UNICEF Image:  The circles indicate that the home contains three families, each of whom has children under five (represented by the dots within the circle) to be vaccinated.
© UNICEF/45-HQ06-2619Tom Pietrasik/India
Anganwadi worker Pushpa Kumari tallies the number of children eligible for polio vaccination in a household in Bhakra Village, Bihar.

In India, UNICEF-supported social mobilization and communication demonstrated improved access to families, with the number of households deciding not to immunize their child reduced to less one out of every 400 households on average. Immunization levels were also high, with children receiving an average of ten doses of OPV by 12 months of age in areas with intensive UNICEF support. Yet with 873 cases of polio in 2007 and 287 so far in 2008, India remains a focus on GPEI immunization efforts. However, only 5 cases of Type 1 virus have been reported in 2008 suggesting that India is proceeding towards its goal of eliminating Type 1 infections this year.  To ensure success, India’s Expert Advisory Group (IEAG) recommends that communication play a key role in the efforts to mop up any Type 1 infection occurring outside the endemic stats. 

Nationwide Efforts
The Indian government has approved and is implementing a revised communication review process. The new system will take a longer and more detailed look at specific issues in key geographic areas where polio transmission remains a high risk. The new approach is expected to produce more specific recommendations to guide the communication effort in achieving the goals set for this year. Targets vary from region to region but focus on themes such as: missed children, the use of influencers, immunisation resistance, getting newborns immunized, and team performance.

The government has also changed its immunization policy in regards to The Haj, the annual pilgrimage to the Holy City of Mecca. Receiving OPV vaccination is now a required part of the application process. Expectations are that the vaccination programme will reach many senior Muslim leaders for the first time and have an opportunity to discuss the benefits of the immunization with them.  By late March in Uttar Pradesh, 27,000 out of an estimated 50,000 applicants had already been vaccinated, up from 23,000 for the entire process last year.

Uttar Pradesh
The state of Uttar Pradesh reported its first case of Type 1 virus in May. This was the first case in eighteen months and the IEAG has recommended a high concentration of mop up vaccinations in the state to ensure that they eliminate Type 1 virus. To achieve the goal, work plans will now focus on the sub-regional level and set quarterly goals. This should enable SMNet to better monitor progress and strengthen the efforts to work with influencers, reach newborns and reduce the number of missed households.

The state is also testing sub-regional media plans in the Agra region of Uttar Pradesh.  Local cable television ads with be coordinated with radio spots and newspaper ads. The shift reflects the new emphasis on sub-regional planning and allows for a targeted messaging campaign that addresses region-specific concerns. It has the added benefit on not spreading the message beyond the coverage area of the NID and avoids the heavy costs of a national ad campaign.

Despite concentrated effort in the state, Type 1 virus transmission is likely to continue in high risk areas. Geography and climate comprise unique challenges to the polio eradication program in the river basin. The swelling of the regions numerous rivers can disrupt life in region especially during monsoon season, reducing the access of vaccinators and giving the virus a chance to multiply.  Approximately 200 community organizers (CMCs) are being recruited before the rains come, and UNICEF is constructing micro-plans to handle the challenges of isolated populations and shifting terrain. The CMCs will mobilize local support for the programme and help ensure that households and settlements are listed in the micro-plans.

Communications efforts are also focusing on the reducing the growing number of refusals in a few areas. The number of refusals is actually quite low, less than 1%, nonetheless, village-based community organizers are carrying out an “underserved strategy” that directly engage poor and marginalized Hindu and Muslims families to address any concerns about vaccination.  These efforts have been supplemented by Mosque announcements and a series or iztemas (women’s meetings where religious instruction is given by women.)  Evidences suggest that the strategy is working as refusals have dropped from 1,400 in January to 771 by March.

West Bengal
Quick response to West Bengal’s 2002 outbreak lead to a correspondingly quick decline in the number of Type 1 cases, down from 48 to 0 three years later.  West Bengal was polio free for two years but when a case was reported in 2007 and two so far in 2008, the region reinvigorated its communication efforts.

The region has undergone numerous rounds of immunizations yet in each instance the number of missed households has risen. Even though the number of cases is low, the ongoing transmission suggests that children are being missed. Combined with the rising number of refusals, West Bengal presents a significant communication challenge for 2008.

Communication and social mobilization efforts are focusing on the Mahestala municipality. The local government is working to improve operations and is taking an active role in policy formation.  Experienced social mobilization organizations such as the Amanat Foundation have been brought in and community organizations such as Engio and Palli Unnayan Samiti are finding community organizers. Rotary International and UNICEF’s ongoing communication efforts have been bolstered by the addition of local cable television messaging. The increased attention on the region is expected to positively impact both the coverage and refusal rates.



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2007 India polio communication review

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