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Polio Communications Update Sept 2011
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Transcript of Polio Communications Update Sept 2011
8/4/2019 Polio Communications Update Sept 2011
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CommunicationsQuarterly Update
Report to the Independent Monitoring Board September 2011
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Contents
1 Overview
13 CountryUpdates
14 Afghanistan
18 India
21 Nigeria
25 Pakistan
30 Angola
33 Chad
37 Democratic Republic of the Congo
41 PolioCommunicationsData Proles
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o v e r v i e w P O I O C O M M U I C I O S Q U R R U P D S P M B R 2 0 1 1
In our last report we described the
unprecedented scale-up of communi-
cation and social mobilization pro-
grammes for polio eradication in the
priority polio affected countries. This
build-up has continued throughout
the year, with the settling in of newstaff, and a growing maturity of social
mobilization processes and systems
operating on the ground, particularly in
high-risk areas.
Tracking of global communication
indicators is pointing to encouraging
signs of progress in some areas, particu-
larly in countries like DR Congo and
Chad. At the same time, and in spite
of tireless efforts from those on theground, there remain major challenges
in Pakistan. Despite commitment from
the very highest levels of government,
the country is still struggling to bring
the current outbreak under control.
Recent events also present risks to the
programme. The tragic attack on the
United Nations Headquarters in Abuja
in late August resulted in a senseless
loss of life, and is a bitter reminder of
the sacrice colleagues make in the
ght to eradicate polio. Both UNICEF
and WHO teams are mourning the loss
of valued colleagues and friends, but
remain undeterred in their commit-
ment to make Nigeria, and the world,
polio free. Signicant security concerns
remain, and it is not yet clear what
impact this will have on the programme
in the coming months.
In addition, new outbreaks in Kenya
and China underscore the level of threat
that faces polio-free countries as long
as transmission is not interrupted in all
viral reservoirs. With the 2012 target
date rapidly approaching, the need to
redouble our efforts has never been
greater. But signs of success are on the
School children rally behind polio eradicationin western Uttar Pradesh, India.
U n I C e F / I n D I a 2 0 1 0 / G U R I n D e R O S a n
“he success of a diseaseeradication initiative... is
largely dependent on thelevel of societal and political
commitment to it from thebeginning to the end.”
Walter R. Dowdle, The Principles of Disease Elimination and Eradication
Overview
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2 S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D o v e r v i e w
horizon. Indicators are showing
encouraging progress in India.
Seven months since the last reported
polio case, the question of how
India can sustain motivation and
commitment within the programme
becomes a critical one.
he importanceof social data
The July report of the Independent
Monitoring Board (IMB) reinforced
the importance of social data to
guide programmes if we are to build
active demand for for oral polio
vaccine (OPV). UNICEF has used this
recommendation to engage with WHO
and other partners in advocating for the
need for a core set of social indicators.
The process of revising independent
monitoring forms is underway in some
countries, but stronger data analysis
and dissemination of results is urgently needed. DR Congo and Afghanistan
have demonstrated how important this
data can be to guide programmes. Based
on a new understanding of campaign
awareness and sources of polio informa-
tion, both countries have been able to
revise their media strategies accordingly
and monitor their impact.
i n t r o d u c i n g P o L i o i n F o
A specialized website – PolioInfo – has been developed to share and
disseminate communication data, together with stories from the eld,
which demonstrate the impacts of social commitment on eradication efforts.
The website includes downloadable quarterl data proles contained in
this report, as well as an interactive data dashboard that presents the
Global Indicators with greater geographic disaggregation.
Also on the site is a sample of communication materials used to motivate
and engage parents for OPV vaccination from the priorit countries.
Stories from the Field show the human face of the communication data.
For example, how do social mobilizers ensure adequate knowledge of campaigns, or what does it mean to persuade a parent
who is resisting the vaccine?
The site will continue to be developed in the coming months, and we will update the partners and the IMB on its progress.
Please visit: http://www.polioinfo.org.
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o v e r v i e w P O I O C O M M U I C I O S Q U R R U P D S P M B R 2 0 1 1
g L o B A L c o M M u n i c A t i o n i n d i c A t o r S
The GPEI Communication Indicators are designed to help ke stakeholders assess and monitor progress towards milestones
outlined in the 2010-2012 Strategic Plan. The provide insights into how well the high risk countries are performing in the
areas of communications and social mobilization, measuring performance against a core set of indicators and targets. A pro-
gramme’s abilit to collect and report on standard communications data is ke to help guide or rene operational strategies,
and to ensure that minimum standards are met.Finall, but no less important, is the caveat that despite well-dened indicator outcomes and targets, determinations of risk
have a subjective component that permits judgment of overall risk. Despite meeting a milestone, work ma still remain to
meet the needs of the countr-specic context; classication of risk has therefore been determined using both a quantitative
as well as a qualitative lens.
g P e i g L o B A L c o M M u n i c A t i o n i n d i c A t o r S A n d tA r g e t S
INDICATORS By CATEGORy TARGET AND RIS ASSESSMENT
M a n a
g e m e n t Polio communication staff
are in place at country levelLow
> 90% occupancy of designated GPI communication posts at the point of eachreporting period
Polio communication staff
are in place at eld level
Moderate70%–90% occupancy of designated GPI communication posts at the point of
each reporting period
High< 70% occupancy of designated GPI communication posts at the point of eachreporting period
P r o c e s s
Social mobilization fundsare available in high risk areasbefore SI’s
Low95% of HR areas receive 100% of approved funding prior to the SI for the pastthree SIs
Moderate85-94% of HR areas receive 100% of approved funding prior to the SI for thepast three SIs
High< 85% of HR areas receive 100% of approved funding prior to the SI for thepast three SIs
Social data is systematically usedfor communication planning Low
90% of plans nationally and in HR areas reect social data based on self-reportingand spot checking. Social data is utilized consistently in planning based on regu-lar coordination meetings and data reected in minutes.
Moderate75-89% of HR areas with communication data reported/presented bycommunication planning team to local polio planning body before the next
SI reported for the past three SIs
High< 75% of HR areas with communication data reported/presented bycommunication planning team to local polio planning body before the nextSI reported for the past three SIs
O u t c
o m e
Proportion of missed childrendue to refusal to vaccinate
LowDownward trends in refusal to vaccinate nationally and in HR areas for all SIs held inthe past 6 months, or less than 8% of all missed children nationally
ModerateStable trends in refusal to vaccinate nationally or in HR areas for all SIs held inthe past 6 months, if percentage is over 2% of the national target population, oraccounts for more 8-10% of missed children
HighIncreasing trends in refusal to vaccinate nationally or in HR areas for all SIs heldin the past 6 months, or if percentage is over 10% of missed children
Percentage of caregiversaware of polio campaigns
Low> 90% or higher awareness levels of caregivers nationally and >80% awarenessin high risk areas prior to arrival of vaccinators
Moderate 80%–90% awareness levels of caregivers nationally and >70% awareness inhigh risk areas prior to arrival of vaccinators
High< 80% awareness levels of caregivers nationally and >70% awareness ofhigh risk areas prior to arrival of vaccinators
Main source of informationon polio campaigns
Lowational and local level data for reported source of information reects overallstrategic focus
ModerateData trends among populations in HR areas do not reect higher levels of inter-personal sources than the national level data
HighReported source of information does not reect national strategy, and high risk popu-lations do not report at least 30% having been reached by an interpersonal source
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4 S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D o v e r v i e w
During this quarter there has been
stronger engagement from all countries
on the way they report on the com-
munication indicators to the global
level. However, the use of both social
and epidemiological data continues
to be limited at national and sub-national levels. Encouraging progress
should, however, be noted from DR
Congo. A study is currently underway
to help unpack the reasons why
children continue to be missed during
supplementary immunization activities
(SIAs). Insights already gained from
the Independent Monitoring data
are helping to tailor communica-
tion strategies much more closely to
the needs at the local level. The main
challenge in DR Congo continues to
be the logistical challenges of reachingcommunities in a country with limited
infrastructure. As in the case of Chad
which faces similar challenges, funding
is urgently being sought to scale up
human and operational resources on
the communications side.
MobilizingdemandThe IMB also pointed to the need to
create more ‘pull’ for the programme,
by mobilizing genuine community
demand. Nowhere is this more of a
concern than in the twelve High Risk
States of Northern Nigeria, where
social commitment to polio eradication
remains fragile at best. However, as part
of the Intensied Ward Communication
c o M M u n i t y e n g A g e M e n t
M o B i L i z e S S u P P o r t F o r o P v
Communit-level engagement is beginning to show results.
In the Pakistani cit of arachi, over 350 communit mobilizers were
hired to build communit support for OPV in the ve highest risk
towns: Gadap, Orangi, SITE, Gulshan and Saddar.
Over 80,000 high risk families were engaged through a local NGO
(RSPN), and the proportion of refusals is starting to go down in
some high risk towns. In SITE, for example the proportion of children
missed due to refusals decreased from 16% to 12% from Ma to
Jul 2011.
A promising partnership with the ver inuential Mulana Fazl ur
Rehman, Chief of the Jamiat Ulmae-Islam (JUI), has been initiated
b the Polio Control Cell in September. The Mulana has offered hispersonal support to promote the importance of OPV through a
wide arra of communication channels carring his endorsement
for OPV. This builds on an existing partnership established in FATA
and P and is a ver promising and critical start to expanding local
support for the programme among high risk communities.
In Sokoto State of Northern Nigeria, the programme is piloting
several ‘bottom-up’ approaches to mobilization. This will comple-
ment the ‘top-down’ messaging from religious leaders that has
been successful, but insufcient for building lasting social com-
mitment. Several approaches are being piloted. ‘Makwabci to
Makwabci’ (‘Neighbour to Neighbour’), relies on a volunteer corps
of villagers to inform neighbours of the need to be vaccinated.
Household Adoption (HHA) assigns commissioned volunteers 25-50households to ‘adopt’, and these volunteers track and record vacci-
nation rates for all individuals, particularl children, residing in those
homes. MODIBO is a faith-based women’s association in Sokoto
state whose members conduct sensitization and compound meet-
ings with women during social events, such as naming and
wedding ceremonies.
These are just a few of the innovative initiatives being explored to
create more ‘pull’ for OPV.
group of mobilizers among the 359newly recruited workers in Karachi,
conducting house to house visits.85,556 high risk households inKarachi’s highest risk towns wereengaged during the June campaign.
UICF/PK2011/HDROV
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o v e r v i e w P O I O C O M M U I C I O S Q U R R U P D S P M B R 2 0 1 1
Strategy or IWCS, some promising
innovations are underway to engage
communities in Sokoto, Kebbi and
Zamfara States. By signing up young
people, respected female elders, as well
as a ‘Neighbour to Neighbour’ approach
we are moving away from an authori-tarian ‘top-down’ approach in favour
of building a movement of grassroots
community demand.
An interesting variation of this has
been formulated in India, with the new
media campaign making a strategic
shift away from the somewhat distant
and directive call to take national
action, towards a compelling movement
urging parents to take personal respon-sibility for vaccinating their own
children. Evidence from pre-testing
indicates that this has the potential to
drive much greater community demand
for reaching the goal of eradication.
Going to scaleInnovations like the ‘Neighbour
to Neighbour’ approach, whilst
encouraging, are still far from being
undertaken at scale. One reason is
simply a question of resources – both
human and nancial. Building intensive
communication and social mobiliza-
tion programmes in these challenging
countries, and working with high risk
marginalized communities is neither
simple nor cheap. However, as the IMB
itself has pointed out, past setbacks
to polio eradication, resulting fromcommunities pushing back against the
programme, have been memorable
as well as costly. They still have the
potential to derail the programme if
not proactively addressed.
In its April report, the IMB also noted
that non-endemic countries should be
placed on the same footing as endemic
countries. This will require substantial
investment and resources, as well as
some patience to bring these nascent
programmes to the same level of
sophistication that has yielded success
in some of the endemic countries andthe now polio-free countries.
Insufcient resources present risks in
DR Congo, Nigeria and Chad in particu-
lar. To accelerate response to on-going
outbreaks, further scale-up is currently
being planned in these three countries.
Scaling-up the communications and
social mobilization programme has
reached a critical point where it is hoped
that partners will now cement their com-mitment, by maintaining, and in some
cases even increasing their nancial
investments in these programmes.
Questions of trustA number of worrying polio-related
stories emerged in both global and local
media during this quarter. These have
the potential to derail public trust in
the eradication programme. The rst
of these was a story in the UK Guardian
newspaper linking clandestine CIA
operations in Pakistan to a fake public
vaccination campaign. Although not
initially linked to polio, it did not take
long to make the connection, and was
fuelled by numerous blog sites that made
the story run for longer than initially
expected. Fortunately, the coverage does
not seem to have impacted the July NID,but the long-term impact in Pakistan
and further aeld will only become
evident in the coming months.
A second issue that emerged rst in
Nigeria, and more recently in Pakistan,
is local ofcials threatening to arrest
parents who refuse to vaccinate their
on-endemiccountries shouldbe placed on thesame footing asendemic coun-tries. his will
require substan-tial investmentand resources,as well as somepatience to bringthese nascentprogrammes
to the level ofsophisticationthat has yieldedsuccess in someof the endemiccountries andthe now polio-
free countries.
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6 S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D o v e r v i e w
children. Whilst achieving vaccina-
tion by threat or force might be seen
by some to be an appropriate
response in the midst of a public
health emergency, experience shows
that a failure to secure local buy-in
and commitment can risk alienatingparents further, increasing the
negative response to the programme.
Media reports such as these are
monitored very closely, and
teams work hard to fashion an
appropriate response. In the case of
the CIA story the chosen approach
was to be well-prepared with
positions, responses, and staff
training tools, but not to respondunless faced with direct questions.
In the case of the jail stories there is a
need to engage with the appropriate
authorities on the ground, making a
strong case for positive rather than
negative interventions.
From macroto microOne of the more challenging IMB
recommendations made in the last
quarter was the call for UNICEF to
pilot and implement a tool to identify,
record, and locally disseminate effective
micro-innovations. Whilst we under-
stand the wisdom of this recommenda-
tion, the practicality of implementing
this globally in the coming months
is less clear. It is becoming clear that
implementing this recommendation
at scale will take time and effort and
results will not be obvious in the near
term. However, we will continue to
explore the idea of developing a more
systematic approach to learning and
sharing micro-lessons from the eld
(see box) as we go forward.
‘ M i c r o B e h A v i o u r S ’ i n n o r t h e r n n i g e r i A
A r e k e y t o B u i L d i n g S o c i A L c o M M i t M e n t
Our understanding of local communities in Nigeria is improving. To help us
learn more about how to talk more meaningfull with mothers, fathers and
village elders, UNICEF Nigeria collects examples of successful micro-behav-
iours from those who work with households on a dail basis.
These micro-behaviours are being compiled into a practical guide that eld
workers can use to strengthen their interpersonal communication skills when
engaging with families. Some examples from Sokoto State:
• “Breaking cola nuts in most parts of Northern Nigeria is an acceptable
code that sparks discussion among adults. When ou share cola nuts,
most people will accept this with positive gratitude, and discussion
can continue.”
• “In most places, radio helps us to stimulate discussion. Therefore, the
use of local FM/AM radio is useful as the attention of the care giver is
captured and discussion usuall starts with the local news before coming
down to polio issues.”
• “If the women are pounding millet, I will sa jokingl that I have come to
help them pound toda. Then I will quickl collect the pestle from one of
them and pound for some time. Women start laughing as the wa I am
pounding is not as effective as theirs.”
• “If the household is refusing because the children ran awa as soon as
the heard me saing ‘salamualaikum’, I will start calling them with a
Hausa name: ‘Aisha’, ‘Babale’, etc. The parents will start laughing, because
I don’t know their names. B naming them correctl this opens room for
discussion that helps me persuade them to accept OPV.”
• “Joking with grandparents is another strateg I use in the communities.
I usuall identif the most elderl person among the group. In a village
square ou nd that people sit in front of a house or a mosque. Crackinga joke with the senior elder brings about acceptance amongst his adult
peers. I normall ask him to come and do wrestling or a race with me and
he will laugh at me and repl: ‘I am old; I can’t wrestle or run.’”
U n I C e F n I G e R I a / 2 0 1 1 / M O R G a n
Facilitators lead a discussion followinga ‘Majigi’ lm screening for women inSokoto State, orthern igeria.
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Why are wemissing children?
Pockets of refusal
Parents’ refusal to vaccinate their
children is not the main reason formissing children in any of the high
priority countries. However, in Nigeria,
DR Congo and parts of Pakistan,
refusals contribute substantially to the
reasons for missed children. In Nigeria,
one quarter of missed children are due
to refusals, and rising in some high
risk areas to over 30%. Although there
are some concerns with the validity of LQAS to assess reasons for missed
children, the data shows refusals
contributing even more substantially
in some areas. In Kano, Sokoto and
Jigawa, refusals reached up to 90%
of missed children in some instances.
In DR Congo, refusals contribute to
13% of missed children nationally,
rising to over 20% in some provinces.Initial analysis in some of the highest
risk health zones has shown that most
PercentAge oF MiSSed chiLdren due to reFuSAL, JuLy 2011
Source: Independent Monitoring data
10.1 – 11.0
Missing value
1.0 – 8.0
8.1 – 10.0
PercentAge oF MiSSed chiLdren due to SociAL reASonS, JuLy 2011
Source: Independent Monitoring data
10.1 – 11.0
Missing value
1.0 – 8.0
8.1 – 10.0
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8 S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D o v e r v i e w
parents refuse OPV due to religious
reasons, because they think the vaccine
is ‘dangerous’, or because the main
decision maker is not at home when
vaccination teams visit.
Pakistan is showing rising pockets of
refusals each month in Balochistan and
Karachi. In July, Balochistan saw thelargest opposition to polio vaccination
in absolute numbers in over 2 years:
14,645 children were missed because
their parents refused the vaccine.
Forty-six percent of Baluchistan’s polio
cases now come from families resisting
the vaccine. The highest concentrations
remain in Karachi, with 22,000 families
rejecting vaccination during SIAs in July.
Refusals in Karachi emerge both from
relatively afuent families who prefer tovaccinate their children through private
clinics, as well as from the Pashtun com-
munities, from which all of Karachi’s
polio cases this year have come.
Four among the 13 high risk districts
in Afghanistan have shown persis-
tent refusal rates throughout the year,
almost triple the regional average of
4.7%. These are Spin Boldak, Musaqala,
Shahid Hassas, and Shawalikot.
Unpacking the data further
When refusals are combined with other
demand-driven barriers to vaccination,
social reasons appear to be responsible
for a greater proportion of missed
children in most countries.
In Afghanistan, while refusals have
accounted for about 5% of all missed
children in the high risk districts since
January, children missed because
they were newborn, sleeping or sick
accounted for approximately 22% of
missed children in the July campaign.
Therefore together with refusals, about
27% of missed children in Afghanistanare missed for social reasons.
In West Bengal State in India, refusals
as a proportion of missed children
remain at their annual average of 6%,
though they have come down from
the 9% spike observed in May. When
combined with the proportion of
children missed because they were
sick at the time of the campaign, these
categories accounted for 18% of missed
children in May.
In Chad, initial qualitative study results
indicate that some children reported as
‘child absent’ in monitoring forms could
actually be hidden by their parents inorder to avoid vaccination. Another
assessment conducted last quarter in
Logone Occidental showed that among
those children who are a not at home
during campaigns, a large proportion is
because their parents are not convinced
about the importance of immunization
and send children out to play when vac-
cination teams are due to arrive.
We need to better understand the
local reasons why children are absent
during campaigns, and do a better job
of distinguishing between operational
operational and social issues in our
monitoring categories. In Chad, which
has the highest rate of missed children
among the priority countries, 55% of
missed children nationally are due to
Particularly urgentis the need to digdeeper into the‘other’ category formissed children inthe independentmonitoring forms.
boy carries a toddler and polio awareness agsthrough a street in Pakbara own in Uttar Pradesh.
UICF/HQ2006-2644/PIRSIK
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o v e r v i e w P O I O C O M M U I C I O S Q U R R U P D S P M B R 2 0 1 1
‘child absent’. Without fully under-
standing what this means, it makes it
difcult to choose the most appropriate
communication intervention.
Understanding ‘other’
Particularly urgent is the need to dig
deeper into the ‘other’ category for
missed children in the independent
monitoring forms. This catch-all
category is currently lumping together
a variety of reasons for missed children,
and limiting the programme’s under-
standing of why children are missed. It
is difcult to develop plans and take the
necessary corrective action when the
problem has not been identied.
A more detailed breakdown explain-
ing what ‘other’ reasons could be is
included in some monitoring sheets.
However, this level of detailed analysis
is not disseminated to programme
managers who develop the operational
and communication plans to address
reasons for missed children.
In some countries, like DR Congo,
‘other reasons’ have accounted for anunacceptable proportion of missed
children (up to 50%), meaning we are
not adequately identifying the causes,
and therefore solutions, that can help
us to reach these large numbers of
missed children.
Similarly, in Angola, ‘other’ reasons
accounted for 36% of all missed
children in May, and 33% throughout
the year on average. Included in this
category are children missed because
they were sick at the time of the vac-
cination campaign, as well as children
missed because the ‘mother was not
aware of the campaign’. This is a mis-
leading classication, since a mother’s
lack of awareness does not fully explain
why the child was missed.
We therefore reinforce our request to
partners and relevant stakeholders to
consider how monitoring forms can be
expanded or revised to better explain
the additional reasons why children are
missed. Work has begun in this area
in many countries, but it has not yet
translated into stronger analysis, dis-
semination, and use of data for decision
making in most contexts. In Pakistan,
for example, the ‘child not available’
category has been better dened in
monitoring forms to help distinguish
between social and operational reasons,
but this has not yet changed how the
data is analysed, interpreted and used.
To simplify this process, it is recom-
mended that LQAS data be used to
assess reasons for missed children, par-
ticularly in countries where it is already
being used to verify coverage.
Where ‘other reasons’ exceed a certain
threshold proportion of missed
children, we also suggest that partners
investigate to ensure that any identied
issues are addressed in the operational
planning for subsequent campaigns.
CampaignawarenessTrends in reaching parents with
information about campaign dates
and the importance of vaccination have
not changed much since last quarter.
Only India, Nigeria and DR Congo
have reached the optimal target of at
least 90% caregivers being aware of
polio campaigns.
Afghanistan and Pakistan remain
very low on the spectrum of campaign
awareness. It is more difcult for teams
to gain entry into households when
mothers are not aware of the campaign,
and are not expecting unknown visitors.
Higher campaign awareness, coupled
with the appropriate gender-balanced
teams, could have a substantial impact
in engaging with mothers in tradi-
tional communities. In Pakistan, data
on campaign awareness is not being
reported consistently by all provinces:
Khyber Pakhtunkhwa province has not
reported on this indicator in 2 years.
This is unacceptable, and monitoring
AverAge PercentAge oF cAregiverS AwAre oF
the PoLio cAMPAign, June–AuguSt 2011
Source: Independent Monitoring data
0%
20%
40%
60%
80%
100%
DR CongoChadAngolaPakistanNigeriaIndiaAfghanistan
[no data]
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1 0 S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D o v e r v i e w
forms submitted without complete
social and operational data should be
sent back for completion.
In Chad, campaign awareness during
this quarter, and throughout the
year, has been about 80% nationally.
But many areas with lower levels of
campaign awareness are the same areas
with higher percentages of missed
children. This explains, at least partly,
why children are missed, and why high
proportions of children are not at home
when vaccinators arrive.
In DR Congo, 13,000 social mobilizers
across the country travel to villages
on foot, announcing campaign dates
with megaphones. With only 5 daysto reach about 15 villages – some of
which are up to 30 km apart from
each other – the mobilizers have to
pass through the villages quickly with
little time for quality engagement with
communities. This explains the high
awareness levels, as well as the difculty
in translating this high awareness into
sustained community demand. Creating
genuine community demand for OPV
in DR Congo will require a substantial
reorganization of how mobilizers are
used and deployed.
Sources ofinformationIn many countries, communication
strategies are starting to show results.
An increasing proportion of parents
cite sources of information that have
been harnessed for strategic delivery
of messages about polio and polio
campaigns. In Angola, the main
sources of information are TV and
radio, reecting the relative investment
of resources in this area.
In F province of Pakistan, where
social mobilization through NGOs has
been increased, and radio messages
announcing polio campaigns have been
aired across the province, the majority
of people cite these two sources for
polio campaign information. Almost
50% of people in May credited social
mobilizers for informing them about
the polio campaign, up from just 4%
in the beginning of the year. Followingthe dissemination of radio spots, 40%
of parents now cite radio as a source of
information, an increase from 17% six
months ago.
Interpersonal communication as a
source of information continues to
show rising trends in Afghanistan
and Nigeria, particularly in high risk
areas with communication inputs. In
Afghanistan, for example, the areas
where civil society is working as part
of the Polio Communication Network
(PCN) show Imams as a source of infor-
mation. This was cited by 32% of the
population, compared to 16% in other
areas. The partners in Afghanistan have
made commendable progress since the
last quarter in including this indicator as
part of routine SIA monitoring, and in
using it to monitor progress of the PCN.
In DR Congo, although 64% of peopleon average cite social mobilizers as
their main1 source of information,
1 he monitoring question for thisindicator in DR Congo differs fromother countries, as data reects ‘mainsource of information’ here as op-posed to multiple sources of informa-tion collected in other countries.
interpersonal communication (IPC)
efforts need to be targeted more
substantively to addresses the highly
localized reasons for refusal to vaccinate.
Using data toguide community
actionTeams in the eld are starting to better
understand the need for localized data
collection, and how it should be used
to guide our interventions with com-
munities. More sophisticated analysis
is now starting to emerge. As teams
have had time to settle in and commis-
sion research, interesting insights are
being gained. While we believe that the
capacity is in place to collect and usesocial data, many country programmes
are just beginning to be more rmly
established, and will require still more
time to develop the necessary systems
to use data as a routine part of
programme planning.
The wording and meaning of this
indicator was revised during the last
quarter to reect the systematic use of
data for communication planning. Webelieve that this is a critical outcome
that could lead to real impact at the local
level, yet is so often the missing link.
A red mark here does not necessarily
indicate that data is not being used, or
that work is not underway. In Pakistan,
for example, one staff member and one
Afghanistan India Nigeria Pakistan Angola Chad DR Congo
Source oF inForMAtion FroM thoSe cAregiverS
who rePort hAving heArd Any cAMPAign MeSSAge
Afghanistan India Nigeria Pakistan Angola Chad DR Congo
SociAL dAtA iS SySteMAticALLy uSed
For coMMunicAtion PLAnning
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o v e r v i e w P O I O C O M M U I C I O S Q U R R U P D S P M B R 2 0 1 1
full-time consultant have been hired in
the last quarter to manage M&E and
research. These individuals are tasked
with identifying data gaps, developing
monitoring systems to assess the new
eld-based Communication Network
(COMNet), and commissioning socialresearch on high risk groups. However
this data is not yet being incorporated
fully into microplans. The high risk
rating here is an example of exactly how
critically the ratings have been assessed
across all the countries in this report.
In Nigeria, data is being used con-
sistently in areas where UNICEF-
supported social mobilization is
taking place. Nigeria’s evidence-based
approach to communications is one
of UNICEF’s strongest. However, just
as India received a ‘moderate’ risk for
this indicator during the last quarter in
spite of setting exemplary standards in
this area, we believe there is still room
for improvement.
Capacity
All polio-affected countries have nowfully recruited the staff members that
were identied last year as critical to
the programme. Many of the priority
countries continue to face human
resource challenges in the context of
overwhelming needs. For example, while
DR Congo has recruited 7 UNICEF
communications staff in Kinshasa and
provinces this year, this is only half the
number of people required to do the
job. Similarly in Pakistan, recruiting thenew army of human resources required
for the programme has been a massive
undertaking, and is not yet complete.
Determining where best to deploy
eld staff, and how to ensure they can
be moved to critical priority areas is
vital. In Afghanistan, for example, the
traditional leader inorthern igeria vaccinates
a child with OPV.
U n I C e F / n I G e R I a / 2 0 1 1 / M O R G a n
Communication strategies in manycountries are starting to showresults. Increasing proportionsof parents cite sources of informa-tion that have been harnessed
for delivering polio messages.Interpersonal communicationcontinues to show rising trends,especially in high risk areas withintensive communication support.
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1 2 S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D o v e r v i e w
Polio Communication Network covers
only 24% of the clusters in the high
risk districts. Within high risk districts
where the PCN does exist, the criteria
for deployment are not yet clear. In
Pakistan, the partnership is struggling
to dene common criteria for deploy-ment of the limited operational and
communication staff in the highest
risk Union Councils. Similar challenges
exist in Nigeria, where, due to shifts in
social trends, UNICEF consultants are
no longer working in the areas with the
most communication challenges. While
the priority is to ensure the limited
resources we have are deployed most
strategically, additional resources are
still required to cover high risk areas atthe appropriate scale.
FundingReporting on nancial resources has
improved over the past quarter in all
countries except Angola, where no
data is available as the government is
funding polio communication inter-
ventions at the local level. In general,
campaigns are being supported by
communication interventions in allcountries, but serious concerns are
agged in Pakistan where still, only
40% of High Risk Areas receive funds
on time. This is a difcult indicator to
track, as although some countries show
100% disbursement gures, nancial
systems do not enable us to track funds
all the way down to implementation
level. Therefore nancial monitoring
gures may conceal eld realities.
The following country updates and data
proles provide the substantive detail and
data analysis that has been summarized in
this Overview section of the report.
Afghanistan India Nigeria Pakistan Angola Chad DR Congo
PoLio coMMunicAtionS StAFF Are in PLAce At country LeveL
Afghanistan India Nigeria Pakistan Angola Chad DR Congo
PoLio coMMunicAtionS StAFF Are in PLAce At FieLd LeveL
Afghanistan India Nigeria Pakistan Angola Chad DR Congo
PercentAge oF high riSk AreAS thAt receive tiMeLy
coMMunicAtionS/SociAL MoBiLizAtion Funding
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Country Updates
U n I C e F / n y H Q 2 0 0 6 - 2 8 9 1 / P I R O z z I
community educator speaksto women in Kueke Village,south of ’Djamena, Chad.
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1 4 S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D A F g h A n i S t A n
The conTexT
z Afghanistan has reported 27
wild poliovirus cases so far in
2011, compared to 14 cases
during the same time last ear.
z andahar, Nada Ali andMusaqala districts, in the high
risk area of the Southern Region,
account for 44% of all cases
z Short interval additional doses
(SIAD) rounds have been taking
place with good results, though
communication strategies are
not et implemented according
to the SIAD guidelines.
z
Over a quarter of missedchildren in Afghanistan are
missed due to social reasons:
either because parents activel
resist OPV, or because the
are not aware of the need to
vaccinate children who are sick,
sleeping, or newborn.
Spotlight onmissed childrenDespite an increase in security incidents
in the Southern Region, the programme
has been able to keep the percentage of
inaccessible children to less than 10%
in 3 out of 5 rounds in 2011. However
the programme only managed to obtain
90% vaccination coverage of acces-
sible children in 6 of the 13 High Risk
Districts in July.
A few districts continue to demonstrate
extremely low levels of coverage, even
in accessible areas. Shawalikot has been
missing over 20% of children since
January, with the gure reaching 32%
in July. Coverage in Dehrawod has
been slowly slipping throughout the
year, with the proportion of missed
Four of fghanistan’s13 highest risk districts
show rates of refusalalmost triple the averagefor the Southern Region.
his urgently needs to be
understood and addressed.
fghanistan
fghan female health worker marks a wall of a house ina SID door to door campaign in the city of Jalalabad.
U n I C e F / a F G a 2 0 1 1 - 0 0 0 1 2 / J a l a l I
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A F g h A n i S t A n P O I O C O M M U I C I O S Q U R R U P D S P M B R 2 0 1 1
children rising every month, from 10%
in January to 19% in July. Conversely,
Shahid Hassas has shown consistent
and dramatic improvement in coverage,
with a reduction of missed children
from 40% in January to 12% in July.
Why are wemissing children?
1
Approximately 50% of children in
Afghanistan are missed due to ‘child
not available’. This data needs to be
unpacked further to understand
exactly where children are when
vaccination teams arrive. Given the
security situation, it is unlikely that
such young children have gone too far
without their mother. If children are in
madrasas or religious schools, vaccina-
tion opportunities in these insitutions
should be explored.
In Kandahar, an accessible district
responsible for 5 of Afghanistan’s cases
this year, 63% of missed children in July
were missed due to ‘child not available’.
This represents an improvement from73% in May, but it is still an excessively
high proportion unless we are sure that
these children are being vaccinated
elsewhere. In Sangin district, indepen-
dent monitoring cites only two reasons
for missing children for almost the
entire year: either the child was
not available or the child was sick,
newborn, or sleeping. This strange
trend should signal an alarm to
programme managers to conduct
further investigation, both to verify
the quality of the collected data and to
understand what is really going on.
1 ll data on reasons for missedchildren is a proportion of totalmissed children.
Pockets of active refusal
In the highest risk districts of the
Southern Region, the proportion of
children missed due to resistance has
decreased slightly since the beginning of
the year, from 5.3% in January to 4.7%
in July. However, four districts among
the 13 highest risk – Spin Boldak,
Shawalikot, Musaqala, and Shahid
Hassas – have shown rates of refusal far
above the collective average of 4.7%.
In some months, rates of refusal here
have tripled the regional average. These
trends have persisted throughout the
year and urgently need to be under-
stood and addressed.
PercentAge oF MiSSed chiLdren in AFghAniStAn,
JAnuAry–JuLy 2011
Source: Independent Monitoring data
0%
10%
20%
30%
40%
50%
JulyJuneMayMarchJan
Shadid Hassas
Shawalikot
Dehrawod
PercentAge oF MiSSed chiLdren due to reFuSAL in 4
higheSt riSk AFghAniStAn diStrictS, JAnuAry–JuLy 2011
Source: Independent Monitoring data
0%
5%
10%
15%
20%
25%
JulyJuneMayMarchJan
Shahid Hassas
Musaqala
Shwalikot
Spin BoldakAverage percentage of missed
children due to refusal in the
13 high risk districts
4.73%
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1 6 S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D A F g h A n i S t A n
Additional social reasons
Over the last 7 months, concerns that a
child is newborn, sleeping or sick have
accounted for about 22% of missedchildren. Combined with the data on
active refusals, such socio-cultural
reasons are accounting for a quarter
of missed children in the 13 High Risk
Districts of the Southern Region.
Limited knowledge about polio,
coupled with the belief that polio is
curable 2, could explain why caregiv-
ers are so reluctant to wake a sleeping
child for vaccination. Tradition-bound
families also believe that babies shouldnot be exposed to the outdoors before
their 40th day of life. This makes it
difcult to vaccinate newborns without
gaining access into the house, which is
almost impossible for all-male vaccina-
tion teams. This highlights the impor-
tance of ensuring that there are female
vaccinators on every team.
Developing appropriate strategies to
address socio-cultural concerns, and to
increase awareness about the impor-
tance of and safety of the vaccine, have
the potential to reach an additional
332,685 children each round.3
The Short Interval Additional
Dose (SIAD) strateg
The recent experience of implementing
the SIAD strategy in specic areas over
the past six months has shown good
impact. While modied monitoring
2 he 2009 KP study revealed thatknowledge of polio is generally low:74% of respondents had heard ofpolio, but only 39% could correctlyidentify paralysis as a sign of thedisease. Only 19% of respondents cor-rectly stated that polio is not curable.
3 Based on administrative target andIndependent monitoring data.
techniques for SIADs are still being
explored, the current data shows that
there has been an overall increase of
coverage with at least one dose of OPVafter SIADs (two rounds) compared to
coverage after one round. Repeating this
multiple times may lead to fatigue and
confusion for the community, and it
will be essential to communicate exactly
why two rounds of OPV are now being
encouraged only days apart. SIAD
guidelines exist, and incorporate advice
for communications, but the imple-
mentation of these guidelines needs
strengthening and active follow-up.Communication messages must
be further adapted for the needs of
SIADs, particularly through radio as
the most effective and extensive source
of information. Training on SIAD
guidelines should also be provided to
the Polio Communication Network
before each campaign.
Ongoing challenges
In the high risk areas of the Southern
Region, community mobilizers are
deployed as part of a government-led
Polio Communication Network (PCN),
which receives technical guidance from
UNICEF. But the lack of reliable social
data, and the weak monitoring of the
work of the Polio Communication
0%
10%
20%
30%
40%
50%
60%
70%
80%
JulyJuneMay
High risk areas with
Polio Communication Network
High risk areas without
Polio Communication Network
PercentAge oF cAregiverS
AwAre oF PoLio cAMPAignS
in 13 high riSk AFghAniStAn
diStrictS, MAy–JuLy 2011
Source: Independent Monitoring data
Socio-culturalreasons account forabout one-quarterof missed children
in fghanistan’s 13high risk districts.
hIgh school principal discusses the benets of vaccines with students and asksthem to cooperate with health workers during an immunization round that covered
the South, South asern, and astern regions of fghanistan and the Farah province.
UICF/FG2011-00023/JI
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A F g h A n i S t A n P O I O C O M M U I C I O S Q U R R U P D S P M B R 2 0 1 1
Network means this resource is not
being utilized as effectively as it could
be. Monitoring data uctuates so
widely from one round to the next
that it is difcult to analyze trends
and correlate progress to specic
activities. Communication reviewsare conducted after each campaign to
review progress, but the reasons for
progress or retreat on communication
outcomes are not documented in the
minutes, nor systematically followed
up on. With little social data available
from research, operational data offers
the only guidance for the programme.
The process of collecting and reviewing
the minimal available data must be
better focused and analyzed to ensurethat communication strategies are as
effective as possible.
Similarly, the deployment, distribution
and role of the Polio Communication
Network mobilizers, especially in the
13 High Risk Districts, needs to be
managed with more precision to ensure
that they are in areas where they are
needed most. At the moment, PCN
mobilizers cover 24% of clusters in
the High Risk Districts; we need touse these limited resources wisely. To
strengthen the deployment of PCN
mobilizers to the highest risk areas, and
to better monitor their outcomes, they
should be systematically incorporated
into the microplanning and supervision
process at the cluster level.
Campaign
awarenessCampaign awareness levels are
extremely low in Afghanistan. On
average, only 58% of caregivers in the
13 High Risk Districts are aware of
campaigns before they take place. In
areas where the Polio Communication
Network is present, an additional
10% of parents know about the
campaigns, and this has been rising
steadily with the increased numbers
of mobilizers working in high risk
areas. This kind of intensity needs to
be maintained in order to reach target
levels of 90% awareness.
Mass media, primarily radio, remains
the largest source of information on
campaigns, with 60% of caregivers
citing this as the main source of infor-
mation about campaigns. In non-PCN
areas, radio increases to 70% as a
source of information, likely due to the
absence of interpersonal sources to dis-
seminate information. This should be
analyzed further and new partnerships
with some key radio stations such asBBC Pashtu should be explored.
Communit engagement
Before each campaign, as part of the
PCN, community elders, mullahs,
teachers and community health workers
mobilize communities for polio vacci-
nation. The proportion of caregivers in
areas where the PCN works now citing
imams, teachers, or elders as a main
source of information in PCN areas is
over twice as high as it is in areas where
the PCN does not exist.
Given the potential of this network to
reach and engage with parents, it will be
critical to ensure they are given appro-
priate training on how to communicate
the importance and safety of vaccina-
tion, even if children are sleeping or sick
when vaccinators arrive.
he way forwardSecurity constraints, socio-cultural
barriers limiting access to women, and
recruitment of female vaccinators still
present substantial hurdles for the com-
munications programme. The following
activities are proposed:
• Conduct an assessment on the
reasons for refusal in the four
districts with refusal rates substan-
tially above the regional average:
Spin Boldak, Shawalikot, Musaqala,
and Shahid Hassas.
• Verify the reasons for missed
children in Sangin
• Establish targets to reduce the
proportion of children missed due
to socio-cultural reasons in the
highest risk districts.
• Better dene the role of
Community Mobilizers, prioritiz-
ing clusters which are high riskdue to social reasons, and incorpo-
rate the mobilizers into the
overall microplans.
• Ensure PCN staff are given specic
training to engage with parents
who refuse OPV due to children
being sick, newborn or sleeping.
PercentAge oF cAregiverS
in high riSk AFghAniS tAndiStrictS who LeArned
oF the PoLio cAMPAign
through interPerSonAL
SourceS, JuLy 2011
Source: Independent Monitoring data
0%
5%
10%
15%
20%
25%
30%
35%
TeachersImamsElders
High risk areas with
Polio Communication Network
High risk areas without
Polio Communication Network
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1 8 S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D i n d i A
The conTexT
z It has been over 8 months
since India’s last polio case in
West Bengal, the longest polio-
free period in India’s histor.
z Both endemic states of Uttar
Pradesh (UP) and Bihar have
not reported an polio cases
for more than a ear.
z No wild poliovirus has been
detected b environmental
surveillance in Delhi, Mumbai
or Patna in 2011.
z However, until India passes
the current high transmission
season without recording an
cases, we cannot be condent
that WPV transmission has
been interrupted.
Spotlight onmissed childrenAccording to independent monitor-
ing data, vaccination coverage in India
remains extremely high, with near-
universal coverage in Bihar, and 98%
coverage in UP since February. West
Bengal is showing stronger coveragesince the beginning of the year, with
95% coverage as of the July campaign,
but more work is required to ensure
that areas of vulnerability are sealed.
The India Expert Advisory Group
(IEAG) met in July and stated that
“the progress towards interrupting
poliovirus transmission in India is
real … the opportunity to eradicate
polio from India has never been better”.
Maintaining socialcommitment topolio eradicationAlmost every Indian child under ve
years old is vaccinated with OPV each
time it’s offered. Political and social
“he progress towardsinterrupting poliovirus
transmission in India isreal … the opportunity toeradicate polio from India
has never been better.”India xpert dvisory Group, July 2011
India
India’s last polio-affected child in West Bengal
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commitment for polio eradication has
never been higher. Refusals against OPV
continue to decrease in UP and Bihar.
Communication efforts are nally
gaining traction in West Bengal, with
refusals declining from 9% in April
to 6% in July. Children missed dueto sickness have also declined, from
15% in April to 12% in June, but this
issue needs continued vigilance by
the communication effort.
According to the 2010 KAP study,
almost every caregiver (98%) in UP
and Bihar believes their child should
receive OPV every time it’s offered.
Ninety percent of parents in UP believe
that Polio could be eradicated from
India forever. The question of how thislevel of motivation can be sustained
throughout the years until certication,
when cases are no longer visible and the
threat of polio will seem increasingly
distant, is absolutely critical.
Combating fatigue
There is growing evidence that the
continued pressure of repeated rounds,
and the number of doses reaching up to
10 per year in endemic states, is leadingto some fatigue among service providers
as well as community members.
Fatigue, and sometimes frustration,
could lead to an increase in refusals, or
simply passive behaviour towards vac-
cination, especially when polio seems to
be a threat of the past. Indeed stubborn
pockets of active resistance still exist
in Agra (Uttar Pradesh), urban Patna
(Bihar) and Maheshtela (West Bengal).
The communication strategy is
therefore focusing on maintaining
social commitment and enthusiasm,
ensuring continued compliance for
each dose of OPV, and focusing speci-
cally on the most vulnerable popula-
tions in the country: migrant and
mobile groups.
From ‘ever child’to ‘m child’
The booming voice of Amitabh
Bhachan, a Bollywood icon, signing
off his Polio commercials with the
words “Har bachcha, har baar” (“Every
child, every time”) is recalled by almost
every Indian citizen. This has been
the rallying cry of the nation to
eradicate Polio for over 7 years, and
has become the most recognizable
symbol of the programme.
While national goals of eradication
are unifying, they mean little to a
family living in the endemic regions
where every day is a ght to survive.
Qualitative research showed that
family’s compliance to OPV in India
emerged out of a feeling of responsibil-
ity to the Government, or to their localhealthworker, rather than something
they felt compelled to do to protect
their own children.
The new polio communication
campaign, launched this month,
personalizes the eradication effort
and communicates vaccination as an
essential role of being a parent. This
new call to parents – to protect your
child completely, by not missing even
a single dose of OPV – is an effort to
create a social norm for the behaviour
of an ideal parent.
Following extensive pre-testing, the
national logo has been rened to
include parents together with the childreceiving the drops, shifting the slogan
from a directive call for national action –
i n d i A P O I O C O M M U I C I O S Q U R R U P D S P M B R 2 0 1 1
PercentAge oF MiSSed chiLdren due to reFuSAL in
uniceF-SuPPorted AreAS oF indiA, JAnuAry–June 2011
Source: Independent Monitoring data
0%
2%
4%
6%
8%
10%
JuneMayAprilMarchFebJan
Uttar Pradesh
West Bengal
Bihar
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2 0
vaccinate every child every time – to a
personalized promise from the voice
of a parent: “Protection from Polio: my
child, every time, until the age of 5.”
Reaching the underserved
For migrants, the campaign’s message
is to “vaccinate your child wherever
you go”, responding to the fact that
between 70% to 80% of missed children
in UP and Bihar on average are missed
due to short or long-term migration.
To reach high risk groups more
effectively with information and
engagement strategies, the strategy has
tried to reach families outside of their
household: at transit stops, festivals, and
even on public transportation.
In the 107 highest risk blocks of UP
and Bihar, where the programme is
strongest, the campaign will encourage
parents to practice four additional
behaviours that can further reduce risk
factors to polio and improve overall
child health: routine immunization,
exclusive breastfeeding, taking ORS and
Zinc during diarrhoea, and washing
hands with soap.
mergencypreparednessThe IEAG has advised India to
initiate an Emergency Response
Plan for the peak period of risk from
June to November. Rapid Response
trainings have been held jointly by
the partners with all states, ensuring
that all relevant actors are prepared to
respond to an outbreak immediately.
Further, all States have been requested
to draw up Emergency Preparedness
and Response Plans, including a media
and communications plan to identify
both a government spokesperson and
a communications focal person. The
Government of India, with support
from UNICEF and communication
partners, is conducting a systematic
analysis to identify and compile a list
of pockets of signicant OPV refusal
in other states to develop plans for
engaging these communities.
To facilitate immediate communication
in the event of an outbreak, the partner-
ship has prepared an Emergency Kit in
seven languages for State Governments,
containing emergency mop-up awareness
posters, FAQs, underserved advocacy
booklets, TV and radio spots, public
announcements and much more.
he way forwardIndia’s priority for the remainder of the
year is to consolidate success and secure
eradication. To secure social commit-
ment and motivation, the following
activities are proposed:
• Launch the new communication
campaign nationally and in high
risk areas, to personalize the threat
polio and parental responsibility to
prevent it, focus on migrants, and
reinforce the need for every dose
of OPV.
• Expand upon the underserved
strategy to communicate more
effectively to high risk populations,
not only in UP and Bihar, but also
in other states.
• Support Emergency Preparedness
and Response Plans by all state
governments, particularly to ensure
media and government spokesper-
sons are identied in each state,
with clear media protocols to
communicate for an outbreak and
strengthened media engagement to
facilitate objective reporting.
S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D i n d i A
Over 50 buses in Mumbai, Delhi and Calcutta now carry poliomessages targeting traveling and migrating parents. Polio messages canalso be seen on hundreds of rickshaws and auto-rickshaws in these capital cities.
reASonS For MiSSed
chiLdren in cMc AreAS oF
uttAr PrAdeSh, June 2011
Source: Independent Monitoring data
Child sick
Child not home
Child out of village
House locked
79.3%
3.4%
9.5%
6.1%
Refusal to accept OPV
1.7%
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n i g e r i A P O I O C O M M U I C I O S Q U R R U P D S P M B R 2 0 1 1
The conTexT
z The recent bombing on the
UN compound in Nigeria has
had a signicant impact on
staff and the programme.
The long-term implications of
this tragic event are still being
full assessed and absorbed.
z Nigeria continues to experi-
ence a surge of polio cases,
following a historic 95%
reduction of cases in 2010.
Nigeria currentl has 26 WPVs
compared to six cases for the
same time period in 2010.
z Borno, ano and ebbi account
for 65% of all cases nationall.
z Continued communit resis-
tance to the programme is
profoundl impacting progress.
LQAS data indicates non-
compliance as a signicant
reason for missing children
in ano and Sokoto.
Spotlight on
missed childrenNational coverage continues to
stand at 93%, with sizable pockets of
under-immunized children in Kebbi,
Kano, Katsina and Yobe. However some
progress is being made in these states:
the proportion of missed children
in Kebbi has been reduced from
14% in May to 10% in July, and in
Kano from 10% to 9%.
Why are wemissing children?Non-compliance still makes up a
signicant proportion of total missed
children, and is on the rise in some high
risk areas from last quarter. According
on-compliance stillmakes up a signicant
proportion of total missedchildren, and is on the rise
in some high risk areas.
igeria
communityleader uses amegaphone toannounce thefour-day polioimmunizationdrive in Isawaown in thenorthern stateof Bauchi.
U n I C e F / y H Q 2 0 0 7 - 0 4 6 4 / n e S B I t t
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2 2 S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D n i g e r i A
to Independent Monitoring data,
one quarter of all missed children are
missed due to refusal, with 68% of
missed children due to ‘child absent’.
As is being seen in some other countries,
triangulating varying sources of data
suggest that at least some of the children
marked as absent when vaccination teams
visit could be a display of covert refusal.
According to LQAS data, refusal –
overt or covert – contributes far more
substantially to the reasons for missed
children than is currently being captured
in Independent Monitoring data.
In Gwale LGA in Kano, Independent
Monitoring data showed 18% of
children were missed due to non-
compliance, whereas LQAS showed the
proportion of children missed due to
refusals to be 95%. In Sokoto South,
LQAS revealed that 88% of missed
children were due to refusal.
It is becoming clear that the biggest
challenges facing the Nigerian
programme are to nd ways to
overcome the operational challenges,
as well as the increasing numbers of
missed children due to resistance.
Engaging communitiesfrom the bottom up
The Intensied Ward Communication
Strategy (IWCS), an evidence-based
approach to social mobilization, has
been instrumental in bringing about
behaviour change in a more strategic
and targeted manner. However, the
teams still face many challenges in
scaling up this strategy to all high risk
LGAs and settlements.
The role of traditional leaders cannot
be overemphasized, as they enjoy a
status of authority and immense respect
in northern communities. However,
there is increasing evidence that shows
communities are nding ways to defy their authority or actively avoid immu-
nization by hiding their children, or
sending children out of the house when
campaigns are being implemented.
To accelerate progress in the 12
Northern High Risk States, UNICEF
and partners are increasing the active
PercentAge oF MiSSed chiLdren in nigeriA
due to reFuSAL, JuLy 2011
Source: Independent Monitoring data
10.1 – 41.0
Missing value
1.0 – 8.0
8.1 – 10.0
PercentAge oF MiSSed chiLdren in nigeriA due to
reFuSAL, According to iM And LQAS dAtA, JuLy 2011
Source: Independent Monitoring and QS
0%
20%
40%
60%
80%
100% Independent Monitoring
LQAS
K a f i n H a u s a
K i r i K a s a m a
M i g a
F a g g e
G e z a w a
G W A L E
K u m b o t s o
S o k o t o S o u t h
W a m a k o
W u r n o
Jigawa Kano Sokoto
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n i g e r i A P O I O C O M M U I C I O S Q U R R U P D S P M B R 2 0 1 1
participation of community members
to resolve non-compliance. Various
community engagement approaches
are being piloted in Sokoto, Kebbi
and Zamfara states. These pilot
projects include the ‘Neighbour to
Neighbour’ strategy (N2N) in Sokoto,Eboki (youth) and ‘Datawa Mata’
(respected female elders) in Zamfara,
and ‘Household Adoption Strategy’
in Kebbi. This is a strategic choice
to build ‘bottom-up’ community
action models that complement the
‘top-down’ traditional leader approach,
and increase community demand for
the programme.
These pilots are also revealing
important lessons on how to saturatehigh risk wards with communication
interventions in a way that compensates
for limited human resources. Initial
analysis of the pilots have shown that
with very limited subsidies for the
community effort (communication
materials and transport/refreshment
allowance) the eld teams have been
able to achieve very encouraging results
in a short timeframe.
Working with operations
It is important for the communication
effort to convince caregivers that OPVis critical for their children’s health,
and also to provide them with the
basic knowledge of campaign dates so
that increased demand will help keep
children at home during vaccination
campaigns. However, special teams
dispatched to immunize children at
playgrounds, markets, social events, and
other areas also need to be strength-
ened. Often, ‘child not available’ simply
means that children are playing with
their friends in front of their homes, and
could be reached with more effort.
In this complex environment, commu-
nication and operations need to work
closer together to maximize vaccination
opportunities from both the supply and
demand side.
CampaignawarenessAlmost all caregivers in Nigeria are
aware of polio campaigns in advance:
campaign awareness remains 98% as
of July, both in high risk and non-high
risk states.
PercentAge oF cAregiverS
AwAre oF PoLio cAMPAignS
in nigeriA, MArch–JuLy 2011
Source: Independent Monitoring data
0%
20%
40%
60%
80%
100%
JulyJuneMayMar
lthough traditionalleaders play a very
important role innorthern communi-
ties, peer-basedcommunication
strategies are beingpiloted to comple-
ment the top-down traditionalleader approach.
Religious scholars meeting
UICF IGRI/2011/MORG
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2 4 S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D n i g e r i A
Caregivers aware of the campaign
through interpersonal communica-
tion continue to increase in high risk
areas since last quarter, from 42% to
55%. It is the lead source of informa-
tion on campaign dates, demonstrat-
ing – at least in part – the positivecontributions of the Intensied Ward
Communication Strategy.
Scaling up
UNICEF is actively looking for
resources to enable rapid and wide
scale up of community action models
in the persistently resistant communi-
ties. This is seen as the most important
strategic development that can have a
huge impact on increasing demand
and community commitment, and
ultimately help achieve reaching a
polio-free Nigeria by the end of 2012.
he way forwardThe fragile social commitment to polio
eradication in Nigeria poses a real threat
that could still derail the programme.
Addressing this will require innovation
and increased resources, as has been
demonstrated in some high risk areas.
The following activities are proposed:
• Continue effective advocacy
at national, state and LGA levels
to maintain political commitment
for the programme.
• Launch an intensive media
campaign to increase acceptance
of OPV, overall visibility of the
programme and attract new
partners at national, state and
LGA levels.
• Continue to scale-up innovative
community-empowerment strate-
gies to increase compliance.
• Based on LQAS trends of non-
compliance, assess the prioritiza-
tion of high risk areas where social
mobilization resources need to be
shifted and/or scaled up.
• Conduct qualitative analysis in
areas with active and increasing
refusal to understand the underly-
ing reasons.
• Identify a strategy that motivates
independent monitors, and ensures
that they record reasons for missed
children more accurately.
SourceS oF inForMAtion FroM cAregiverS
who rePort hAving heArd Any cAMPAign MeSSAge
in nigeriA, MArch–JuLy 2011
Source: Independent Monitoring data
0% 10% 20% 30% 40% 50% 60% 70% 80%
July
June
May
March
% reached through any health service worker
% reached through any interpersonal source
% reached through any form of mass media
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P A k i S t A n P O I O C O M M U I C I O S Q U R R U P D S P M B R 2 0 1 1
The conTexT
z Pakistan continues to see
worring increases in cases,
particularl from Balochistan,
which is now responsible
for 41% of cases in 2011.
Almost half of Balochistan’s
cases (46%) are from families
resisting OPV, a substantial
rise from 8% last ear.
z Local administrative ofcials
in Peshawar and Quetta
threatening to arrest parents
refusing the vaccine is a
signicant concern. This could
lead to an active backlash
against the programme,
with the potential for furtherloss of trust.
z Sindh, identied b the IMB
as the “marker for success”
in Pakistan due to its relative
securit and accessibilit,
has been rocked b political
violence and severe ooding in
the past 3 months.
z 77% of this ear’s cases have
come from Pashtun communi-
ties. Adapting operational and
communication strategies to
the needs of these high risk
communities will be critical to
success in Pakistan.
Spotlight onmissed childrenThe deep-rooted challenges in Pakistan
reach across the country. However, the
trends of missed children from Sindh
and Balochistan point us to some key
priorities at the moment. In spite of
the armed clashes in Sindh over the
past few months, intensied efforts in
Karachi have begun to show results.
Gains in Karachi must be consolidated,
and expanded to the high risk areas
Intensied efforts inKarachi are beginning
to show results.
Pakistan
Communitymobilizers in
Karachi reviewpolio fact sheets
before visitinghouseholds.
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2 6 S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D P A k i S t A n
of Northern Sindh. The extended
monsoon oods have already affected
campaign operations, and will quickly
pose additional challenges; it will be
crucial to ensure that polio activities
are fully integrated into the ood
response to sustain and accelerate
momentum in Sindh.
Balochistan continues to raise serious
concern, with double its cases compared
to this time last year, and a rising trend
of missed children. This province
now has the highest burden of cases,
contributing to 41% of Pakistan’s cases
in 2011. Three-quarters of Balochistan’s
cases come from only 3 districts, all on
the border with Afghanistan: Pishin,
Killa Abdullah and Quetta.
According to independent monitor-
ing data, coverage is rising slowly in
FATA, but LQAS data highlights major
challenges here too. In the July NID,
according to LQAS, less than half the
union-councils in FATA (47%) met the
target for 95% vaccination coverage.
Why are wemissing children?
Management and accountability
remain the most signicant barriers to
performance in Pakistan. Nationally,
38% of children are still missed due to
‘no team’, a proportion that has stub-
bornly persisted for much of this year.
While insecurity continues to make it
difcult for teams in FATA and KP to
reach communities and households,
it does not fully explain why teams
failed to reach almost 50% of missed
children in Balochistan in July. There
are currently no security issues in the
Quetta block, suggesting that insuf-
cient commitment – on the part of
vaccinators, political and social leaders
as well as communities – seem to be the
biggest threat to success in this critical
stronghold of polio.
Understanding refusals
The proportion of children missed
due to refusals has gone down
substantially in Balochistan and
Sindh since January – for example
from 23% to 11% as of the July
campaign in Balochistan. However,
due to the greater numbers of children
targeted for vaccination each month,
the lower percentages of refusal in many areas actually yield higher absolute
numbers of missed children. During
the July NID, the 11% of missed
children due to refusal in Balochistan
was the largest opposition to polio
vaccination in over 2 years: 14,645
children were missed because their
parents refused the vaccine.
But by far the highest concentration
of family refusals are in Karachi, risingfrom 17,000 in the beginning of the
year to 22,000 as of July.
Increasing refusals are leading to
discouraging outcomes. Over the past
year, the percentage of polio cases in
Balochistan that came from families
who refused OPV has jumped from
8% to 49% as of July. In Sindh, it has
gone from 0% to 17% for the same time
PercentAge oF MiSSed chiLdren in PAkiStAn,
JAnuAry–JuLy 2011
Source: Post Campaign Monitoring
0%
1%
2%
3%
4%
5%
6%
7%
JulyJuneMayAprilMarchJan
Sindh
Balochistan
reASonS For MiSSed
chiLdren in BALochiStAn,
JuLy 2011
Source: Post Campaign Monitoring
Other
Child not available
No team
Refusal to accept OPV
49%
35%
11%
6%
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P A k i S t A n P O I O C O M M U I C I O S Q U R R U P D S P M B R 2 0 1 1
period. The only province with encour-
aging trends in this area is FATA.
If widespread social commitment
for OPV and polio eradication is not
quickly secured, this will pose a real
threat for the entire global programme.The threat from local administrative
ofcials in Peshawar and Quetta to
arrest parents refusing the vaccine is a
signicant concern, and could poten-
tially lead to a backlash against the
programme, and a deeper loss of trust
among the community.
Refusal trends seem to reect the ground
realities, but the lack of quality data
coming out of independent monitoring
makes it difcult to use this data with
condence in order to redirect strate-
gies at local levels. Rapid assessments
to understand the reasons for such low
public support for polio vaccination
are being conducted in three provinces
of Pakistan, but high-quality system-
atic data is more urgently required.
LQAS should be adapted to verify not
only coverage, but also the reasons for
missed children, as is done in Nigeria.
Empowering communitiesto demand OPV
To date, 77% of polio cases in Pakistan
have been reported from the Pashto-
speaking population. Sixty-eight
percent of cases over the past 5 years
have come from this group, who make
up only 13% of Pakistan’s population.
Empowering communities in Pakistan
to actively demand OPV, therefore,
must begin with the intensive engage-
ment of this highest risk group.
In July, provincial and federal teams
from Government, WHO and UNICEF
came together to develop strategies to
reach the country’s highest risk groups.
The Pashto-speaking population was
identied as the primary group to
focus on, together with slum dwellers,
mobile, migrant and nomadic groups.
PercentAge oF MiSSed chiLdren in PAkiStAn
due to reFuSAL, JuLy 2011
Source: Independent Monitoring data
ccess towomen byoutsiders,
particularlymales, remainsvery difcultin this traditionalsociety. Mobiliz-ers and vaccina-tors need to bepredominantlyfemale in orderto gain accessinto the house-holds.
10.1 – 11.0
Missing value
1.0 – 8.0
8.1 – 10.0
health worker vaccinates a child against po U n I C e F / a S a D z a I D I
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2 8 S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D P A k i S t A n
Socially, the Pashtun population is likely
to be affected by conict in KP and
FATA, or will try to ee the violence,
making them difcult to access in
either context. Some of these groups
have settled in urban areas like Karachi
and have their own communities there
within geographically dened areas.
Access to women by outsiders, particu-
larly males, remains very difcult in this
traditional society. In a context where
most vaccinators are men, and often
do not come from the same communi-
ties or the same ethnic background,
engaging with these mothers will
require several structural changes
to the composition of teams.
With the recent pay raise for vaccinators
initiated this month, the programme
is in a better position to recruit higher
quality staff. Pashto-speakers will be
critical if we are to win the trust and
credibility of our highest risk group.This is somewhat of a catch-22, as we
need an initial layer of community trust
to rst attract these women as vaccina-
tors and mobilizers, even before we can
begin to reach mothers.
To build these bridges, community
support is being sought from
inuential political and religious
leaders. Local parliamentarians in the
Quetta Block will be asked to play
a greater role in social mobilization
activities in the high risk districts, forexample, and to take greater ownership
of the programme. The Provincial
Minister, Mrs Begum Shama Parveen
Magsi, will be chairing a meeting with
parliamentarians in September.
Campaignawareness
Campaign awareness remains extremely low in Pakistan; but it is difcult to
draw trends for this indicator due to
such sporadic reporting of data. Only
one province reported independent
monitoring data on this indicator
from the two SIAs this quarter. In June,
only Sindh reported, demonstrating
an encouraging increase from 46%
awareness to 60%, perhaps due in part
to the recent intensication of commu-
nication activities in Karachi (see page
4). In July, only Balochistan reported
data, showing a consistent trend of 43%
awareness. KPK has not reported data
on this indicator in over two years.
PercentAge oF wPv cASeS in PAkiStAn
thAt reFuSed oPv, 2010-2011
Source: Case linelist, WHO
0%
20%
40%
60%
80%
100%
NationalGilget-
Baldistan
KPFATASindhBaluchistanPunjab
8%
46%
2010
2011
20%25%
15% 15%11%
17%
40%
27%
100%
“We shall be arresting all those elements, even parents,under 16/3 Maintenance of Public Order who will obstructor refuse polio vaccinations to the children.”
District Coordination Ofcer of Peshawar to the media, 7 September, 2011
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P A k i S t A n P O I O C O M M U I C I O S Q U R R U P D S P M B R 2 0 1 1
In insecure areas like Balochistan and
FATA, and increasingly now in Karachi,
if caretakers are not aware of campaign
dates, it is less likely that they will
open their door to unknown visitors.
Without data on this indicator it is
impossible to know if we are reachingfamilies with sufcient information.
Monitoring forms put forward without
complete social information should not
be accepted for submission.
he way forwardPakistan has an overwhelming list
of priorities to ensure it interrupts
transmission. The key will be to furtherprioritize activities in the highest risk
UC’s and focus on the highest risk
groups in these areas.
The following actions are key for
Pakistan’s communication programme
until the end of the year:
• Advocate strongly with local
ofcials against the use of legal
action to force vaccine compliance.
• Finalize the list of highest risk
UCs for operational and social
mobilization focus amongst all
partners, identifying stafng needs
for these areas immediately.
• Hire vaccinators and social
mobilizers, reaching clearly
identied targets for female
team members, local residents,
and local language speakers.
• Ensure that provinces develop
operational and communication
plans that identify their highest
risk groups, and how they will
reach them.
• Improve the collection of
social data. Social data is not yet
considered a critical component
by all stakeholders.
• LQAS should be adapted toverify reasons for missed
children, as per the 2011 TAG
recommendation.
RSP workers announce polio campaigns in the high risk towns of Karachi.
U n I C e F / P a K / 2 0 1 1 / H a y D a R O V
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3 0 S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D A n g o L A
The conTexT
z Angola has made strong
progress with the lowest
incidence of poliovirus among
all the priorit countries.
z This ear onl four cases
have been reported so far,
compared to 21 for the same
period last ear. Cases were
clustered in uando ubango,
but traced back to transmission
in Luanda province.
z Localized communication
planning, guided b a better
understanding of indepen-
dent monitoring data, will be
important to reaching morechildren with OPV.
Spotlight onmissed childrenIndependent post-campaign monitor-
ing has shown the proportion of missed
children consistently rising since April –
from 6% to 9% in the last quarter.
Luanda continues to show the highestrates of missed children in the country,
at 11% in July, rising from 10% in
May, due largely to poor quality
campaigns and a failure of the teams
to reach every household.
Why are wemissing children?
Throughout the year, the dataindicates that the primary reason
children are missed is because they
are not at home when the vaccinators
arrive. In 2011, 37% of children were
missed for this reason.
The second largest reason children
are missed is simply because the teams
Understanding the‘other reasons’ of missed
children could help theprogramme recover upto one- third of missed
children nationally.
ngola
Many unreached children live in slum areas ofuanda. Poor sanitation, unsafe water, and otherunsanitary conditions help to spread polio.
U n I C e F / n y H Q 2 0 1 1 - 0 1 4 0 / G R a e M e W I l l I a M S
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A n g o L A P O I O C O M M U I C I O S Q U R R U P D S P M B R 2 0 1 1
fail to reach every household. In the
July campaign, 39% of missed children
were missed because vaccinators did
not visit.
There is therefore an urgent need to
improve the quality of campaigns in
Angola if every child is to be reached.
Analsing the data
Nationally, active refusals continue to
be low, at 2% of missed children.
However provinces that include
high risk areas – such as Uige –
have refusal rates about 4 times the
national average, at 8%. Similarly the
province of Moxico - which is epide-
miologically characterized as low risk,
yet borders the province of Kuando
Kubango which reported this year’s
4 cases – reports refusals accounting
for 7% of missed children. Both of
these areas are remote rural provinces
with small capital cities. Breaking such
data down further to sub-province
level will be key to understanding
exactly where and why children are
missed in certain pockets of Angola.
‘Other’ reasons formissed children
A more serious concern is the highproportion of children missed due
to ‘other reasons’. This category
accounted for 36% of all missed
children in May, and 33% throughout
the year on average. Included in this
category is children missed because
they were sick at the time of the vac-
cination campaign. In the last quarter,
about 3% of missed children were
missed because their parents did not
want to give OPV to a sick child.
This raises the proportion of children
missed due to ‘hard’ or ‘soft’ refusal to
5% – still not a substantial proportion,
but one that is more signicant than
initially reected in the data.
A further proportion of the missed
children in this category – 31% out
of 36% in May and 17% out of
24% in July – were missed because
the ‘mother was not aware of thecampaign’. This is a misleading
classication in the Independent
Monitoring forms, since a mother’s
lack of awareness does not fully explain
why the child was missed. Did the
mother’s lack of awareness cause her
to be out of the house when vaccina-
tion teams visited? Or did it lead her
to refuse the vaccine because of a low
perceived threat of polio, or a low felt
need for the vaccine? Did she decide
not to open the door to the unknown
vaccinators knocking at the door? Did
the vaccination team even visit the
house? Although this is an easy reason
to record on the form, it masks both
the operational and social reasons why
children continue to go unvaccinated.
It is therefore an urgent priority to
review and revise the Independent
Monitoring forms. Understanding
the ‘other reasons’ of missed
children could help the programme
recover up to one- third of missed
children nationally.
CampaignawarenessAwareness of campaign dates is increas-
ing, now at 88% nationally, and it is
encouraging to see even higher rates
PercentAge oF cAregiverS
AwAre oF PoLio cAMPAignS,
in AngoLA, MAy–JuLy 2011
Source: Independent Monitoring data
0%
20%
40%
60%
80%
100%
JulyMayAprilMarFeb
reASonS For MiSSedchiLdren in AngoLA,
June 2011
Source: Independent Monitoring data
Child sick
Mother not aware
No team
Child not available
Other
2%
Refusal to accept OPV
32.1%29.6%
1.5%
36.0%
31.0%
3%
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3 2 S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D A n g o L A
of 94% awareness in the high risk
province of Kuando Kobango in the
July campaign.
Most people (55% nationally) cited
mass media as their main source of
information about campaigns in July,due largely to a successful national TV
and radio effort implemented by the
government and partners, with support
from UNICEF.
In other areas, sobas (village elders)
and churches are almost, if not even
more effective than mass media. In
the high risk province of Kwanza Sul,
for example, information from soba’s
(22%) was almost as high as radio
(25%) during the May campaign.
In Cunene for the same campaign,
churches were on par with TV at 19%.
Closer collaboration with churches in
some areas is starting to show some
success. This highlights the need to
explore how best to complement the
current mass media approach, with
more nuanced and localized com-
munication approaches to reach the
12% nationally who are not currently
receiving advance information about
the campaign, or the potentially larger
proportion who does not yet perceive
the need for OPV each time it’s offered.
he way forwardIt is important for the Angola
programme to better understand the
populations most at risk to being
missed with OPV, and why. The
following actions are proposed:
• Revise the independent monitoring
category of ‘mother not aware’ as a
reason to classify missed children.
• Introduce a tally sheet for vaccina-
tion teams to record the absolute
number of missed children, and
reasons for missed children in
order to have another source of
information in addition to inde-
pendent monitoring
• Train independent monitors and
vaccinators to ensure that they
can accurately record reasons for
missed children, in tally sheets and
monitoring forms.
• Complete and publish a study to
help understand not only reasons
for refusal, but also other potential
social reasons for missed children,
particularly in high risk areas
• Ensure the ICC reviews social
data by high risk area during each
relevant coordination meeting.
• Explore other communication
approaches to complement mass
media, particularly in the highest
risk areas to reach those who may
not have access to mass media.
SourceS oF inForMAtion FroM cAregiverS
who rePort hAving heArd ABout the cAMPAign
in AngoLA, FeBruAry–JuLy 2011
Source: Independent Monitoring data
0% 20% 40% 60% 80% 100%
July
May
March
Feb
% reached through any health service worker
% reached through any interpersonal source
% reached through any form of mass media
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The conTexT
z Chad has the highest number
of reported polio cases of an
countr in the world this ear.
At the time of this report, Chad
had 112 conrmed wild polio-
virus cases compared to 14 for
the same time last ear.
z In spite of monthl campaigns,
transmission is now wide-
spread with wild poliovirus now
detected in 14 out of 21 regions.
z Chad’s risk to its southern
neighbour, the Central African
Republic, is now considered
ver real. Recent monitoring
data shows more than 40%of AFP cases under 5 ears of
age had unknown vaccination
status, or had not received a
single dose of OPV.
z Engaging with families on
the importance of OPV and
ensuring families know when
campaigns are taking place
are the communication priori-
ties. Weak infrastructure and
staggered campaign dates
continue to pose challenges.
Spotlight onmissed childrenThe percentage of children missed
during monthly campaigns continues
to increase. The proportion of missed
children has doubled since December
2010 (from 7% to 14%), giving Chad
the highest proportion of missed
children among the eight priority
countries. In Guera’s July campaign
for example, the proportion of
children missed was greater than the
proportion of children covered. Some
contextual factors contribute to such
poor coverage. For example:
c h A d P O I O C O M M U I C I O S Q U R R U P D S P M B R 2 0 1 1
he percentage of childrenmissed during monthly cam-paigns continues to increase,
doubling since December 2010.
Chad
child gets vaccinated with polioin Moundou, ogone Occidentale.
U n I C e F / C H a D / P a t R I C I a e S t e V e
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3 4 S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D c h A d
• July ooding in Dar Sila rendered
5 out of 9 areas unreachable;
• poor road infrastructure in Salamat
consistently hampers teams’ access
to communities; and
• the national electoral process has
affected campaign management
in all areas.
But, in spite of the challenges, poor
implementation of campaigns remains
the most acute reason for missing somany children.
Why are wemissing children?The general breakdown of why children
are missed has not changed throughout
the year. ‘Child not available’ remains
the primary reason for missed children
in Chad. Nationally 55% of childrenare missed for this reason. ‘No team’
is second, accounting for 33% of
children missed.
Although operations remain the most
critical obstacle to making progress in
Chad, the lines between operational and
social barriers are blurred.
Gaining social insights
A qualitative study on the reasons
for children’s absence during polio
campaigns was recently conducted in
Logone Oriental, Moyen-Chari and
N’Djamena. Initial results suggest that a
number of children reported as absent
could in practice have been hidden by
their parents in order to avoid receiving
OPV. Thus what may seem like an
operational issue in monitoring data
may in fact be partially attributable to
covert refusals.
Another assessment conducted last
quarter in Logone Occidental showed
that among those children who are
not at home during campaigns, it
is largely because parents are not
convinced about the importance of
immunization. Many are not aware of
the dates of the campaigns, and send
children out for chores, or for play.
However, if this is the case, given theage of these children it might be
assumed that many of them would
remain relatively close to home and
could be easily located.
There are limitations on the reliability
and representativeness of this data, but
the studies provide some insights into
the social context among some of the
highest risk areas. It is important that
operational and communication plans
incorporate these ndings into revised
local strategies.
Addressing refusals
A small proportion of missed children
(6%) are due to refusals, although
N’Djamena and Mayo Kebbi Ouest
show rates that are more than double
reASonS For MiSSed
chiLdren in chAd,
JuLy 2011
Source: Independent Monitoring data
Other
Child not available
No team
Refusal to accept OPV
55%
33%
7%
6%
recent study in select regions indicated that childrenreported absent might have been hidden by their parents
when teams arrived. In other cases, children were often not
at home during campaign visits, because parents did notunderstand the importance of immunization or know cam-
paign dates. Operational and communication plans mustincorporate these ndings into revised local strategies.
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c h A d P O I O C O M M U I C I O S Q U R R U P D S P M B R 2 0 1 1
the national average. There are growing
signs of polio vaccination fatigue
among the population, especially in
N’Djamena where refusals accounted
for 16% of missed children in July, up
from 4% the previous month. However,
following the July campaign, a jointteam of partners and local and tra-
ditional leaders successfully engaged
with families who refused vaccination,
persuading 64% of them to give their
children OPV. These activities are still
ongoing and demonstrate the power of
interpersonal communication.
Campaign
awarenessCaregivers’ awareness has been recorded
between 78%-81% this year, increasing
from 2010 levels, but not yet meeting
national and international targets
of 90%. Many areas with low levels
of campaign awareness are the same
areas with high percentages of missed
children, explaining – at least partly –
why children may be missed, and why
high percentages of children are not at
home when vaccinators arrive.
The lack of a mass media infrastructure,
combined with a largely illiterate,
traditional rural population, pose
challenges to raise awareness and
persuade communities to immunize
their children in Chad.
Staggered immunization dates
have made it even more difcult to
communicate exact dates to caregivers,
which potentially contribute to high
rates of child absence. The National
Technical Committee has thus far been
unable to establish clear dates for SIAs
ahead of time, and it has not been
possible to harmonize campaign dates
at the national, regional and district
levels. This means districts within
a single region could have different
campaign dates.
Staggered campaign dates also make it
hard to assess progress, with household
and street monitoring data reportingdifferent coverage gures. The latter
might include people from different
health districts where immuniza-
tion has not yet taken place, showing
higher gures of missed children from
household monitoring data.
Communication resources in the past
quarter have been heavily invested in
increasing campaign visibility, with
intensied community engagement intargeted high risk areas. This has con-
tributed to the higher rates of campaign
awareness, but without improvements
in overall campaign quality, this has not
managed to improve results on its own.
To lower the risk of virus importation
into Cameroon, vaccination tents were
set up in each of the three N’djamena
districts on the border, vaccinating
454 children at these sites in July. Cars
equipped with loudspeakers were
deployed throughout N’Djamena
to inform the population about the
upcoming or ongoing polio immuniza-
tion campaigns. Public criers have been
provided with megaphones briengs
prior to the campaign.
Signs of progress
While awareness levels can still be
improved, they are not low everywhere.
In Dar Sila, awareness has gone from70% to 96% in the past month; in
Chari Beguimi from 71% to 89%.
However, in some areas with very
high awareness, children continue to
be missed. This suggests that parents
o lower the risk of virus importation intoCameroon, vaccination tents were set up in each of the three
’djamena districts on the border, vaccinating 454 children at these sites in July.Cars equipped with loudspeakers were deployed throughout ’Djamena to inform
the population about the upcoming or ongoing polio immunization campaigns. Publiccriers have been provided with megaphones briengs prior to the campaign.
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3 6 S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D c h A d
remain passive in their demand for
the vaccine, or worse, actively avoid
vaccinators during campaigns.
Initiatives are planned for the
September round to demonstrate
the effectiveness of community level
engagement. If successful, such pilot
activities urgently need to be scaled
up and replicated in all high risk areas.However there are severe constraints
with funding and skilled human
resources, both presenting a serious
risk to the programme.
he way forwardThere is an urgent need to dig deeper
into the underlying reasons for missed
children in Chad, and to identify the
most effective communication channels
and strategies to engage with parents.
The priorities are to:
• Focus on the highest riskareas and groups: the high risk
areas are known. The highest risk
groups within these areas need
further denition and outreach.
The existing plan to reach nomads
should be operationalized as
soon as possible.
• Involve key actors at the
community level to strengthen
social and personal commitment
to polio eradication. Renew the
commitment of local authorities,
traditional and religious leaders,
and village/neighbourhood
chiefs for social mobilization
in their communities.
• Reach out to communities widely
and creatively, taking into account
local needs and tailored strategies in
targeted high risk areas.
• Establish Ministry of Health
communication and social
mobilization focal points at decen-
tralized levels to ensure their active
involvement in the organization
of polio campaigns.
• Support the scaling up of the
GPEI’s operations in Chad,
including expanding communica-
tion capacity in the newly estab-
lished zonal hubs, as well as at
the district and village levels.
This will require intensive support
both in terms of nances and
technical inputs.
MiSSed chiLdren And cAregiverS’ AwAreneSS
in high riSk AreAS oF chAd, JuLy 2011
Source: Independent Monitoring data
0%
10%
20%
30%
40%
50%
60%
70%
80%
GueraSalamatBarh el Ghazal
Percentage of missed children
Percentage of caregivers aware of the campaign
44%
32%
17%
66%
56%
75%
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d r c o n g o P O I O C O M M U I C I O S Q U R R U P D S P M B R 2 0 1 1
The conTexT
z DR Congo has reported 79 tpe
1 polio cases this ear, com-
pared to 21 at this time last ear
z All new cases in the last
quarter were recorded in thehard to reach areas of North
atanga and the Bas Congo/
Bandundu border, highlighting
the complex logistical chal-
lenges that continue to make it
difcult for both mobilizers and
vaccinators to access remote
communities
z DR Congo remains second
onl to Nigeria in rates of
communit refusal to OPV.Although national rates of
refusal in missed children stand
at 13%, this has risen to as
high as 32% in some provinces
over the last quarter. There are
growing concerns that covert
refusals ma also be rising.
Spotlight on
missed childrenEven though the reporting of polio cases
has slowed in recent months, campaign
quality continues to be a major concern.
Twelve percent of children were missed
in the June campaign; double the
proportion missed one month earlier
in May. Although only 7% of children
were missed in July, this is still too
many to ensure that transmission is
halted in the challenging context of DR
Congo. With so many insecure and hard
to reach areas, the need to vaccinate
every acessible child cannot be over-
stressed. For example, in the capital
city of Kinshasa, where access is not a
constraint, the highest rates of missed
children continue to be seen, with 13%
of children missed in June.
With so many insecureand hard to reach areas,
the need to vaccinate everyacessible child in DR Congo
cannot be overstressed.
DemocraticRepublic of
the Congo
polio-affected journalist speaks to a communityin Bas Congo about his life with polio.
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3 8 S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D d r c o n g o
Why are wemissing children?DR Congo has one of the highest
refusal rates, second only to Nigeria.
Although rates were recorded to be
at their lowest with 13% of missed
children due to refusal nationally, this
soared up to 32% of missed children
in particular provinces. DR Congo
remains one of the few countries where
active community resistance presents a
serious risk to the programme.
Over the last quarter the data also
shows that 23% to 57% of childrenmissed in DR Congo were missed
because they were not at home when
vaccinators arrived. This has been the
main reason throughout the year for
missing children. It is not yet clear why
so many children are not at home when
teams visit, as DR Congo enjoys one of
the highest rates of campaign awareness
in the world, with an annual average of
92% of the population stating they were
informed of the campaign in advance.
Such persistent community resistance
to the vaccine, coupled with high rates
of child absence, could suggest that
a trend is shifting more prominently
from overt to covert resistance. Are vac-
cination teams visiting at inconvenient
times, or do families hide their children
and even take them out of the house
when they know that vaccination teams
are to arrive?
Research is now underway to test this
hypothesis. Gaining a better under-standing of where children are when
they’re not at home, as well as identify-
ing better strategies to reach them is a
critical piece of the puzzle. For example,
outreach vaccination conducted
through churches in some areas is a
strategy that should be evaluated for
testing on a much wider scale.
Digging deeperinto refusals
A rapid analysis of independent
monitoring data from the 20 high risk
Health Zones with the highest numbers
of refusal1 showed that most refusals
(27%) are from parents who don’ttrust the vaccine. Twenty-ve percent
cited religious beliefs as their reason
for refusal, usually stating a belief
that only God – not a vaccine – can
protect their children from disease.
A further 21% said they refused
vaccination because the main decision
maker (generally the husband) was
not at home during the teams’ visit;
and 9% said that their child was sick
and could not take the vaccine.
Such reasons vary signicantly by
province. In the northern part of
Katanga, for example, a province where
31% of all missed children are due
to refusals, 44% are due to religious
1 Health zones were in Katanga,Bas Congo, Bandundu andKinshasa provinces.
PercentAge oF MiSSed chiLdren in dr congo
due to reFuSAL, JuLy 2011
Source: Independent Monitoring data
10.1 – > 11.0
Missing value
1.0 – 8.0
8.1 – 10.0
reASonS For MiSSed
chiLdren in dr congo,
June 2011
Source: Independent Monitoring data
Other
Child not available
No team
Refusal to accept OPV
49.6%
22.9%
19.4%
8%
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d r c o n g o P O I O C O M M U I C I O S Q U R R U P D S P M B R 2 0 1 1
beliefs. In Bandundu province, almost
40% of parents who refused OPV said
it is because they believe that it is a
“dangerous vaccine.”
These differences highlight the impor-
tance of collecting and analysingsocial data at local levels to ensure
that communication, engagement,
and operational strategies are tailored
to the specic needs of particular
communities.
What are the ‘other reasons’for missing children?
As in several other countries, a large
proportion of children in DR Congo
are missed due to an assortment of
explanations, ambiguously classi-
ed by independent monitoring as
‘other reasons.’ This category – which
lumps together children missed due to
operational and social reasons – has
accounted for 50% of missed children
in the June campaign.
There is an urgent need to document
and unpack this data much more clearly
in the Independent Monitoring process.
The current lack of understanding of the
range of reasons why these children are
being missed means that neither opera-
tional nor communication plans can be
developed to effectively address them.
In the June campaign, not knowing why
we missed 50% of unvaccinated children
could potentially mean that we fail to
vaccinate several hundred thousand
children in subsequent campaigns.
The Government of DR Congo,
supported by UNICEF and the National
School of Public Health, is currently
implementing a qualitative study on
the reasons for missing children. The
results should be released by November
and will provide valuable insights into
underlying causes of missing children.
But Independent Monitoring forms
need to be rened to provide systematic
analysis on this critical issue.
CampaignawarenessAlthough DR Congo has had continued
high rates of campaign awareness this
past quarter (over 90% on average),
we are clearly failing to translate this
high awareness into a robust demand for
OPV, given the high rates of refusal across
the country.
Based on initial analysis from the
independent monitoring data, there is a
lack of trust in the safety of the vaccine,
accompanied in some cases with a low
felt need for vaccination. Anecdotal
reports suggest that parents don’t
understand why so many polio rounds
are needed, with a number of groups
politicizing the polio programme and
increasing the general mistrust. This
loss of public condence cannot be
overcome unless the current communi-
cation programme is overhauled in how
it is managed.
PArentS’ MAin reASonS
For reFuSing oPv in drcongo heALth zoneS with
higheSt reFuSAL, June 2011
Source: Independent Monitoring data
Other
Religious beliefs
Main decision makernot home
Do not trust the vaccine
Child sick
27%
21%
18%
9%
25%
‘Other reasons’ for missedchildren must be unpacked and
documented more clearly inIndependent Monitoring data. failure to understand why we
missed 50% of unvaccinatedchildren in June could meanthat we miss the opportunity
to vaccinate as many as 264,374
children in the next campaign.
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4 0 S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D d r c o n g o
Approximately 13,000 social mobiliz-
ers currently walk to their assigned 15
villages in 5 days - 2 days before, and 3
during the campaign. They announce
the campaign by megaphone, moving
quickly onto the next village. With
distances ranging somewhere between
one and 20 kilometers, this means that
the pressure to reach each village before
the vaccination team leaves gives them
little time to engage with communities
on a more meaningful level.
Social mobilizers need more time to
engage with communities and increase
demand for vaccination by explain-
ing the reasons for repeated rounds,
why OPV is safe and necessary, and the
importance of vaccination for children’shealth. This can be done by:
• Increasing the number of days
mobilizers spend in the eld before
the campaign giving them more
time with communities and laying
the groundwork for vaccinators to
arrive; and
• Providing mobilizers with bicycles
to enable them to travel the long
distances and arduous roads
more efciently.
he way forwardPutting non-endemic countries on
the same footing as endemic countries
requires substantial investment and
resources. UNICEF has developed an
Emergency Operational Plan that maps
out the resources required to win public
trust and social commitment to Polio
until 2013. This plan needs nancial
support if signicant results are to be
achieved. The priorities are as follows:
• Government and partners should
invest additional resources for
social mobilization in the highest
risk areas, and increase the amount
of time available to social mobiliz-
ers to meaningfully engage with
communities before the campaign
• Independent monitoring data
needs to be unpacked further.
Reasons for refusal are collected in
Independent Monitoring forms,
but they need to be systematically
analysed and published after each
round, together with other routine
indicators.
• The partners should consider how
to reach the large proportion of
children who are apparently not
at home when vaccination teams
arrive. Outreach and vaccination
at church services or other key
locations should be considered for
wider scale up.
• ‘Other reasons’ for missed children
need to be more clearly articulated in
Independent Monitoring forms and
in operational plans. Monitoring
quality standards should be
adopted so that this category does
not account for more than 20% of
missed children in any campaign
without corrective action.
Social mobilizers need moretime to engage with com-
munities and increasedemand for vaccination
by explaining thereasons for repeatedrounds, why OPV issafe and necessary,and the importance
of vaccination for
children’s health.
representative of the Congolese Ministry of Health (left)
meets with a leader from the Islamic community to ask for hisassistance promoting the upcoming second round of poliovaccination in the town of Djambala, in Plateaux Department.
UICF/HQ2010-2783/SSI
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Polio CommunicationsCountry Profiles
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S P M B R 2 0 1 1 P O I O C O M M U I C I O S Q U R R U P D d A t A P r o F i L e S4 2
MANAGEMENT
Polio communication staff in place at field level (%)
PROCESS
100
Missed children due to refusal July Risk Assessment (Q3) Level of risk
100
May Jun Jul
- - -
Source: UNICEF monitoring
Jun Jul
40
4040
100
40
100
In place
Districts that received the funds (%)
Districts that received the funds (#)
In place
4
4
1
1
-
Districts targeted (#)
May
40 40
100
100
100
100
100
1
1
1
Source of information on polio campaigns Low
Area%
In placeTarget
Polio communication staff in place at country level (%)
Source: UNICEF monitoring
Source: UNICEF monitoringSource: SIA Monitoring (PCA data) 2011
100
Source: Financial Monitoring data 2011
Afghanistan
Regions
Eastern Region
Western Region
South Eastern Region
Target
4
4
1
1
Low
High
High
High
Polio communication staff in place at country level
Polio communication staff in place at field level
Social mobilization funds are available in high risk
areas before SIA's
Social data is systematically used for communication
planning
Missed children due to refusal
Parents aware of campaign dates
Low
Moderate
Management
Process
Outcome
Social mobilization funds are available in high risk areas
before SIA's
National and sub-national plans
incorporate social data (Yes/No)
Provinces/ Districts
Jun Sep
Target
47 47
%
In place
100
TargetIn place
%
In place
4
Source: UNICEF monitoring
%
In place
-
100
100
SepArea
100
100
-
1
1
100
1
1
1
1
Southern Region 1
Jun
4 4
In place
4
1
1
Social data is systematically used for communication
planning
MAnAGeMenT
PRoceSS
fghanistangLoBAL coMMunicAtion indicAtorS
June–AuguSt 2011www.polioinfo.org
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d A t A P r o F i L e S P O I O C O M M U I C I O S Q U R R U P D S P M B R 2 0 1 1
OUTCOME
Parents aware of campaign dates (%)
15.66
Source: PCA data
Mass media Health service worker Interpersonal source
HRAs without
Communication input (Non
PCN) 73.93 64.58 70.06 5.69 8.08 10.96 9.86 14.87
Area May Jun Jul
42.8 39.81 31.97
Missed children due to refusal (%)
Jul
3.7
4.9
May Jun Jul May Jun Jul
Source of information on polio campaigns (%)
Source: Post Campaign Assessment data 2011
44.6
5
13.3
4.9
5.3
5.9
22.4
20.7
25.1
32
4.8
9.3
Kandahar CitySpin Boldak
Panjwayee
Maiwand
6.47.1
12.9
12.9
5.68.1
16.1
18.9
4.611.9
13.5
21.2
Source: SIA Monitoring (PCA data) 2011
Percentage of missed Children
JulJunMayArea
Afghanistan
Southern Region
Area May Jun
2.4 5.1
3.1 6.3
6.3
9
5.9
7.7
7.7
9.2
Source: Post Campaign Assessment data 2011
JulReasons for missed children (%)
Shah Wali Kot
Bust (Lashkar Gah)
Nada ali
Nawzad
Musaqala
Sangin
Dehrawod
Trinkot
Shahid hassas
Source: SIA Monitoring (PCA data) 2011
4.7
5.1
18.5
13.4
11.8
10.7
0
5.8 0
2.5
Trinkot
Shahid hassas
2.3
11.3
18.2
35.4
0
4.5
0
2.1
0
4.7
8.4
0
0
0.6
7.1
0
1.5
0
0.5
28.2
24.4
4.4
11.8
Nawzad
Musaqala
Sangin
Dehrawod
0
0
5
0.2
0.5
2.220.6
0
8.4
13.1
0
1.7
Afghanistan
HRAs (Southern Region)
Kandahar CitySpin Boldak
Panjwayee
Maiwand
Shah Wali Kot
Bust (Lashkar Gah)
Nada ali
13 HR Districts 10.5 12.5 10.4 13 HR Districts 2.3 4.8 4.7
HRAs with Communication
input (PCN) 64.69 57.93 60.83 36.6 33.36 21.27
016.5
0
0.314
0
6.9
9.2
0
Refusal toaccept OPV,
3.7
Noteam/teamdid not visit,
23.3
Child notavailable,
53.6
New born,sleep andsick, 18.5
55.81
68.58
51.76 52.19
0
20
40
60
80
100
June July June July
HRAs withcommunications input
HRAs withoutcommunications input
National data
fghanistangLoBAL coMMunicAtion indicAtorS
June–AuguSt 2011www.polioinfo.org
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IndiagLoBAL coMMunicAtion indicAtorS
June–AuguSt 2011
MANAGEMENT
Polio communication staff in place at field level (%)
PROCESS
Districts that received the funds (#)
Missed children due to refusal June Risk Assessment (Q3) Level of risk
Source: UNICEF monitoringSource: Independent monitoring data
86
Source: Financial Monitoring data 2011
Delhi
Bihar
West Bengal
Target
14
6
7
1
In place
Districts that received the funds (%)
In place
12
Districts targeted (#)
In place
Jul
6
6
1
6
UP
100
Source: UNICEF monitoring
Area Jun
Source: UNICEF monitoring 2011
Aug
65
100 1
1558
-
100
86
99
65
100
-
-
Low
Low
Moderate
Low
Polio communication staff in place at country level
Polio communication staff in place at field level
Social mobilization funds are available in high risk
areas before SIA's
Social data is systematically used for communication
planning
Missed children due to refusal
Parents aware of campaign dates
Low
Low
Management
Process
Outcome
Source of information on polio campaigns Low
Area
100
Jun
Yes
5330
%
In place
Polio communication staff in place at country level (%)
National and sub-national plans
incorporate social data (Yes/No)
Bihar
UP
Sep
14
6
34638
5686
32753 93
94
14 100
West Bengal 1778 1778 100 1558
37752
Jul Aug
Yes Yes
100
Source: UNICEF monitoring 2011
Social data is systematically used for communication
planning
Social mobilization funds are available in high risk areas
before SIA's
65
65
5581
7
%
In place
95
Jun Sep
Target
%
In place Target
86
100
39908
5636
Target In place
%
In place
6
1
Jun
MAnAGeMenT
PRoceSS
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OUTCOME
Parents aware of campaign dates (%) Jun
Source: Independent monitoring data
Mass media Health service worker Interpersonal source
-
7.7West Bengal 13.9 14.4 14.8 35.6 36 32.4 8.6 8.8 9.4Bihar 48.7 47.4 48.2 19 20.8 18 6.2 7
UP - - - - - - - -
Source: Independent monitoring data
Source of information on polio campaigns (%)
1.5
1.7
0.4
6.4
Area Apr May Jun
4.1
1.7
0.2
5.99 5.5
India
Apr May Jun Apr May Jun
West Bengal
Area Apr May
India 1 3.8
UP 1.3 1
West Bengal
-
1.2
0.3
5.3
Source: Independent monitoring data
Percentage of missed Children
JunMayApr Area
5
UP
Bihar
Missed children due to refusal (%)
Jun
-
2
0.3 Bihar 0.35 0.3
Reasons for missed children (%)
Source: Independent monitoring dataSource: Independent monitoring data
Bihar
Uttar Pradesh West Bengal
Refusalto
acceptOPV,1.7
ChildSick,3.4
Childnot
home,9.5House
Locked,6.1
Childout of
Village,79.3
95 9691 92
0
20
40
60
80
100
May Jun May Jun May Jun
Bihar CMC Areas Bihar Non CMC Areas UP CMC Areas
Refusal to acceptOPV, 0.2
Child not home,1.5
House Locked,30.3
Other reasons, 0.5
Child out of Village, 67.5
Refusalto
acceptOPV,5.9
ChildSick,12.2
Child nothome,41.4
HouseLocked,
40.5
oUTcoMe
IndiagLoBAL coMMunicAtion indicAtorS
June–AuguSt 2011
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MANAGEMENT
Polio communication staff in place at field level (%)
PROCESS
Source: UNICEF monitoring
Missed children due to refusal July Risk Assessment (Q3) Level of risk
100
May Jun Jul
Yes Yes Yes
Jun Jul
10
108
100
Districts that received the funds (#)
72
Districts targeted (#)
May
8 12
98.3
142
In place
59
%
In place
86 72
%
In place
83.7
Target
89.3
In place
142
58
Source of information on polio campaigns Moderate
Area%
In placeTarget
12
100
Source: Independent monitoring data
Source: UNICEF monitoringSource: Independent monitoring data
Source: UNICEF financial monitoring and reporting matrix
Nigeria
States
Target
157
58
In place
Districts that received the funds (%)
In place
Moderate
Moderate
High
Low
Polio communication staff in place at country level
Polio communication staff in place at field level
Social mobilization funds are available in high risk
areas before SIA's
Social data is systematically used for communication
planning
Missed children due to refusal
Parents aware of campaign dates
Low
Low
Management
Process
Outcome
Polio communication staff in place at country level (%)
Social data is systematically used for communication
planning
Social mobilization funds are available in high risk areas
before SIA's
National and sub-national plans
incorporate social data (Yes/No)
HR LGAs
SepArea
90
100
86
Jun
159
60
Source: UNICEF monitoring
%
In place
84
Jun Sep
Target
MAnAGeMenT
PRoceSS
igeriagLoBAL coMMunicAtion indicAtorS
June–AuguSt 2011
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OUTCOME
Parents aware of campaign dates (%)
6 51 46
-
Source: Independent monitoring data
Mass media Health service worker Interpersonal source
Non High Risk Areas - - - - - - - -
55High Risk Areas 17 19 15 3 3
Area May Jun Jul
Missed children due to refusal (%)
Jul
25
25
-
-
-
- -
Gombe - 8
Nigeria (HR States)
May Jun Jul May Jun Jul
FCT
6
6
6
-
4
Source: Independent monitoring data
Source of information on polio campaigns (%)
7
-
5
-
-
5
-
8
7
8
-
6
7
Jigawa
Kaduna
Kano
Area May Jun
Nigeria (HR States) 28 28
Bauchi - -
Jigawa
Kaduna
Kano
Katsina
Kebbi
Plateau
Sokoto
Yobe
Zamfara
Percentage of missed Children
JulJunMayArea
-
-
Bauchi
Borno
FCT
Gombe
8
7
7
10
7
10
-
Source: Independent monitoring data
Source: Independent monitoring data
7
5
- Borno 32 25
Source: Independent monitoring data
JulReasons for missed children (%)
6
7
6
6
8
9
8.2
9.8
-
6
8
6.9
Katsina
Kebbi
Plateau
Sokoto
Yobe
Zamfara
36 19 18
- 33 26
38 38 35
22 21 18
4 15 11
- - -
32 40 27
33 36 41
15 15 17
Refusal toaccept OPV,
25
No team/teamdid not visit, 9
Child notavailable,
66
Other reasons,
0
National data
98 98 98
80
100
May Jun Jul
HR states
oUTcoMe
igeriagLoBAL coMMunicAtion indicAtorS
June–AuguSt 2011
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MANAGEMENT
Polio communication staff in place at field level (%)
PROCESS
Missed children due to refusal July Risk Assessment (Q3) Level of risk
40
May Jun Jul
No No No
Source: UNICEF monitoring
Jun Jul
5
22
40
2
In place
6
2
1
1
48
Districts targeted (#)
May
5 5
75
66
33
67
33
3
4
4
12
In place
3
2
2
15
40
Source: UNICEF monitoring
Source: UNICEF monitoringSource: PCM data
100
Source: Financial Monitoring data 2011
Islamabad
Balochistan
Khyber Pakhtunwa
Punjab
Sindh
Target
10
3
1
3
In place
Districts that received the funds (%)
%
In place
Districts that received the funds (#)
82
In place
High
High
High
High
Polio communication staff in place at country level
Polio communication staff in place at field level
Social mobilization funds are available in high risk
areas before SIA's
Social data is systematically used for communication
planning
Missed children due to refusal
Parents aware of campaign dates
High
High
Management
Process
Outcome
Source of information on polio campaigns High
Area%
In placeTarget
4
Source: UNICEF monitoring
35.6
%
In place
100
Jun Sep
Target
100
560
71
%
In place
71
15
Target
75
75
80
Polio communication staff in place at country level (%)
Social data is systematically used for communication
planning
Social mobilization funds are available in high risk areas
before SIA's
National and sub-national plans
incorporate social data (Yes/No)
High Risk Districts
High Risk Areas (UCs)
SepArea
60
67
48
230
3
3
66
82
2
1
3
3
FATA 3
Jun
MAnAGeMenT
PRoceSS
PakistangLoBAL coMMunicAtion indicAtorS
June–AuguSt 2011
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OUTCOME
Parents aware of campaign dates (%)
-
Source: PCM data
Mass media Health service worker Interpersonal source
Sindh 25 27 - 17 16 - 18 12
-Punjab - - - - - - - - -Khyber Pakhtunwa - - - - - - - -
6
FATA 17 40 - 10 8 - 32 48 -
Balochistan 27 24 30 24 21 18 10 10
Jul Mar May Jul
Pakistan - - 30 - - 18 - - 6
Area Mar May Jul
Missed children due to refusal (%)
Jul
6
11
1
5
1
4
5 8
Punjab 2 2
Sindh 8 4
Pakistan
Mar May
Khyber Pakhtunwa
3.97
6.4
7.16
2.95
1.98
3.27
Source: PCM data
Source of information on polio campaigns (%)
3.25
5.02
7.01
3.65
1.62
3.47
Area May Jun
Pakistan 6 6
Balochistan 11 13
Percentage of missed Children
JulJunMayArea
3.08
1.7
2.28
Balochistan
FATA
Khyber Pakhtunwa
Punjab
Sindh
Source: PCM data
Source: PCM data
3.14
6.15
5.83 FATA 2 2
Source: PCM data
JulReasons for missed children (%)
Refusal toaccept OPV,
6
Noteam/teamdid not visit,
38
Child notavailable, 46
Other reasons, 8
National data
43 44
75
46
60
71
49
64
0
20
40
60
80
100
May Jul May Jul May Jun May Jul May Jul May Jul
Balochistan FATA Sindh DHSCODistricts
NONDHSCODistricts
Pakistan
oUTcoMe
PakistangLoBAL coMMunicAtion indicAtorS
June–AuguSt 2011
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MANAGEMENT
Polio communication staff in place at field level (%)
PROCESS
Missed children due to refusal July Risk Assessment (Q3) Level of risk
-
%
In place
-
July Aug Sep
- - -
In place
8
2
2
2
10366
Districts targeted (#)
Districts that received the funds (%)
Source: Independent monitoring data
-
821
2
Sep
-
--
Jun
100
July
- -
100
100
100 2
Source: UNICEF monitoring
Aug
2
Districts that received the funds (#)
In place
2
2
National and sub-national plans
incorporate social data (Yes/No)
Source of information on polio campaigns Moderate
Area%
In placeTarget
-
Source: UNICEF monitoringSource: Independent monitoring data
Luanda
Benguela
Lunda Sul
2
2
High
High
Moderate
Moderate
Polio communication staff in place at country levelPolio communication staff in place at field level
Social mobilization funds are available in high risk
areas before SIA's
National and sub-national plans incorporate social
data
Missed children due to refusal
Parents aware of campaign dates
LowLow
Management
Process
Outcome
Sep
Target
8 10366
%
In place
100
100
TargetIn place In place
100
%
In place
100
Polio communication staff in place at country level (%)
Social data is systematically used for communication
planning
Social mobilization funds are available in high risk areas
before SIA's
Luanda
Benguela
SepArea
Lunda Norte
Jun
100
100
100
Lunda Norte
Lunda Sul
215
Target
10366
Source: UNICEF monitoring
215 215
89 89 100 89 89
215 100
100
100
10366
821
100
821
2
8
2 821
8
Source: UNICEF monitoring
MAnAGeMenT
PRoceSS
ngolagLoBAL coMMunicAtion indicAtorS
June–AuguSt 2011
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Parents aware of campaign dates (%)
Source: Independent monitoring data
Mass media Health service worker Interpersonal source
-
Zaire - 31 - - - - - 53
5
-
Lunda Norte 54 - - 41 - - 32 -
Lunda Sul
Bengo
Bie
Cabinda
Cunene
Huambo
Kuando Kubango
Kuanza Norte
Kuanza Sul
Malanje
Moxico
Namibe
0
18
Area Apr May Jul
7
Benguela 34 28 - 27 - - 38 35 -
Luanda 75 79 79 27 11 9 8
Angola 43 40 55 30 11 9 36 35
Apr May Jul
-
-
13 -
Zaire - 3.9
Apr May Jul
Source: Independent monitoring data
Source of information on polio campaigns (%)
-
-
-
Luanda
Benguela
Lunda Norte
Zaire
0 -
Cabinda
Cunene
Huambo
Kuando Kubango
Kuanza Norte
- 2
7
-
-
4 7
- 3
Namibe
Source: Independent monitoring data
6
10
8
2
-
Angola
Missed children due to refusal (%)
Jul
Source: Independent monitoring data
July
10
9
2
-
-
3 -
- 6
11
- Benguela 0 0
Percentage of missed Children
JulMayApr Area Apr May
2 1.5
3
Angola
Bie 0 -
2
7
Source: Independent monitoring data
9
Area
57.1
Luanda
Lunda Norte
2
- 0 -
Reasons for missed children (%)
-
Malanje
Kuanza Sul
Moxico
-
- 6 -
- 4 -
3 -
- 5 5
- 6
Lunda Sul
Bengo
-
-
-
Uige
Lunda Sul
Bengo
Bie
Cabinda
Cunene
Huambo
Kuando Kubango
Kuanza NorteKuanza Sul
Malanje
Moxico
Namibe
Uige
- 33 -
- 5 2
--
-
4.5 -
- 0 0
- 0 -
- 2.9 0
0 -- 0 -
- 7.1 2
- 0 -
- 6.6 -
- 0 -
- -
- 80 -
- 45 -
- 52 -
- 19 -
- 46 -
- 55 73
- 39 -
- 31 -
- 49 -
- 20 -
- 58 -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- 58 -
- 60 -
- 23 -
- 26 -
- 63 -
- 27 23
- 35 -
- 29 -
- 34 -
- 57 -
- 18 -
44Uige - 32 38 - - - - 30
Refusal toaccept OPV,
1.5
Noteam/teamdid not visit,
39
Child notavailable,
39
Other reasons,
27
Mother notaware, 17
Child sick, 2
National data
9086
69
85 85 8488 94 96
79
91
8494
0
20
40
60
80
100
May Jul May Jul May Jul May Jul May Jul May Jul May Jul May Jul
Luanda Benguela Cunene Angola Uige Bengo Bie KuandoKubango
oUTcoMe
ngolagLoBAL coMMunicAtion indicAtorS
June–AuguSt 2011
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MANAGEMENT
Polio communication staff in place at field level (%)
PROCESS
Missed children due to refusal July Risk Assessment (Q3) Level of risk
100
%
In place
100
May Jun Jul
Yes Yes Yes
Source: UNICEF monitoring
Jun Jul
22
2222
100
Source: UNICEF monitoring
Source: UNICEF monitoringSource: Independent monitoring data
Source: Financial monitoring data 2011
Chad
Target
6
In place
Districts that received the funds (%)
In place
5 60
Districts targeted (#)
May
22 22
6
In place
Districts that received the funds (#)
In place
Low
Moderate
Moderate
Moderate
Polio communication staff in place at country level
Polio communication staff in place at field level
Social mobilization funds are available in high risk
areas before SIA's
Social data is systematically used for communication
planning
Missed children due to refusal
Parents aware of campaign dates
Low
High
Management
Process
Outcome
Source of information on polio campaigns Moderate
Area%
In placeTarget
22
Polio communication staff in place at country level (%)
Social data is systematically used for communication
planning
Social mobilization funds are available in high risk areas
before SIA's
National and sub-national plans
incorporate social data (Yes/No)
Regional
SepArea
83.3 123
Jun
6
Source: UNICEF monitoring
%
In place
48.7
Jun Sep
Target
123 57
%
In place
46.3
Target
100
MAnAGeMenT
PRoceSS
ChadgLoBAL coMMunicAtion indicAtorS
June–AuguSt 2011
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OUTCOME
Parents aware of campaign dates (%) Jul
No data
49
Source: Independent monitoring data
Mass media Health service worker Interpersonal source
Chad 27 20 20 - 16 15 63 56
Area May Jun Jul May Jun Jul May Jun Jul
Chari Baguirmi
Dar Sila
Guera
Hadjer Lamis
Mayo Kebbi Est
Mayo Kebbi Ouest
Moyen Chari
N'Djamena
Ouaddai
Salamat
Tandjile
Wadi Fira
Source: Independent monitoring data
Source of information on polio campaigns (%)
Salamat
Tandjile
Wadi Fira
9
17
7
3
8
15
Mayo Kebbi Est
Mayo Kebbi Ouest
Moyen Chari
N'Djamena
Ouaddai
Kanem
Lac
Logone Occidental
Logone Oriental
Mandoul
7
17
Logone Oriental
8
11
11
13
12
1413
Mandoul
11
7
18
3
14
-
25
5
-
-
4
22
23
29
7
9
7
7
44
Source: Independent monitoring data
Missed children due to refusal (%)
Jul
6
Area May Jun
8 5
Source: Independent monitoring data
Percentage of missed Children
JulJunMayArea
Chad
Barh El Gazal
Batha
Chari Baguirmi
Dar Sila
Guera
Hadjer Lamis
Kanem
Lac
Logone Occidental
14 Chad
Barh El Gazal
Batha
Source: Independent monitoring data
JunReasons for missed children (%)
45
6
9
9
-
16
18
24
-
-
11
6
8
17
13
5
56
-
5
7
-
11
1
4
-
-
-
4
-
-
-
16
10
-
16
4
4
11
2
3
0
13
-
5
8
0
13
1
-
16
-
0
7
0
0
10
1
0
8
20
-
16
5
0
-
1
-
3
0
0
-
1
0
-
0
17
3
1
3
Tibesti - 8 -
Ennedi - 16 -
Tibesti - 27 -
Ennedi 0 --
9
6
-
81
32
84
89
96
80
64
81
82
86
88
84
66
72
0 20 40 60 80 100
National
Barh El Gazal
Batha
Chari Baguirmi
Dar Sila
Kanem
Lac
Mandoul
Mayo Kebbi Quest
Logone Oriental
N'Djamena
Ouaddai
Salamat
Wadi Fira
Refusal toaccept OPV,
5
Noteam/teamdid not visit,
31
Child notavailable,
57
Other reasons,
7
National data
oUTcoMe
ChadgLoBAL coMMunicAtion indicAtorS
June–AuguSt 2011
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MANAGEMENT
Polio communication staff in place at field level (%)
PROCESS
Missed children due to refusal June Risk Assessment (Q3) Level of risk
100
May Jun Jul
Yes Yes Yes
Source: UNICEF monitoring
14-Jul 27-Jul
3
34
80
40
Districts that received the funds (#)
Districts targeted (#)
Jun
5 2
50
2
5
Source of information on polio campaigns Low
Area Jun Sep
Target
2
100
Source: UNICEF monitoring
Source: UNICEF monitoringSource: Independent monitoring data
Source: Financial Monitoring data 2011
Kinshasa
Provinces
Target
5
19
In place
Districts that received the funds (%)
Low
Moderate
High
Low
Polio communication staff in place at country level
Polio communication staff in place at field level
Social mobilization funds are available in high risk
areas before SIA's
Social data is systematically used for communication
planning
Missed children due to refusal
Parents aware of campaign dates
High
High
Management
Process
Outcome
5
%
In place
33
Target
5
Polio communication staff in place at country level (%)
In placeIn place
2
5
In place
%
In place
%
In placeTarget
Social data is systematically used for communication
planning
Social mobilization funds are available in high risk areas
before SIA's
National and sub-national plans
incorporate social data (Yes/No)
High Risk Districts
SepArea
40
26
7
Jun
5
10
Source: UNICEF monitoring
%
In place
7115
MAnAGeMenT
PRoceSS
Dem. Rep. of the CongogLoBAL coMMunicAtion indicAtorS
June–AuguSt 2011
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OUTCOME
Parents aware of campaign dates (%)
7 Dem.Rep.Congo 16 19.4 13.1
Missed children due to refusal (%)
*JulArea May Jun
Percentage of missed Children
*JulJunMayArea
Jun
Equateur -
13
-
6
3
23.3
5
9
5
5
5
-
22.2
8
3
Kinshasa
Western Kasai
Eastern Kasai
Bandundu
Dem.Rep.Congo 6 12
Source: Independent monitoring data
Mass media Health service worker Interpersonal source
27-Jul May Jun 27-Jul
Dem.Rep.Congo - 29 27 - 11 9 - 60
Area May Jun 27-Jul May Jun
-
- 7.4
Bandundu 16.5 20.3
Orientale 13.9 -
11.9
Bas Congo
Katanga
Maniema
North Kivu
21.3
Eastern Kasai
-
64
3
31.7
-
-
-
17.9
-
-
-
-South Kivu
13.1
9.7
Source: Independent monitoring data. *Jul-data value is for the date '27 July'.
Source of information on polio campaigns (%)
6
Bas Congo
Katanga
Maniema
-Orientale
10
9
4
6
-
-
-
6
-
-
-
5
7
-
North Kivu
South Kivu
4
Source: Independent monitoring data
-
- Western Kasai 6.1 -
Equateur 9.4 -
Kinshasa 23.5 19.5
-
12.1
-
Source: Independent monitoring data. *Jul-data value is for the date '27 July'.
-
Source: Independent monitoring data
Reasons for missed children (%)
Refusal toaccept OPV,
19.4
No team/teamdid not visit, 8
Child notavailable, 23
Other reasons,
49.6
National data
90
83
95
93
89
95
94
97
93
86
0 20 40 60 80 100
Jun
27-Jul
Jun
27-Jul
Jun
27-Jul
Jun
27-Jul
Jun
27-Jul
Jun
27-Jul
Katanga
Bas Congo
Bandundu
Western Kasai
Kinshasas
Dem. Rep. Congo
oUTcoMe
Dem. Rep. of the CongogLoBAL coMMunicAtion indicAtorS
June–AuguSt 2011
8/4/2019 Polio Communications Update Sept 2011
http://slidepdf.com/reader/full/polio-communications-update-sept-2011 58/58
www.polioinfo.org
For more information
Susan Mackay
Senior Communications dvisor
UICF
“Of the lessons learned in the past 85 years, none ismore important than the recognition that societaland political considerations ultimately determinethe success of a disease eradication effort.”
merican Journal of Public Health, 2000