Communication for Development (C4D)

A Women–to–Women Communication Strategy for Polio Eradication

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© UNICEF / Afghanistan / 2009
Door to door marketing by Women 's Courtyard

Summary

In Afghanistan, the high immunization coverage achieved during the National Immunization Day (NID) in early 2008 was beginning to stagnate. One possible cause for this was too much reliance on the regular channels of communication such as radio, TV and training of teachers, mullahs, and community elders. The other factor was the over-burden of administrating polio vaccine in communities by male community health workers. In the face of social and cultural barriers which inhibit women from participating in social events or even appearing in public without a “burqa”, the programme successfully demonstrated synergy in mobilizing women to tackle the difficult task of ensuring 100% coverage of polio drops in polio endemic areas on the border of Pakistan and Afghanistan.

Based on results from surveys, women visiting neighborhoods to talk to women in their courtyards about NIDs was seen as an effective means to ensure that mothers and women are informed on NIDs and involved in the process of meeting an important milestone for their village. Women’s groups are now trained and mobilized to bring about behavior changes in hygiene and sanitary practices and even produce household latrine units to be sold in the community in WASH programme. This strategy has contributed to both social acceptance of an inclusive approach and helped deliver a desirable result as no recurrence of polio case has been noted since the inception of the strategy.

Innovation

In a context where women are forbidden to participate in social events, a culturally sensitive strategy is necessary for them to be trained and organized social mobilization activities for other women. With the mobilization of men and community leaders, permission is granted for women to be trained locally and to visit households to inform all mothers and caregivers about the NIDs. Trained women visited from courtyard to courtyard and ensured that all mothers and child care-givers are well informed on NIDs and encouraged to bring their children under five years of age to receive polio drops.

The overall outcome of working together with community elders and leaders to allow and assist women to access the neighborhood has: (a) contributed to maintaining the high coverage during National Immunization Days (NIDs); (b) affected positively in routine immunization coverage; (c) granted movement and engagement of women as community activators and leaders; and (d) allowed for the mobilization of girls and adolescents as community health workers who are trained and mobilized by the Department of Provincial Public Health. This strategy has the potential for bringing in a process of social transformation that will be cultivated, expanded, and lead towards the changes envisaged for all of the Medium Term Strategic Plan (MTSP) priorities.

Potential application 
 
The non-threatening, pragmatic and practical approaches adopted by the project is an effective strategy to ensure that mothers and women are approached in their local settings and are informed and organized so that they become part of the process in meeting an important milestone for their village. This approach of women, slow but steadily moving among the communities from courtyard to courtyard, is something that can form the basis of a social mobilization strategy for bringing about a positive change in other programme areas as well. The strategy is especially applicable in societies where women are prohibited from participating in social events.  

Issue 
 
In Afghanistan, the high immunization coverage during the National Immunization Day (NID) in early 2008 was beginning to stagnate. Over reliance on the regular channels of communication such as radio, TV and training of teachers, mullahs, and community elders was one factor. Over-burdened health staff was another. It became apparent that reported high immunization coverage alone could not transform communities to becoming polio-free as it would take just one or very few absentees or refusals to retain the virus in the community. Messages needed to reach inside of each house. The ground reality also dictated that social and cultural sensitivity needed careful consideration when designing a communication strategy. For example, male health workers are unable to pass messages to women in the households due to the cultural factor that men do not discuss general issues with women inside their home even when related to health. Furthermore, in order to get approval from community elders, additional work is required to encourage their involvement and understanding of the persistence of the polio virus lurking within the communities. It must also be noted that both the areas where the programme was implemented were in large semi-urban settings where no serious effort had been initiated to significantly involve women in the social mobilization.

Strategy 
 
Main strategies used in the “Women’s Courtyard” initiative include:

  • Assurance from community leaders and religious leaders (mullahs) was received through dialogue and consultation
  •  Refinement of radio and TV messages.
  • Inclusion of female vaccinators in posters and banners.
  • Encouragement of local school girls and adolescents to become community health volunteers.
  • Initiation of trainings and mobilization activities prior to National Immunization Days rounds. Extensive training of women took place in their courtyard. Women were consulted and encouraged to visit each household during National Immunization Days.

All of the above strategies have contributed to acceptance of an inclusive approach and to delivering a desirable result, as recurrence of polio case has not been noted since the inception of the strategy. There have been certain traditional elements that downplay or sometimes undermine the effectiveness of “women’s courtyard” strategy. However, it is evident that the momentum gained through the implementation of the strategies cannot be discounted.

  • Assurance from community leaders and religious leaders (mullahs) was received through dialogue and consultation.
  • Refinement of radio and TV messages.
  • Inclusion of female vaccinators in posters and banners.
  • Encouragement of local school girls and adolescents to become community health volunteers.
  • Initiation of trainings and mobilization activities prior to National Immunization Day rounds. Extensive training of women took place in their courtyard. Women were consulted and encouraged to visit each household during National Immunization Days.

All of the above strategies have contributed to acceptance of an inclusive approach and to delivering a desirable result, as recurrence of polio case has not been noted since the inception of the strategy. There have been certain traditional elements that downplay or sometimes undermine the effectiveness of “women’s courtyard” strategy. However, it is evident that the momentum gained through the implementation of the strategies cannot be discounted.

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Reported Source of Information PCA (Oct NID , Nov, 2008 SNID and Jan, 2009 NID)

Progress

Since the initiation of Women’s Courtyards, independent post-immunization surveys are beginning to show that women are able to ensure that messages reach all households, indicating that this could be a sustainable and reliable approach before and during NIDs. The table below shows that 39% of interviewed households reported village women as a source of information regarding the National Immunization Days (July 2009). Data also shows that the routine immunization coverage (DPT-3) in target areas has improved compared to the control area. In July 2009, 39% of interviewed households reported village women as a source of information regarding the National Immuniztion Days. Data also shows that the routine immunization coverage (DPT-3) in target areas has improved compared to the control area.

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Micro Survey on Source of Information via Different Communication Channels

After the initial success, women groups have been trained and mobilized to bring about behavior changes in hygiene and sanitary practices and even produce household latrine units to be sold in the community under the WASH programme. Mother’s groups are trained and they assist in developing a community support network so that awareness and access to health facilities are improved for safe deliveries even in the remote volatile districts of Nuristan. Women are trained and organized into self-support groups for protection of children in partnership with Women Development Affairs and Terres Des Homme (TDH) so that families relying on income from child-labour are assisted.

According to the July 2010 report, 350 women who were trained through the "Women's Courtyard" initiative were actively involved in the Sub National Immunization Days (SNIDs) in the Eastern Region in July 2010. The number of women involved in this campaign accounts for 32% of the total number of community mobilizers.

Since the initiation of Women’s Courtyards, independent post-immunization surveys are beginning to show that women are able to ensure that messages reach all households, indicating that this could be a sustainable and reliable approach before and during National Immunization Days. The table below shows that 39% of interviewed households reported village women as a source of information regarding the National Immunization Days (July 2009). Data also shows that the routine immunization coverage (DPT-3) in target areas has improved compared to the control area.

Next steps 
 
Given the initial success of the “Women’s Courtyard” approach in promoting key messages on National Immunization Days through a socially accepted manner, UNICEF will continue advocating for the Ministry of Public Health to mainstream the approach to improve access to health facilities through mother’s group network and mobilization of female community health volunteers. The strategy should also be applied in order to tackle and reduce the burden of death and disabilities among pregnant women and newborns.


 

 

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