or more fully independent agencies to deployment and the addition of one or more fully independent agencies to conduct in and end process monitoring and provide periodic reports to the conduct in and end process monitoring and provide periodic reports to the partners in Abuja.partners in Abuja.

Rationale:Rationale: Quality control remains a very large issue for household level data collection, Quality control remains a very large issue for household level data collection,

accurately transferring data from one level to another and ensuring maximum accurately transferring data from one level to another and ensuring maximum coverage during IPDs.coverage during IPDs.

Numbers of monitors have been increased significantly over recent rounds but Numbers of monitors have been increased significantly over recent rounds but their training and skills are not consistent.their training and skills are not consistent.

Independent (e.g. outside the polio programme partners) and fully trained Independent (e.g. outside the polio programme partners) and fully trained monitors doing proper in and end process monitoring would help identify gaps monitors doing proper in and end process monitoring would help identify gaps and problems and allow specific training and other needs to be identified and and problems and allow specific training and other needs to be identified and targeted.targeted.

1818

Community DialoguesCommunity DialoguesRecommendation 5:

That Community Dialogues (CDs) be improved and strengthened throughgreater methodological coherence and focus on local communityleadership, agenda setting and facilitation. Specifically this will include:

Reviewing and consolidating the approach, purpose and practice of CDs. Conducting CD’s year round focused on community determined PHC issues but used to spot emerging issues pre-round and evaluation post-round. Identification of appropriate local facilitators. Training facilitators directly. This has resource implications as cascade training will not be adequate. Moving government and technical agency staff to support roles and negotiating a larger role for Ward Development Committees. Continued support and expansion of ‘peer’ CDs for women, religious leaders and other segments of the community. Following Katsina’s lead – integrating community dialogues with local radio.

1919

Community DialoguesCommunity Dialogues con’t con’t

Rationale:

Polio, RI and PHC programmes are considerably strengthened by local ownership. CD’s can be an important tool to link and embed programmes in local systems and cultures helping to support long term healthy behaviour change. CD’s are significant but under-utilised sources of pre and post round information and evaluation.

2020

Social MappingSocial Mapping

Recommendation 6:Recommendation 6:That more extensive use be made of social mapping strategies. That more extensive use be made of social mapping strategies.

Specifically this should include:Specifically this should include: Engaging all actors in a community [local community members to Engaging all actors in a community [local community members to

international agency personnel] in jointly building over time a social international agency personnel] in jointly building over time a social map of their community – incorporating key social themes, data, map of their community – incorporating key social themes, data, resources, problems and issues along with polio, routine and other resources, problems and issues along with polio, routine and other primary health care knowledge.primary health care knowledge.

Building on the route/social maps now used and already being Building on the route/social maps now used and already being adapted to include some social information.adapted to include some social information.

A strong relationship with the community dialogue process.A strong relationship with the community dialogue process.

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Social MappingSocial Mapping con’t con’t

Rationale:Rationale:

Social Mapping places the specific issues – eg polio – in the context Social Mapping places the specific issues – eg polio – in the context of overall community, LGA, State and other resources and of overall community, LGA, State and other resources and opportunities.opportunities.

Mapping out the full depth of social resources will help identify and Mapping out the full depth of social resources will help identify and track important local partners for the IPDs over time.track important local partners for the IPDs over time.

Data presently shows that the involvement of some CBOs and NGOs Data presently shows that the involvement of some CBOs and NGOs is irregular and there is evidence to show that in some communities is irregular and there is evidence to show that in some communities they may be getting fatigued.they may be getting fatigued.

Reviewing and updating these on a regular basis will enable tracking Reviewing and updating these on a regular basis will enable tracking over time and support communication strategies to strengthen and over time and support communication strategies to strengthen and build on these relationships and respond to changes between rounds.build on these relationships and respond to changes between rounds.

Social maps will provide a coherent relatively simple platform built on Social maps will provide a coherent relatively simple platform built on already existing tools for accumulating knowledge and taking already existing tools for accumulating knowledge and taking advantage of relationshipsadvantage of relationships

These maps will be an important post polio PHC support and tool.These maps will be an important post polio PHC support and tool.

2222

Vaccinators and Supervisors: Vaccinators and Supervisors: Front Line for CommunicationFront Line for Communication

Recommendation 7:That vaccinators and supervisors be formally recognised as the front line

communicators for polio, routine and other primary health care initiatives and be supported to be more effective communicators through:

An improved selection process that stresses experience; skills; the ability to understand and relate to household dynamics; and personal commitment to child health.

More extensive inter-personal communication skills training. A support ‘package’ that increases retention and motivation possibilities

– allowance, transport, equipment. Tracking of retention rates and identification of reasons for low retention.

RationaleAs the public interface between the delivery system and the households the quality of the communication by vaccinators is vital for success – this aspect of their work has been overlooked.

2323

Data Collection and AnalysisData Collection and AnalysisRecommendation 8:That data collection be improved so that it is accurately captured,

organised, analysed and submitted upwards or re-submitted downwards in a timely fashion.

In the short term this should include: Training to vaccinators, supervisors and monitors on accurate data

collection and proper use of forms. Training for supervisors and monitors on assessing data quality and

implementing simple quality control measures. Data sampling to determine areas of weakness for targeting in

successive rounds.For the longer term Nigeria should: Explore more advanced technologies for collecting, analysing and sharing data -

for example: Widening access to computers and internet (to LGAs for instance)

would enable faster and more open distribution of data and reduce the points at which data is transferred from one form to another by hand.

Other technologies for collecting data such as mobile phone or personal digital assistants (PDAs) could also be explored.

2424

Data Collection and AnalysisData Collection and Analysis con’t con’t

Rationale

A long term goal for immunisation and the wider health system is the advancement of health information systems. Improving how data is gathered from the local level to a central organising point and then back to the local level for planning is vital. Data collection and accuracy has been identified as a major problem within Nigeria’s polio programme starting from the house to house collection during rounds and then moving up through the collection and anlaysis system. Without dependable data shared in a timely fashion it will be very difficult to know how successful the programme is or how to strategically focus communication.

2525

Strengthening Knowledge SharingStrengthening Knowledge Sharing

Recommendation 9:

Establish a platform for sharing and critically reviewing the very significant knowledge being generated at LGA, State and Federal levels and throughout the full range of partners – so for example what is learned in Katsina can be easily accessed by Jigawa

Key actions to include: A monthly update – email/print – on [a] key developments in past

week [b] major learnings [c] main issues and [d] new communication programme developments [Federal level to facilitate].

A text message network – so people from an agreed communication support network can both [a] share key developments quickly and [b] seek guidance on particular issues.

An online knowledge base. Financial data sharing.

2626

Strengthening Knowledge SharingStrengthening Knowledge Sharing con’t con’t

Rationale

Vitally important knowledge is generated at LGA and State level but is not consistently shared.

Such knowledge could become an essential tool resonating with, and therefore significantly helpful to, those involved in the “on-the-ground” action.

2727

Mass Media and Communication Mass Media and Communication Support UnitSupport Unit

Recommendation 10:Recommendation 10:That suitably qualified Nigerian entities – agency/university/company – be That suitably qualified Nigerian entities – agency/university/company – be

contracted (possibly by the Social Mobilisation Working Group) to contracted (possibly by the Social Mobilisation Working Group) to provide national mass media and communication support and to provide national mass media and communication support and to generate knowledge for use by all partners and states that includes:generate knowledge for use by all partners and states that includes:

A regularly updated comprehensive map of the Nigerian media A regularly updated comprehensive map of the Nigerian media landscape with state specific breakdowns.landscape with state specific breakdowns.

A listing of the most popular programmes and their audiences.A listing of the most popular programmes and their audiences. Continuous monitoring of the impact of mass media polio communication Continuous monitoring of the impact of mass media polio communication

programmes at national and state levelprogrammes at national and state level Regular communication and information and support to partners and Regular communication and information and support to partners and

government placing content in mass media.government placing content in mass media. Support and development of suitable partnerships with media.Support and development of suitable partnerships with media. Rapid assessments, surveys and research as needed.Rapid assessments, surveys and research as needed.

Rationale:Rationale:Mass media plans and the monitoring of campaigns will be considerably Mass media plans and the monitoring of campaigns will be considerably

strengthened by this resource.strengthened by this resource.

2828

IEC State HubsIEC State HubsRecommendation 11:Recommendation 11:

That the capacity of states to produce IEC materials specific to their That the capacity of states to produce IEC materials specific to their needs and based on their communication strategies be increased.needs and based on their communication strategies be increased.

Specifically this means:Specifically this means: Updating existing (such as HECTIC) and/or establishing new IEC Updating existing (such as HECTIC) and/or establishing new IEC

production centres in the high risk states.production centres in the high risk states.

Rationale:Rationale: IEC production technologies are now quite cheap and easy to use.IEC production technologies are now quite cheap and easy to use. States presently spend a lot of time producing things like hand States presently spend a lot of time producing things like hand

painted banners and other IEC materials for IPDs. This cost in time painted banners and other IEC materials for IPDs. This cost in time and resources could be reduced by introducing relatively and resources could be reduced by introducing relatively inexpensive new technologies.inexpensive new technologies.

As states continue to take on greater leadership roles they will need As states continue to take on greater leadership roles they will need to produce more IEC materials tailored to their specific needs.to produce more IEC materials tailored to their specific needs.

2929

Engaging Key Community Groups Engaging Key Community Groups

Recommendation 12:Recommendation 12:

Consolidate, institutionalise and further strengthen partnerships with Consolidate, institutionalise and further strengthen partnerships with traditional, religious, women and youth groups in their role in PEI, RI traditional, religious, women and youth groups in their role in PEI, RI and other PHC initiatives.and other PHC initiatives.

Rationale:Rationale: Considerable progress in reaching many more under-five children Considerable progress in reaching many more under-five children

has been made through building partnerships such as those with has been made through building partnerships such as those with Qur’anic Schools, Ulamas, CAN, Traditional Birth Attendants, Qur’anic Schools, Ulamas, CAN, Traditional Birth Attendants, FOMWAN, the Miyetti Allah Association and the Christian FOMWAN, the Miyetti Allah Association and the Christian Association of Nigeria.Association of Nigeria.

3030

Thank you – over to you