Polio Strategy Perspectives SurveyFebruary to March 2013

• About the survey• Headlines and

comparisons• Question by question

analysis and data

A few things to keep in mind as you skim through the slides

About the survey1. Intent was to gather a small number of

informed and detailed responses2. Questions were relatively extensive and

took some time to complete3. Only those in the CI network in India,

Pakistan, Nigeria, Afghanistan and Horn of Africa received an invitation.

4. The quality and substantive nature of many responses coupled with the direct experience of significant numbers of respondents provide instructive insights.

5. Response numbers were a little lower than expected given experience from previous ‘niche’ surveys.

6. This is likely reflective of the comparatively low numbers of people involved in polio action and perhaps the low attention to polio by people and agencies involved with other development issues.

The slides that follow show the main (though still initial and draft) results of a survey conducted by The Communication initiative of small sections of its network involved in polio work. The sample size is not large nor was it meant to be as the survey sought to gain insight into a range of issues such as perceptions of public trust, leadership style, messaging, and reaching hard to reach populations from a targeted group with direct experience of the programme in very high priority countries.Key findings are looked at in aggregate and disaggregated by country and level of involvement in the polio programme.

Overview• 142 respondents• Most (80%) from Pakistan, India and Nigeria• 70% involved in polio work across a broad cross

section of polio work• Coming mainly from UN, government, academic,

NGO and Media organizations.• 132 asked for a copy of the summary findings

Key Findings: Comparing those heavily involved with those somewhat or not at all involved in polio work.

• Public Trust: – Heavily involved rated public trust

higher than those less involved.• Local Engagement:

– Heavily involved rated engagement of religious community, tribal and traditional leaders and local community groups higher than less involved.

• Leadership: – Heavily involved agreed with describing

leadership as Data Driven, Responsive and Partnership Based more than those less involved.

• Decision Making: – Less involved described the programme

as having a top down approach more often than those who described themselves as heavily involved.

• Public Conversation: – Heavily involved described the

programme as having higher levels of public conversation, accurate information and prominent local perspectives than the less involved.

• Innovation: – Heavily involved rate the programme

much higher for innovation though close to 50% of both groups gave the programme an average rating.

• Polio and Routine Immunisation:– Heavily involved more often described

the relation between polio and routine immunisation as being close and strategic but separate.

What are some of their different assessments on the core strategic foundations for the polio programme?

Key Findings: Comparing India, Nigeria and Pakistan

How do different priority countries compare on some of the core strategic foundations for the polio programme?

• Public Trust: – Nigeria rated this strongly as

mixed, Pakistan rated public trust as low.

• Local Engagement: – Pakistan felt religious and tribal

groups not engaged and Nigeria felt community groups not engaged.

• Leadership: – Pakistan had the lowest ratings

across all groups.– Pakistan rated leadership low for

being Decisive and Determined.• Public Conversation:

– Pakistan felt more inaccuracies and less public conversation than other countries.

• Innovation: – Pakistan rated innovation

significantly lower than other countries.

• Polio and Routine Immunisation:– Pakistan rated separate and

parallel approaches highest, India gave the lowest rating for information sharing and Nigeria gave the highest rating for there being a close strategic working relationship.

Key Findings In Aggregate IWhat emerges from the overall?

• Overall Perception: – Most positive about programme’s

strategies and direction.

• Public Trust: – Most describe as mixed.

• Messaging: – Clarity on date and need rated high

but low on what to expect from vaccinators.

– Nearly 30% felt messaging not reaching hard to reach populations.

– Religious and migrant populations rated lowest in terms of message saturation.

• Engagement: – Local government officials are

actively engaged. – Technology and communication

companies, tribal leaders and religious leaders not effectively engaged.

• Mass Media: – Nearly all felt programme uses mass

media well.

• Digital Technologies: – Lowest effectiveness ratings - least

effective was the use of GIS/GPS.

Key Findings In Aggregate II What emerges from the overall?

• Leadership: – UN agencies, government and health

workers rated most effective. – Programme leadership described as

Determined, Active, Responsive and Partnership Based but poor at being Astute and Collegial .

• Decision Making: – The programme is perceived by most to have a

decision making process that flows from the top down.

• Public Conversation:– India scored highest while Pakistan

was rated as having the least public conversation with the most inaccuracies.

• Innovation:– Most rated this between high and

average.

• Relation between polio and routine immunisation: – Rated as poorly integrated but

improving.

Country of Residence/Nationality

How involved were respondents in the polio programme?Nearly 70% or respondents were heavily or somewhat involved. A review of those who provided more information on the type of involvement the cross section of polio work was broad including:•Mobilisation•Research•Media/journalism•Training•Programme management•Strategy development•Technical support•Creative activities such as theatre, radio and audiovisual•Vaccine procurement•Logistics•STOP Teams•Community volunteers

Type of OrganizationRespondents came from a range of organizational types with UN Organizations and Academic Institutions being most represented at 19.58 and 17.48% respectively. However, international and national NGOs or CBOs represented nearly 26% of respondents (plus 6.29% local organizations) and government and media responses representing about 10% each. Very few respondents described themselves as coming from a religious community organization.

Respondents perceptions on programme strategy and actionThe majority of respondents to this question felt positive or somewhat positive about present programme strategies and activities in their countries though nearly 43% felt somewhat negative or negative.

Select overall assessment commentsPositive• The polio eradication strategy is well

prepared and the action is going on well in the secure part of the country.

• The government and the Federal Ministry of Health are committed to see that it is eradicated completely.

• The strategy is good because it is implemented at local, state and federal government levels

• The strategy reached a wide section of the society and used different media tools to convey the message in different languages.

• The whole concept of social mobilisation through the SMNET has been immensely successful and deserves an award of some kind.

• Bottom-up approach, ie, the local government were mostly on the frontseat of implementation

Negative• Without access, security and stability,

polio transmission will not be stopped in 2013.

• Expensive and misplaced priority. Routine immunisation which is a major strategy for polio eradication is nonexistent so to speak.

• The message has been high jacked (sic) by militants with threats of violence. The Polio campaign has not succeeded in getting the message back on track.

• Access does not equal success . Consistency of intervention esp. in the porous border areas is crucial.

• Emphasis must be given to advocacy and social mobilization at the community level especially on hard to reach and difficult- to- convince people.

• Building trust and commitment from the community and policy makers are yet to be achieved.

Public TrustOverall ratings for public trust are relatively high with fewer than 10% answering there is low public trust and nearly 36% believing it to be high. Controlling for residents of India, Nigeria and Pakistan it is not surprising to find India with the highest public trust ratings. Nigeria’s ratings are close to the overall for low public trust but much higher for mixed trust. Comments from Nigeria indicate concern for resistance and anti-polio sentiments in northern Nigeria. Pakistan has the highest rating for low public trust at nearly 27%. Given the violence of recent months this is not surprising though such a high rating is concerning.

Public TrustComparing the responses of those who described themselves as heavily involved in the polio programme with those who described themselves as somewhat or not at all involved we see that the former felt public trust was generally higher than the latter (43.5 compared to 32.8% for very high public trust). Those who were somewhat or not at all involved felt a higher number of people had mixed levels of public trust.

Select comments public trustHigh Public Trust• There is a high level of public trust

in the polio work in most part of the Afghanistan. The public trust is low in the remote areas and in the insecure areas.

• For a large majority across the length and breadth of the country, it enjoyed high level of public trust.

• Once reached, the community accepts services provided to them.

• Only very small pockets of people question the immunisation programme.

• The communication strategy has been successful in winning the trust of groups refusing the vaccine using local networks and community mobilizers

Low Public Trust• Some people particularly in the

northern areas of the country have misconception about OPV safety

• Some religious leaders criticize polio drops as a medicine to stop population growth

• Personnel employed often are unqualified and undedicated young people, not from that locality, thereby not having good geographical knowledge of where to cover.

• Public trust is low in remote and insecure areas.

MessagingMessages on date and need are generally considered high with ratings from those resident in India at 100%. Messages on what to expect from vaccinators were considerably lower especially in Nigeria and Pakistan.

Saturation of polio messagingWhile the largest group of respondents felt that messaging was reaching hard to reach populations almost a third felt that it was not. Religious and migrant populations were rated lowest in terms of message saturation.It is worth noting that amongst those resident in Pakistan more felt that messages were reaching minority populations (65.5%), religious populations (44.8%) and minority language populations (62%). Given the lower scores for public trust amongst Pakistani resident respondents this points to a weak correlation between message saturation amongst hard to reach and minority groups and public trust.

Local EngagementThe overall figures indicate a strong perception that local government officials are being actively engaged. The highest overall No ratings were for effective use of technology and communication companies, active engagement of tribal leaders and active engagement of religious leaders. Pakistan resident respondents felt that the engagement of religious communities tribal leaders was not active enough (67% and 53% respectively). Nigeria resident respondents felt that traditional and tribal leaders were being actively engaged (69% and 59% respectively) but that community groups were not being engaged actively (48%).Those who described themselves as heavily involved in polio work felt the engagement of the religious community, tribal and traditional leaders and local community groups was higher than those with less or no involvement in the programme (see next slide).

Local EngagementHeavily vs Less Involved in Polio Work

Mass MediaIn general the majority feels that the programme uses mass media well though is less convinced of its effective use of community media and specialty publications.Controlling for India, Pakistan and Nigeria a variable picture emerges. Indian resident respondents rated mass media use as 96% effective overall. Nigerian resident respondents gave an overall use of media rating of 55% with the highest ratings in the use of radio and television (71% and 77% respectively). Pakistan resident respondents gave the lowest overall rating of 40% with television and radio at 53% each.Breaking down the numbers there is a perception that both Pakistan and Nigeria have considerable room to improve their use of mass media.

Digital TechnologiesOverall this area has the lowest effectiveness scores. The most effective area was in the use of mobile phones (25%) and the least effective was in the use of GIS/GPS.Controlling for India, Nigeria and Pakistan a somewhat different picture emerges with India rating mobile phone use at 40.7% effective compared to Pakistan at 20% and Nigeria at 10.3%. Pakistan rated social media the highest at 26.7%.GIS/GPS use was rated at 9.5% overall, 22.2% by Indian resident respondents, 6.7% by Pakistan and 3.4% by Nigeria. Given the importance place on this and other new technologies in the new strategic plan this is an interesting finding.

Leadership

From the overall chart UN agencies are rated most effective (89.3%) followed closely by all levels of government (85.3%), Health Workers (84.5%), International NGOs (79.7%) and Local Organisations (73.8%). Traditional Leaders, Women Leaders and Professional Associations could be seen as having room for improvement (61.8%, 59.5% and 54.7% respectively). Universities were rated least effective (34.5%).When controlled for national residence India stands out as rating government at 100% for all levels of governance together with high ratings for Health Workers, INGOs and UN (see chart on next slide). Pakistan gave government effectiveness the lowest rating (66.7%), INGOs (53.4%) and Universities (13.4%). Those less involved felt UN and traditional leaders were somewhat less effective than those heavily involved in polio work.

Effective Leadership(Percentages of those who answered ‘Very Effective’ combined with those who

answered ‘Kind of Effective’)

Effective Leadership (Percentages of those who answered ‘Very Effective’ combined with those who

answered ‘Kind of Effective’)

Strategic StyleOverall, respondents felt the programme’s leadership was Determined (70.2%), Active (69%), Responsive (67.9%) and Partnership Based (65.5%). It did somewhat less well at being Attuned to Local Culture (58.3%), Data Driven (57.1%), Decisive (51.2%) and at Listening (53.6%). Respondents felt it did the worst at being Astute (39.3%) and Collegial (34.5%).Breaking down these ratings by country of residence tells a somewhat different story with India rating leadership strategy higher across the board and with Pakistan rating leadership much lower in all categories. The lowest ratings were for Collegial and Astute though Pakistan notably also gave very low ratings for Decisive and Determined. The chart on the next page shows the comparative ratings.Those heavily involved in polio tended to agree to more of the descriptors than those who were less involved especially with the terms Data Driven, Responsiveness and Partnership Based.

Strategic Leadership Style(Percentages of those who answered ‘Agree’)

Strategic Leadership Style(Percentages of those who answered ‘Agree’ to the descriptor)

Decision MakingThe main finding for this question is not surprising and the numbers bear this out whether looked at overall or compared by country. The programme is perceived by most to have a decision making process that flows from the top down. This is most evident in Nigeria with the highest percentage rating it top down and lowest rating it a mix of top down and bottom up.

Decision Making: Heavily vs less involved in polio workThose who are less involved in the programme tend to view it as having more of a top down approach and less of a mixed approach than those who described themselves as heavily involved in polio work.Neither group described the programme as being bottom up.

Public ConversationRespondents were asked to Agree, Disagree or say Not Sure to the following questions:•Extensive levels of public conversation take place •Accurate information is shared in those public conversations •Local perspectives are prominent in the public conversations •Polio experts tend to dominate the conversation •There is little public conversation about polio •Many inaccuracies are prominent in the public conversations about polioWith the exception of there being extensive levels of public conversation taking place fewer than 50% agreed that accurate information was being shared or local perspectives made prominent.

Public ConversationComparing answers among country resident respondents India generally scored highest on levels of public conversation involving accurate information while Pakistan ratings represented perceptions of less public conversation and more inaccuracies in those conversations.

Public Conversation: Heavily vs less involved in polio workThose who are heavily involved in polio work feel there are higher levels of public conversation, accurate information and local perspectives than those with less involvement.

Polio InnovationOverall most felt that innovation levels were between high and average. India felt most strongly about levels of innovation. Pakistan offered the lowest rates for high and average innovation and the highest rating for low innovation.

Polio Innovation: Heavily vs less involved in polio workThose who are involved rate the programme much higher for innovation than those who are less involved though close to 50% of both groups give the programme an average rating for innovation.

Relation between polio and routine immunisationPakistan respondents felt that the relationship was that of very separate and parallel activities. Nigeria respondents felt that polio and routine immunisation had a close strategic and working relationship. This is quite varied with some divergent views within and across countries.

Relation between polio and routine immunisation: Heavy vs less involvement in polio workThose heavily involved described the relationship between polio and routine immunisation as having better information sharing than those less involved and were less likely to describe them as being separate or parallel strategies on the one hand or essentially the same on the other hand.Essentially those with more involvement described the relation between polio and routine immunisation more often as being close and strategic but separate.