Author: Gage, A. J.
The Republic of Niger is one of the 160 member countries of the World Health Organisation that officially endorsed the WHO Declaration in 1995 to eradicate polio by the year 2000. The Expanded Programme of Immunisation (EPI) began in 1988 in 50 centres. Since 1997, Niger has embarked on yearly polio eradication campaigns, with a limited number of rounds being conducted each year to increase polio immunization coverage at a more accelerated rate. Immunisation activities are presently carried out in more than 400 centres. However, full immunization coverage remains low at 42%.
Purpose / Objective
The overall goal of the evaluation is to assess the effectiveness of the social mobilisation strategies and activities that have been conducted before and during National and Local Immunisation Days. The specific objectives are:
- To investigate each sub-strategy used in social mobilization since the onset of the 2000 NIDs and assess its impact on behavior change among the Nigerian population
- To undertake a rapid assessment of sources of information on polio eradication according to sex, age, and area of residence
- To examine educational material used by health workers for each social mobilisation strategy used during NIDs
- To formulate innovative, replicable, sustainable strategies that could be used to improve social mobilization activities for upcoming NIDs and the national EPI Programme
Review of available literature and on polio eradication and social mobilization activities for immunization in Niger.
Process evaluation in order to measure how well social mobilization activities were conducted. This component of the evaluation examined the quality of program planning and implementation, and entailed the use of key informant interviews.
A caretaker questionnaire was administered during a household survey that was conducted in one rural site (Soumarana) and one urban site (the quartier of Soura Bildi), covering 101 and 117 caretakers, respectively. Two other questionnaires were developed to collect information on the training and experiences of vaccinators and mobilizers, the type of information that is communicated by vaccinators and mobilizers during the immunization activities, and the extent to which vaccinators and mobilizers were able to reach special groups with NIDs messages in the past 12 months.
Four focus group discussions were conducted among male community members in the household survey sites, with each group having an average of 10 participants. In addition, 2 focus group discussions were held with religious leaders (Marabous) in Maradi Town. One group was composed of Marabous who were supportive of polio eradication efforts and NIDs, and the other of Marabous who were opposed to such efforts. Each group of Marabous consisted of approximately 5 participants.
Key Findings and Conclusions
Only 22 of the 42 districts of the country have integrated social mobilization into their immunization action plans and only these 22 districts have included strategies for reaching difficult and hard-to-reach population, including zero-dose children. The planning process should be strengthened by providing technical assistance to the remaining 20 districts of the country to include social mobilization activities in their respective immunization action plans.
The results of the vaccinator and mobilizer surveys demonstrate that there is an urgent need to improve personal communication skills among mobilizers and vaccinators. The quality of counseling is poor and vaccinator knowledge on immunization issues was assessed to be low. Only 47 percent of vaccinators were assessed to be well informed about immunization issues and about a third of mobilizers had never received training on NIDs. One result of the poor quality of interpersonal communication was a general lack of caretaker understanding and knowledge regarding the diseases against which children were immunized and poor comprehension of the rationale for the coexistence of routine immunization and NIDs. In addition, the lack of respect and courtesy displayed by health workers at fixed facilities towards clients had repercussions on the rate of acceptance of the door-to-door strategy.
The assessment of the adequacy of advocacy activities revealed that advocacy and resource mobilization activities have not targeted private companies and commercial enterprises in the past three years. There is no representative from the commercial sector in the Maradi Regional Social Mobilization Sub-Committee and in the National Social Mobilization Sub-Committee. It is recommended that social mobilization activities be extended to gain the support and involvement of the commercial sector.
Conduct separate/specific training sessions on social mobilization and interpersonal communication for vaccinators and mobilizers. The current training program is deficient in a number of ways. It is too short, and the inclusion of interpersonal communication as one of the many topics covered in the NIDs' training program does not allow sufficient time to be spent on communication issues.
The role of the community in social mobilization for polio eradication and immunization should extend beyond NIDs to encompass routine immunization. Current activities of the social mobilization subcommittees are focused on planning and monitoring NIDs. This expanded role could contribute to the reinforcement and strengthening of routine immunization.
In addition, the level of functioning of the sub-committee could be improved by training its members in communication and social mobilization. All NIDs' supporters, including members of the social mobilization sub-committees, need training on the basics of advocacy, interpersonal communication and key messages, if they are to plan and carry out social mobilization activities effectively.
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WHO, Ministère de la Santé Publique et de la Lutte Contre les Endémies, the Direction Régionale de la Santé Publique - Maradi