Partnership examples: health
India (Partnering with religious leaders to eradicate polio)
Over 80 per cent of the children in India struck by polio in 2002 were below age two, predominantly boys and predominantly Muslims. The majority of cases – 80 per cent – were traceable to Uttar Pradesh (UP) in northern India. The World Health Organization and Government of India’s surveillance data showed children in western UP, primarily those in Muslim communities, as being consistently missed during National Immunization Days or Sub-national Immunization Days and for routine immunization.
The reasons behind this situation were multiple and complex. In terms of general health care, the region was already greatly underserved; many parents did not believe it was necessary for all children to be vaccinated against polio and regarded vaccination as ineffective; and most believed that polio could be cured by giving ‘proper medication’. There were also high levels of fear and suspicion. The Muslim population in western UP had already been targeted for birth control initiatives and saw the repeated rounds of polio vaccination as another attempt to control population growth.
In order to address the misperceptions, fear, suspicion and lack of trust this confluence of issues created, UNICEF partnered with key opinion makers, professionals and influential figures within the affected communities. Three Muslim universities, each with an extensive network of institutions – religious, academic and professional – and organizations close to the grass roots partnered to conduct advocacy and outreach and plan and implement the vaccination campaigns.
Partners that constituted the District Task Force, led by the District Magistrate (the highest governing authority of a district), engaged in intensive social and community outreach activities. Community mobilizers then carried out a series of actions 15 days before each vaccination round that included:
- Courtyard meetings and mothers’ meetings to enhance knowledge of polio, address concerns of repeated doses, side effects and whether vaccination is possible when a child has fever.
- Day-long health camps to offer general curative care for children, routine immunization and preventive health counselling for parents.
- Meetings with ‘influencers’ – respected figures such as imams, teachers, medical doctors and local activists – to enhance the quality of interaction with families, often door to door.
The combination of advocacy, social mobilization and behaviour change communication approaches yielded lessons in several workable approaches:
- The support of religious leaders, eminent persons and medical authorities, including traditional health workers, helped address resistant attitudes founded on rumours.
- Opinion changes through local interactions with resistant families were sustainable only when buttressed by similar opinions in the larger environment, especially through the engagement of religious leaders whose viewpoints mattered greatly to targeted communities.
- The presence of traditional health workers and religious figures in every neighbourhood represented an effective source of outreach and a channel for tracking down missed children.
- The district health department recognized the value of the Jamia Millia Islamia network’s involvement in planning, coordination and implementation.
- The appeals and statements secured from important Islamic centres such as Darul Uloom and Miftaul Uloom Deoband proved helpful to changing behaviours in reluctant Muslim families.
- The advocacy booklet that was prepared was also critical to opening doors to more Muslim institutions and opinion makers to enlist further support.
- The seamless coordination between these institutions and their local networks contributed to high turnout on both days and the effective house-to-house search for children.
Democratic Republic of Congo
In 2010 UNICEF entered into a partnership in the Democratic Republic of the Congo with the five major Christian, Muslim and traditional religious communities, which have a combined network of over 30 million people, to promote key family health practices such as breastfeeding and immunization. The five groups were strategically selected based on their credibility and capacity to promote behaviour and social change, as well as their representation of more than half of the country’s estimated 65 million people. A similar programme is underway in neighbouring Republic of Congo.
The Catholic Vicariate Apostolic of Esmeraldas and UNICEF are partnering in north-western Ecuador to support mainly indigenous rural communities in: (a) primary health care, including maternal and child health and nutrition; (b) teacher training and development of culturally relevant educational materials; and (c) life-skills activities for at-risk adolescents and youth. The Government relies on the Catholic Vicariate Apostolic of Esmeraldas for the provision of these services because of its influence and reach within this highly volatile region of the country.
UNICEF and the Algerian Ministries of Religious Affairs and Health launched a series of training sessions in 2009 for mourchidates, or women preachers, on promoting and protecting the health of women and children. More than 30 mourchidates have been trained in a programme targeting 300 women preachers throughout the country. The programme seeks to introduce participants to principles of communication for behavioural change, providing them with essential information on the health of mothers and children and highlighting the role of communication in promoting health.
In the Dominican Republic in 2009 UNICEF provided technical and financial assistance for the extension of the Catholic Church’s Pastoral Materno Infantil [Maternal and Child] programme, which provides training for mothers in health and nutrition, group dynamics and communication skills, as well as home visits. With UNICEF support and advocacy, the Pastoral was included in the National Public Budget to make its work more financially sustainable.
UNICEF Myanmar conducted over 400 Facts for Life training sessions – with an avian influenza component – in over 50 townships with the help of six religious/ethnic groups: Buddhist, Catholic, Muslim, Protestant and ethnic Kayin and Chin. UNICEF also published a ‘Buddhist Leadership Project Manual’ for Lay Buddhist trainers in 2006.
During the 2010 cholera epidemic in Haiti, UNICEF partnered with an interfaith coalition – the Haiti chapter of Religions for Peace -, that brought together Catholic, Protestant, Voodoo and Muslim communities to reach thousands of people with both information about cholera and emergency care. More than 4,000 religious community members were trained with cholera prevention and response messages and, in turn, reached close to 2 million people (20 per cent of Haiti’s population) with their social mobilisation efforts
Together with the Ministry of Public Health and Sanitation and the Inter-Religious Council of Kenya, UNICEF launched an initiative in 2009 to promote key high-impact interventions for maternal and child health. Christians, Muslims and Hindus came together and prioritized seven such interventions, which they then translated with reference to the Bible, Qur’an and Gita. The final product is a ‘Handbook for Faith Communities’ promoting maternal and child health in Kenya. Through the religious coordinating bodies in the country’s 47 counties, this programme will reach all 8 provinces and train 27,000 religious leaders. Each trained leader is expected to share information on maternal and child health with at least 1,000 congregation members over a three-year period.
During the civil war in El Salvador, the Catholic Church negotiated a ceasefire to allow children on both sides of the conflict to be immunized. Similar efforts have been replicated in other conflict-affected countries such as Sri Lanka and Sudan.
Before announcing Egypt as polio free, UNICEF Egypt requested the Grand Mufti to issue an important fatwa that encouraged and mobilized caregivers during the undertaking of the intensive polio campaigns.
UNICEF partners with the Inter-Religious Council of Sierra Leone, a national inter-faith network with representation in all districts of the country, to promote essential family practices and other child survival and development practices. The partnership includes a memorandum of understanding between the two organizations outlining a closer and more strategic collaboration.
Historically, imams not only provide religious leadership to the people in Bangladesh but also contribute to promoting and maintaining public health, development activities, social peace and communal harmony. In general the population, particularly in rural settings, place great importance on the imams’ instructions. UNICEF has partnered with religious leaders in a number of ways, including:
- Working with Islamic as well as Buddhist leaders in support of community-based measles campaigns that were incorporated into regular religious services, including weekly prayers.
- Forming a strategic alliance with the National Islamic Foundation, seeking the support of imams on the dissemination of healthy and positive messages for children and their families and the promotion of child rights at national and local level. The UNICEF Country Representative participates regularly in the National Imam’s Conference to discuss children’s issues, seeking religious leaders’ support on the promotion of key life-saving, care and protective behaviours for children. Particular issues of focus have been the promotion of hand washing with soap, breastfeeding, education and health-related behaviours. Booklets with the key messages and information have been shared with communities. As a result hand washing with soap is being promoted before ablutions and at critical moments in the day, and some communities are donating soap to the mosques.
- Mobilizing imams and Buddhist monks from districts affected by the H5N1 and H1N1 viruses to promote preventive and response behaviours.
To ensure ongoing communication with religious leaders, especially within local communities, UNICEF created a database with the mobile phone numbers and addresses of religious leaders.