Meeting the challenge ofCommunication & Social Mobilization

in an India with no cases

Structure of the presentation• Social Mobilization Network and Communication• Guarding against complacency in an India without cases• Media & Advocacy• Emergency Preparedness• Questions for the IEAG

The impact of the Social Mobilization Network

*Data as on 1st Feb 2012

UNICEF HR SUPPORT IN POLIO HIGH RISK AREAS, UTTAR PRADESH, 2011

UNICEF CMC – 4931CORE – 1319

Source: Form A

2007 2008 2009 2010 2011

87

264

526

628

827

165

236

391

390

591

Rest of BiharKosi

SMNet strength in Kosi & Bihar, 2012

252 500 917 1018 1418

Source: PDSCL

(246)2010

(616)2011

24%

44%

% Female

High levels of knowledge and trust for OPV

UPBihar

9394

96.3

94

Knowledge on need for multiple doses of OPV

R1 R2

UPBihar

91.6

76.1

98 99.1

OPV prevents PolioR1 R2

UPBihar

35.133.4

66.2 73.1

Increased risk if a child misses dose of OPV

2010 2011

UPBihar

6.117

18.3

53

Will take corrective action if a child misses dose of OPV

2010 2011

Strong acceptance of need to immunize against polio

0 1 2 3 4 5 6 7 8 9 10 11 120

1

2

3

4

5

6

7

8

9

100.

2 0.8 1.2 1.

9 2.3 2.

8 3.4 4.

1 4.9 5.

7 6.2 6.

7 7.0

0.4

0.7 1.

1

1.5 1.

8 2.0

2.4

2.6

2.7

2.9 3.

0 3.0 3.

0

Average RI DosesAverage SIA Doses

Age (Months)

Dose

sAverage OPV doses through RI & SIA to infants,

41 HR blocks, CMC areas

A child at one year of age has an

average of 10 OPV doses in SMNet blocks of Bihar

Source: CMC Fieldbook

Guarding against complacency in an India with no cases

Respondents believe that Polio can affect children in their household

UPBihar

59

8.5

15.1

9

HRAs2010 2011

UPBihar

8

12

3

10.5

HRGs2010 2011

Trust is not as strong for Routine Immunization in the general population

86.582.7

98.196.2 94.3 98.7

Belief on RI UP Bihar

Received 3 doses of OPV

in RIHave RI card

67.2

32

81.1

67.4

Availability of RI card UP Bihar

RI poster:“Lay the Foundation for a healthy future today. Protect your child against six life-threatening diseases with timely Routine Immunization vaccination and polio immunization in every round.”

Communication materials promoting routine immunization

RI Handbill distributed to parents by polio teams to remind them of RI days and schedule

Bottlenecks in Monitored RI sessions, 41 HR BlocksBihar Mar-Dec 2011

March

AprilMay June

July

August

Septem

ber

October

November

December

-10%

0%

10%

20%

30%

40%

50%

60%

70%

20% 16%

31%10%

27%

47% 30%

68%54%

37%

No BCG

No DPT

No OPV

No AD syringes

No Diluent

No RI Card

Source: RI Monitoring: SM net

429 445 485 642 714 639 637 673 671 760Sessions = Monitored

N=6095

Need to sustain MOMENTUM.

Need to sustain IMMUNITY.

Indian parents and caregivers need to understand that they must protect their child against a disease that is no longer a direct threat, and against all other five vaccine-preventable diseases.

There is a significant opportunity to use the momentum and trust generated in the SMNet to promote routine immunization, which acts as our best buffer to ensure high levels of immunity, in addition to other convergence activities.

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

DPT-1 in 41 HR DPT-3 in 41HR DPT-1 in Non HR DPT-3 in Non HR

DPT coverage in Infants: Jan to Dec 2011 Bihar HR Blocks Vs. Non HR Block

Source: Block Coverage GoB

Target (80%)

41 HR Block Yearly Target <1 Ch= 256836 Monthly Target <1 Ch= 21403

Non HR Block Yearly Target <1 Ch= 1272500 Monthly Target <1 Ch= 106042

Routine Immunization improves in areas with SMNet

THE SOCIAL MOBILIZATION OPPORTUNITY • Children from 80% of refusal families in Howrah

remain unvaccinated in RI• 9% of children in Howrah are fully immunized• 18% of children are delivered at an institutional

facility.• Exclusive Breastfeeding rates are low

ACTION (IF SUPPLY LINES ARE HEALTHY): LARGE-SCALE RI COMMUNICATIONS CAMPAIGN – media buys, communication campaigns and sustained community mobilization, awareness and advocacy — that can transition into broader areas of child survival and development

EBF Diarrhoea RI

75149 65185

222425

24222 15815

215691

Number of contacts made by SMNet on convergence interventions in UP and Bihar

UP Bihar

SMNet convergence for other child survival interventions

West Bengal

HandWashing Toilet Use Breast Feeding Routine Immunisation IPC

46553

36010

9255

29439

65363

97058

79458

24472

67070

123189

57707

43532

25661

47262

71865

Families reached with convergent activities in West Bengal, Oct 11 - Jan 12

Oct 11Nov 11Dec 11Jan 12

Learning Needs Strategy • Communication Training

• Five convergence areas • Underserved Strategies Training• Data-based planning Training on interventions

• Training of trainers• Sub-Regional Training Coordinators• BMC level

• Management training • Supervisory level of staff

Focus on supporting training for Front-Line Workers

Media Tonality Monitoring reports State Polio Convergence Taskforce MeetingsState Polio Partners MeetingsNational Social Mobilization Working Group meetingsCommunications Review

PLANNED STUDIES FOR 20121. Mega KAP 3 for HRA and HRG in UP and Bihar2. Migration patterns and KAP on Polio among

HRGs of Punjab, Haryana, Maharashtra, West Bengal and Delhi

3. Impact evaluation of RI activities in west UP4. Impact in SMNet v non-SMNet areas for

initiatives under convergence

107 block-level profiles reviewed monthly

Continuous risk assessment for communication

Maintaining community support + tackling

remaining resistance

Community’s engagement in Polio Programme100

70.2 7697

100

58.372

99

UP Bihar

0.70%

1.60%

2.40%2.50%

3.40%

3.70%

0.00%

1.00%

2.00%

3.00%

4.00%

2007 2008 2009 2010 2011 2012 (Jan)

Continued decline in resistant households in CMC areas Uttar Pradesh, 2007 – 2012 (Jan)

Source:Tallysheet

97% 94% 95% 97%91%

96%3%

8% 8%

12%

7% 9%

0%

20%

40%

60%

80%

100%

April May June August September November

CMC Area Non CMC Area

Local influencer visiting all X houses with the teams, UP

Source :SMNet & Partners

N=9269 N=10040 N=14775 N=15446N=8117 N=12310

2.5%

1.1%

1.4% 1.9% 2.3%

2.4% 3.

4% 3.5% 4.

4% 5.6%

7.6% 8.

6%

11.3

%

0%

2%

4%

6%

8%

10%

12%

Sta

te

Bad

aun

Mee

rut

Mor

adab

ad

Kan

pur(N

agar

)

Alig

arh

Bar

eilly

Luck

now

Gha

ziab

ad

Alla

haba

d

Agr

a

Var

anas

i

Gor

akhp

ur

Subregionwise % XS Houses Uttar Pradesh, Jan 2012

Source:TallysheetSIA round partially covered Gorakhpur, Alllahabad, Varanasi, Lucknow data is updated as on Sep 11 for the same & rest of the updated where SIA held on Jan 2012

Refusal to immunize due to child sick is still an issue in

some areas

REASONS FOR OPV Refusal

Non receipt of Govt. services 57%

Misconception including ‘OPV causes infertility’31%

Con-genital issues

7%

Others5%

% of mosque where announcements happened in West Bengal

Source-FV data

99% refusal families in West Bengal belong to the Muslim community.

INTERVENTIONS• IEC/IPC to address misconception such as vaccine safety• Private doctors, Rural Medical Practitioners and non-registered

medical practitioners mobilized• Mobile health teams visit houses during rounds

PLUS• Trend analysis to identify persistent passive resistance• Identify pockets of resistance and develop strategic response• redistribution of staff to highest-resistant areas• 2 x PRI Workshop with 350 participants each• Rotary plastic balls in highest-resistance areas• Health camps in Howrah, South 24 Parganas, Kolkata and

Murshidabad

Media and Advocacy

New polio campaign launch by UNICEF Goodwill Ambassador for Polio

44%

41%

15%

PositiveNeutralNegative

Media Tonality, last quarter

Coverage has been predominantly positive (418

stories) and neutral (393 stories) across the reporting period

covering 13 January.

Significant positive coverage also resulted due to WHO taking

India off from the list of polio-endemic countries.

Extensive roll out of media campaign for programme visibility & reinforcement key messages to diverse target audience. 1533 TV spots on 21 satellite channels and cable2030 spots on 9 radio channels

IEC for Polio Immunisation NIDs Posters:      973,370 Rally flags   685,000 Sun visors   537,550 Rally banners   9,000

Whistles     1,088,000

Mass Media campaigns

Making polio advocates of media

114 radio announcers and presenters trained on polio and RI in 2011

15 print & electronic media workshops held in key high-risk Areas: Indo-Nepal border, Nasik-Malegaon, Howrah-West Bengal (pictured), Agra and Varanasi in UP and block-level media in Bihar.

Field visits by national & international media around important events – 13 Jan milestone, NIDs and SNIDs.

Key Challenges: • The risk of AFP being misreported as ‘Polio’ & VDPVs being

highlighted in a zero WPV scenario.• Having media report accurately in the event of WPV importation

Key Strategies: Updated standard responses on AFP/VDPV shared with

spokespersons, officials & partners to effectively respond to media to prevent inaccurate reports.

In addition to media workshops, media trainings for spokespersons & key partner representatives to effectively handle media.

When AFP is reported as polio, information on the lab results shared with media for further coverage, by highest authority.

Ensuring EPRP media plans are in place in all states for timely media engagement and response for accurate coverage.

Key Media Challenges & Strategies

Recent EventsBowl Out Polio with India, West Indies teams

Australia v India Test in Perth

Polio advocacy by F1 world champion

driver Fernando Alonso.

Advocacy events & material

Bihar CM Nitish Kumar polio banner

Prime Minister Dr Manmohan Singh launches GOI/Rotary Summit

WB CM Mamata Banerjee polio posters

Advocacy events & material

Advocacy with PRI elected representatives in high-risk districts of Howrah and 24 South Parganas in West Bengal and Mewat in Haryana.

From 200,000 to Zero:The journey to a polio-free India

Preparing for Emergency Response Emergency Kits developed in seven languages

Each kit has 20,000 emergency posters, 3,000 FAQs, 500 Green advocacy booklet, 500 IPC flip books, artworks of dated and undated posters, emergency TVand radio spots and CDs with mike announcements.

Rapid Response Teams

Six orientation workshops held for Rapid Response Teams – trained on responding to media, oriented on social mobilization in the event of a polio case.

Each state to develop Communication and Media Plan and identify spokesperson to respond to media.

1. How does the IEAG perceive the development of the Road Map for all aspects of polio eradication in India, including:Social Mobilization to maintain strong community

support, tackle complacency, and promote RI/other convergence interventions

Continuous interaction with the media and advocacy at all levels

Readiness to rapidly respond to any case

2. How does the IEAG perceive Planning for the mainstreaming of the polio

infrastructure in India for other child survival initiatives?

The future of the SMNet in India and replication of certain elements of the SMNet in other high-risk areas?

Questions for the IEAG

3. The IMB has requested that India document and share its lessons learned/best practices. How does the IEAG suggest the polio programme move forward on this recommendation?

4. In light of continued resistance in pockets of West Bengal, does the IEAG support sustained focus on tackling resistance in that state, despite the absence of cases? What about resistance in other areas?

Questions for the IEAG

Towards a polio-free India