Social Mobilisation/Communication Polio Eradication Partnership - India
India has incorporated a social mobilisation/communication (SM/C) component into its polio eradication process, which is aligned with the Polio Eradication Initiative (PEI) that was launched in 1988 under the aegis of the World Health Assembly (WHA). In India, primary partners in this effort include the national and local government (through the infrastructure of the Ministry and Departments of Health & Family Welfare) and UNICEF India, with input from Rotary International and the Core Group of international non-government organisations (NGOs). These collaborators have designed and implemented a number of SM/C activities to advocate for immunisation, using mass media, printed materials, networking, and training. A key purpose of these activities is to encourage participation in supplementary immunisation activities such as National Immunization Days (NIDs) and Sub-National Immunization Days (SNIDs).
Communication Strategies
At the centre of this programme is interpersonal communication in the form of training and subsequent activity of vaccination teams (VTs), primarily in the context of the NIDs/SNIDs. SM/C activities planned at the local (District, Block and Village) level are tied in with the work of VTs. Training sessions, which incorporate an interpersonal communication (IPC) module, place heavy emphasis on making the transitional link between eradication and longer-term routine immunisation strengthening. VTs are trained in a modified form of the "cascade approach" developed by USAID's Basic Support for Institutionalizing Child Survival (BASICS). Each campaign round starts with a 'booth day', advertised in mass media, reinforced with posters, and further publicised prior to and/or on the day in question by mobile megaphone (miking), mosque announcements, school rallies, banners, and marked or dressed booths that are stocked with vaccine and manned by varying numbers of health-worker and volunteer vaccinators. On subsequent days, VTs travel house to house in assigned areas to deliver oral polio vaccine (OPV) on the doorstep.
To foster support for the activities of the trained VTs, not only during the NIDs/SNIDs but throughout the year, various communication strategies have been developed. The dissemination of messages through mass media is one tool. Television, radio, and newsprint remain key areas of communication; a series of 'spots' featuring the film star Amitav Bachchan have been developed. (An evaluator (please see contact details, below) comments that, while Amitav Bachchan has considerable countrywide appeal, greater cultural breadth might be attained through the participation of celebrities representative of or better known among minority groups. However, there is some resistance to the production of similar TV spots featuring, for example, well-known Muslims on the grounds that this approach could be perceived as patronising. 'Majority' and minority celebrities might be brought together to create dialogue spots. In addition to these issues, programme partners have discussed - but are divided on - the question of whether the mass media channels can be used in India in a way that goes beyond a one-way, instructive message delivery approach, that is, to address specific (often localised) popular questions and issues, as they arise. Less mainstream circuits of local 'mass' information dissemination, this evaluator suggests, might be explored.)
In addition, information, education, and communication (IEC) print materials have been produced and distributed en masse. Some of these posters, flyers, brochures, leaflets, and handouts are produced only in Hindi; others include the Urdu script as well (according to a 2003 evaluation, some partners feel that, while much of the population being addressed is illiterate and so cannot read the information anyway, the inclusion of both scripts helps establish the polio programme as a service meant for all). Agencies, local government, and private contractors have been used to post posters prior to campaign rounds, though coverage in the centre of towns has, not surprisingly, found to be more regular and frequent than in rural areas.
Various administrative structures have been set up to support these SM/C activities and to coordinate strategies at different levels. For example, at the State level, a 'communications cluster' has been established in UNICEF Lucknow as a commitment both to PEI communication and to decentralised programming. The cluster focuses on training, NGO and local relations, and IEC. At the District-Block-Settlement level, a 'Social Mobilisation Network' has been established to extend the SM/C planning and activities from Delhi to the State, and from the State through District and Block to the village level. The Network focuses on:
To foster support for the activities of the trained VTs, not only during the NIDs/SNIDs but throughout the year, various communication strategies have been developed. The dissemination of messages through mass media is one tool. Television, radio, and newsprint remain key areas of communication; a series of 'spots' featuring the film star Amitav Bachchan have been developed. (An evaluator (please see contact details, below) comments that, while Amitav Bachchan has considerable countrywide appeal, greater cultural breadth might be attained through the participation of celebrities representative of or better known among minority groups. However, there is some resistance to the production of similar TV spots featuring, for example, well-known Muslims on the grounds that this approach could be perceived as patronising. 'Majority' and minority celebrities might be brought together to create dialogue spots. In addition to these issues, programme partners have discussed - but are divided on - the question of whether the mass media channels can be used in India in a way that goes beyond a one-way, instructive message delivery approach, that is, to address specific (often localised) popular questions and issues, as they arise. Less mainstream circuits of local 'mass' information dissemination, this evaluator suggests, might be explored.)
In addition, information, education, and communication (IEC) print materials have been produced and distributed en masse. Some of these posters, flyers, brochures, leaflets, and handouts are produced only in Hindi; others include the Urdu script as well (according to a 2003 evaluation, some partners feel that, while much of the population being addressed is illiterate and so cannot read the information anyway, the inclusion of both scripts helps establish the polio programme as a service meant for all). Agencies, local government, and private contractors have been used to post posters prior to campaign rounds, though coverage in the centre of towns has, not surprisingly, found to be more regular and frequent than in rural areas.
Various administrative structures have been set up to support these SM/C activities and to coordinate strategies at different levels. For example, at the State level, a 'communications cluster' has been established in UNICEF Lucknow as a commitment both to PEI communication and to decentralised programming. The cluster focuses on training, NGO and local relations, and IEC. At the District-Block-Settlement level, a 'Social Mobilisation Network' has been established to extend the SM/C planning and activities from Delhi to the State, and from the State through District and Block to the village level. The Network focuses on:
- social mobilisation - working with civil social groups: meetings with a variety of social groups, but with a special emphasis on contact between the programme and individuals or groups considered 'influencers' or elites in their communities
- programme communication - working with households where OPV delivery has been problematic: Community Mobilisation Coordinators (CMC) who are intended to be 'reputable community members' recruited on a short-term (generally 15-day) basis, according to identified areas of vaccine 'resistance'. These CMCs are trained using a 'flip-book' and picture cards covering several different areas of maternal and child health (MCH), including nutrition and immunisation (with a set of explanatory pages on polio). This training adopts a 'life cycle approach', in which immunisation for polio eradication is a component. The IPC that trainees learn is predominantly one of lecture delivery.
Development Issues
Immunisation & Vaccines, Children, Health.
Key Points
The Universal Immunisation Programme (UIP) raised routine coverage (including oral polio vaccine, or OPV) in India to an average of 90% between 1984 and 1990-91. Declining rates thereafter gave rise, from 1995, to Supplemental Immunisation Activities (SIA) in support of PEI. Between 1995 and 2003 there were approximately 34 NIDs/SNIDs in northern India. As of 2003, circulating Wild Polio Virus (WPD) remained widespread in only two Indian states - Uttar Pradesh (1,599 confirmed cases in 2002 - 80% of Indian cases) and Bihar (119 confirmed cases in 2002) - though local spread has occurred in West Bengal, Rajasthan, Gujarat and Haryana.
Figures provided by the Global Polio Eradication Initiative indicate that in a 6-day period, the 2004 NID in India led to:
One evaluator offers the following thoughts on India's polio partnership programme: "Evidence suggests that local people are more often than not extremely well-versed in the basics of Polio and vaccination, and have developed more sophisticated and specific questions than the lecture-style and essentially educative life cycle IPC in which [Block Mobilisation Coordinators] BMCs and CMCs are trained are capable of adequately addressing. Consequently, while...life cycle and MCH communication approaches are entirely valid in the context of long-term awareness and education for 'strategic' behaviour change in household health seeking, the communication approach for PEI needs to be somewhat more 'tactical', specific and oriented to interaction rather than simple, one-way message delivery."
Figures provided by the Global Polio Eradication Initiative indicate that in a 6-day period, the 2004 NID in India led to:
- 167 million children being immunised
- by 2.5 million vaccinators
- who dispensed 200 million doses of vaccine
- during 191 million home visits.
One evaluator offers the following thoughts on India's polio partnership programme: "Evidence suggests that local people are more often than not extremely well-versed in the basics of Polio and vaccination, and have developed more sophisticated and specific questions than the lecture-style and essentially educative life cycle IPC in which [Block Mobilisation Coordinators] BMCs and CMCs are trained are capable of adequately addressing. Consequently, while...life cycle and MCH communication approaches are entirely valid in the context of long-term awareness and education for 'strategic' behaviour change in household health seeking, the communication approach for PEI needs to be somewhat more 'tactical', specific and oriented to interaction rather than simple, one-way message delivery."
Partners
Government of India (Ministry and Departments of Health & Family Welfare), UNICEF India, Rotary International, the Core Group of international NGOs.
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