Post on 19-Dec-2014
description
Purple Pinkies
Dr. Roma Solomon, DirectorMr. Manojkumar Choudhury, M & E Officer
CORE Group Polio Project India
CORE Group Spring Meeting 3 May , Wilmington, DE
Social Mobilisation for Hard to Reach Populations
• Brief introduction through narrative & slides• Role Play• How we reach the unreached• Using LQAS for improving social mobilisation
activities• Short film – ‘A drop of dialogue’
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Polio
case
s (th
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Polio Eradication: Historical Context
19882008
Last type 2 polio in the world in India
2012: 14
Monovalent 1 & 3 Bivalent
Progress in Polio Eradication1988 – 2012
2009
Source: WHO 17 04 2012
1988
125 endemic countries 1000 cases per day 350,000 cases per year
20101292 cases -20% reduction since 2009; 99% reduction since 1988
Type 1
Type 3 4 endemic countries(India, Nigeria, Pakistan, Afghanistan)
1604 cases/year
201246 cases; 43 in endemic & 3 in non-endemic countries
THE CORE GROUP POLIO
PROJECTINDIA
1999 - 2012
IMAGINE THE
• 394 million people live in U.P., Bihar & W. Bengal• 500,000 children are born every month in U.P and Bihar • 2.3 million vaccinators used in one National Immunization Day• 500,000+ vaccinators cover about 45 million children in each SNID• 900 million doses of OPV were used in 2011• 9,125 community mobilisers visit over 3 million families each
month in the three states• In 2011, the SM Net tracked 30,000 migrant families and helped
vaccinate 1,814,266 children on the move in transit and border areas.
Field OperationsSmall mop-up in India
4,200,000 children under age 5280,000 vials of vaccine
50,000 square miles37,000 vaccinators4,000 supervisors2,500 mobilizers2,000 vehicles
18,000 vaccine carriers/ice/markers/chalk/tally sheets
3 days
Two National Immunization Days (Booth-based)
Much fanfare in a campaign mode
172 million children under 5 immunized in every NID
But
More than 15% children continued to be missed in every Round…
1999 House to House
strategy introduced
Stiff resistance
encountered
Community Resistance grew in W. Uttar Pradesh, 2001
Communities believed that…o Polio immunization led to impotencyo It was a family planning program o Different color of polio vaccines were
used for different communities
Hindu and Muslim mothers in Western U.P. felt strongly that polio program targets a specific community
Muslim mothers reported the
highest rates of hearing
rumours/concerns about OPV(Unicef KAP study)
Shift from extensive mass awareness approach to
addressing specific conditions/needs of
specific groups
Communication response initiated
CORE volunteersfrom schools, nursing schools & NGOs in High
risk areas of Uttar Pradesh tackled resistance to OPV
Increase in female vaccinators
Community Mobilisation Coordinators (CMCs) were Born
• Selected from the same communities
• To overcome resistance and
• Sustain community participation for polio eradication and routine immunization
Unicef & CORE set up the Social Mobilisation Network in Uttar Pradesh, deploying hundreds of CMCs in High risk
areas to tackle resistance
Each CMC covers 400-500 houses
Focus on skill building of
communicators(CMCs &
Vaccinators)
Analysed ‘Resistance' to develop ‘Negotiation' strategies
Shift from instructive to negotiation approach
Shift to localised mobilisation activities
• Government mobilization– Formation of district core groups on polio & RI– Involvement of other departments like education,
women & child welfare, etc.• Religious and opinion leaders’ mobilization
– Regular and continuous meetings – Izthema meetings (Meetings of Muslim ladies)
• Targeted IPC & mother/influencer meetings with resistant families/pockets
Hard to Reach??
How Do We Reach?Let me count the ways…………….
CMCs visit each pregnant woman and give Congratulation Card after child birth
By focused IPC for Communities
Mapping & RegistersProviding Immunization status of each child to
vaccination teams
CMCs track polio immunization status of children under 5 years
Health Camps
Children's Rallies
1. Greater involvement of religious leaders 2. Formation of state ulemas committee3. Appeals from religious institutions and leaders
9 million people exposed to polio messages during religious congregations in 2010
Billboards, posters, etcfor brick kilns, construction sites, & transit teams
Wherever you go, make sure
your child receives OPV
Snakes and Ladder Game
Message booklet
Flip book
Flash Cards
StreamerFlash Cards
Leaflets on Diarrhea Management and Routine Immunization
• Booth day– Bulawwa toli – child mobilisers– Decorated polio booths inaugurated by local
influencers– Visit to X houses
2009
Who was sustaining transmission?
Very young: Definitely
Migrants: Yes
Older children: Maybe(?)
Status of Wild Poliovirus Cases – UP Year 2009*
* data as on 19th Jun 2009
75% cases below 2
yrs of age
Emphasis on Birth Dose
Migrants1. Brick Kilns
Children of parents working in brick kilns
2. Construction sites
Children of parents working on construction sites
3. Slums
Migrants in urban/peri-urban slums
4. NomadsCommunities who travel from place to place for
livelihood, setting up temporary homes on empty tracts of land near railway stations, market places, etc.
Often work as blacksmiths, basket weavers, puppeteers,
acrobats, fortune-tellers, singers and dancers.
CMCs conduct special IPC sessions with migrant families on the importance of polio & routine immunization
Barbers, shopkeepers, etc. engaged as informers on migrant groups
More than 4000
informers enrolled
Soap strips distributed to promote hand washing behavior
2010
80% polio cases contributed by only 2% (107) of India’s
blocks
Revised Communication Package for Polio Developed
Revised Communication Package for the very High Risk Blocks
Get 2 drops of OPV + polio
plus messages
% Resistant Houses (XR) in UP - CMC areas
2007- 2011
Source:Tallysheet
Mapping for MonitoringRelevance and Use
•Lack of detailed maps in rural & urban areas•Need to map growth momentum•Desire of wider audience to view the location and data concurrently
CORE Work Area Map of Ward 46, Howrah, W.BengalBooth Locations
Web based Booth-specific Information
25th Feb. 2012 India declared Non-endemic
country
2011 Rukhsar from
W. Bengal, the only case
Each child receiving polio drops gets the
left pinky marked with
purple indelible ink