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



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



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



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.




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




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




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.




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.




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


10.1 – 11.0

Missing value

1.0 – 8.0

8.1 – 10.0




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




‘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


0%

20%

40%

60%

80%

100%

DR CongoChadAngolaPakistanNigeriaIndiaAfghanistan

[no data]



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


SociAL dAtA iS SySteMAticALLy uSed

For coMMunicAtion PLAnning




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.



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.


PoLio coMMunicAtionS StAFF Are in PLAce At country LeveL


PoLio coMMunicAtionS StAFF Are in PLAce At FieLd LeveL


PercentAge oF high riSk AreAS thAt receive tiMeLy

coMMunicAtionS/SociAL MoBiLizAtion Funding



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.



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



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.


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


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


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%



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


PercentAge oF cAregiverS

AwAre oF PoLio cAMPAignS

in 13 high riSk AFghAniStAn

diStrictS, MAy–JuLy 2011


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



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.


in high riSk AFghAniS tAndiStrictS who LeArned

oF the PoLio cAMPAign

through interPerSonAL

SourceS, JuLy 2011


0%

5%

10%

15%

20%

25%

30%

35%

TeachersImamsElders

High risk areas with


High risk areas without




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

U n I C e F / I n D I a / 2 0 1 1 / C U R t I S



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


0%

2%

4%

6%

8%

10%

JuneMayAprilMarchFebJan

Uttar Pradesh

West Bengal

Bihar

“Protection from Polio: My Child,very ime, Until 5 ears”



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


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%



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



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


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



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.


AwAre oF PoLio cAMPAignS

in nigeriA, MArch–JuLy 2011


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



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


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



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.



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.


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


49%

35%

11%

6%




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



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



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




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



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.


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



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


AwAre oF PoLio cAMPAignS,

in AngoLA, MAy–JuLy 2011


0%

20%

40%

60%

80%

100%

JulyMayAprilMarFeb

reASonS For MiSSedchiLdren in AngoLA,

June 2011


Child sick

Mother not aware

No team

Child not available

Other

2%


32.1%29.6%

1.5%

36.0%

31.0%

3%



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


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



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



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


Other

Child not available

No team


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.



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.



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


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%



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.



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



10.1 – > 11.0

Missing value

1.0 – 8.0

8.1 – 10.0

reASonS For MiSSed

chiLdren in dr congo,

June 2011


Other

Child not available

No team


49.6%

22.9%

19.4%

8%



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


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.



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



Polio CommunicationsCountry Profiles



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 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


%

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


planning

MAnAGeMenT

PRoceSS

fghanistangLoBAL coMMunicAtion indicAtorS

June–AuguSt 2011www.polioinfo.org



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

oUTcoMe




www.polioinfo.org

IndiagLoBAL coMMunicAtion indicAtorS

June–AuguSt 2011

MANAGEMENT


PROCESS


Missed children due to refusal June Risk Assessment (Q3) Level of risk

Source: UNICEF monitoringSource: Independent monitoring data

86


Delhi

Bihar

West Bengal

Target

14

6

7

1

In place


In place

12


In place

Jul

6

6

1

6

UP

100


Area Jun

Source: UNICEF monitoring 2011

Aug

65

100 1

1558

-

100

86

99

65

100

-

-

Low

Low

Moderate

Low




areas before SIA's


planning



Low

Low

Management

Process

Outcome


Area

100

Jun

Yes

5330

%

In place




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


planning


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




www.polioinfo.org

OUTCOME

Parents aware of campaign dates (%) Jun

Source: Independent monitoring data


-

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 - - - - - - - -



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



JunMayApr Area

5

UP

Bihar


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




www.polioinfo.org

MANAGEMENT


PROCESS



100

May Jun Jul

Yes Yes Yes

Jun Jul

10

108

100


72


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: UNICEF financial monitoring and reporting matrix

Nigeria

States

Target

157

58

In place


In place

Moderate

Moderate

High

Low




areas before SIA's


planning



Low

Low

Management

Process

Outcome



planning


before SIA's



HR LGAs

SepArea

90

100

86

Jun

159

60


%

In place

84

Jun Sep

Target

MAnAGeMenT

PRoceSS

igeriagLoBAL coMMunicAtion indicAtorS

June–AuguSt 2011




www.polioinfo.org

OUTCOME


6 51 46

-



Non High Risk Areas - - - - - - - -

55High Risk Areas 17 19 15 3 3

Area May Jun Jul


Jul

25

25

-

-

-

- -

Gombe - 8

Nigeria (HR States)

May Jun Jul May Jun Jul

FCT

6

6

6

-

4



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


JulJunMayArea

-

-

Bauchi

Borno

FCT

Gombe

8

7

7

10

7

10

-



7

5

- Borno 32 25



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


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




www.polioinfo.org

MANAGEMENT


PROCESS


40

May Jun Jul

No No No


Jun Jul

5

22

40

2

In place

6

2

1

1

48


May

5 5

75

66

33

67

33

3

4

4

12

In place

3

2

2

15

40


Source: UNICEF monitoringSource: PCM data

100


Islamabad

Balochistan

Khyber Pakhtunwa

Punjab

Sindh

Target

10

3

1

3

In place


%

In place


82

In place

High

High

High

High




areas before SIA's


planning



High

High

Management

Process

Outcome

Source of information on polio campaigns High

Area%

In placeTarget

4


35.6

%

In place

100

Jun Sep

Target

100

560

71

%

In place

71

15

Target

75

75

80



planning


before SIA's



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




www.polioinfo.org

OUTCOME


-

Source: PCM data


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


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


3.25

5.02

7.01

3.65

1.62

3.47

Area May Jun

Pakistan 6 6

Balochistan 11 13


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



6


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




www.polioinfo.org

MANAGEMENT


PROCESS


-

%

In place

-

July Aug Sep

- - -

In place

8

2

2

2

10366




-

821

2

Sep

-

--

Jun

100

July

- -

100

100

100 2


Aug

2


In place

2

2




Area%

In placeTarget

-


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


areas before SIA's

National and sub-national plans incorporate social

data



LowLow

Management

Process

Outcome

Sep

Target

8 10366

%

In place

100

100

TargetIn place In place

100

%

In place

100



planning


before SIA's

Luanda

Benguela

SepArea

Lunda Norte

Jun

100

100

100

Lunda Norte

Lunda Sul

215

Target

10366


215 215

89 89 100 89 89

215 100

100

100

10366

821

100

821

2

8

2 821

8


MAnAGeMenT

PRoceSS

ngolagLoBAL coMMunicAtion indicAtorS

June–AuguSt 2011




www.polioinfo.org




-

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



-

-

-

Luanda

Benguela

Lunda Norte

Zaire

0 -

Cabinda

Cunene

Huambo

Kuando Kubango

Kuanza Norte

- 2

7

-

-

4 7

- 3

Namibe


6

10

8

2

-

Angola


Jul


July

10

9

2

-

-

3 -

- 6

11

- Benguela 0 0


JulMayApr Area Apr May

2 1.5

3

Angola

Bie 0 -

2

7


9

Area

57.1

Luanda

Lunda Norte

2

- 0 -


-

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


1.5


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




www.polioinfo.org

MANAGEMENT


PROCESS


100

%

In place

100

May Jun Jul

Yes Yes Yes


Jun Jul

22

2222

100



Source: Financial monitoring data 2011

Chad

Target

6

In place


In place

5 60


May

22 22

6

In place


In place

Low

Moderate

Moderate

Moderate




areas before SIA's


planning



Low

High

Management

Process

Outcome


Area%

In placeTarget

22



planning


before SIA's



Regional

SepArea

83.3 123

Jun

6


%

In place

48.7

Jun Sep

Target

123 57

%

In place

46.3

Target

100

MAnAGeMenT

PRoceSS

ChadgLoBAL coMMunicAtion indicAtorS

June–AuguSt 2011




www.polioinfo.org

OUTCOME

Parents aware of campaign dates (%) Jul

No data

49



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



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



Jul

6

Area May Jun

8 5



JulJunMayArea

Chad

Barh El Gazal

Batha

Chari Baguirmi

Dar Sila

Guera

Hadjer Lamis

Kanem

Lac

Logone Occidental

14 Chad

Barh El Gazal

Batha


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


5


31

Child notavailable,

57

Other reasons,

7

National data

oUTcoMe

ChadgLoBAL coMMunicAtion indicAtorS

June–AuguSt 2011




www.polioinfo.org

MANAGEMENT


PROCESS

Missed children due to refusal June Risk Assessment (Q3) Level of risk

100

May Jun Jul

Yes Yes Yes


14-Jul 27-Jul

3

34

80

40



Jun

5 2

50

2

5


Area Jun Sep

Target

2

100




Kinshasa

Provinces

Target

5

19

In place


Low

Moderate

High

Low




areas before SIA's


planning



High

High

Management

Process

Outcome

5

%

In place

33

Target

5


In placeIn place

2

5

In place

%

In place

%

In placeTarget


planning


before SIA's



High Risk Districts

SepArea

40

26

7

Jun

5

10


%

In place

7115

MAnAGeMenT

PRoceSS

Dem. Rep. of the CongogLoBAL coMMunicAtion indicAtorS

June–AuguSt 2011




www.polioinfo.org

OUTCOME


7 Dem.Rep.Congo 16 19.4 13.1


*JulArea May Jun


*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



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'.


6

Bas Congo

Katanga

Maniema

-Orientale

10

9

4

6

-

-

-

6

-

-

-

5

7

-

North Kivu

South Kivu

4


-

- 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'.

-




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



www.polioinfo.org

For more information

Susan Mackay

Senior Communications dvisor

UICF

[email protected]

“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

Polio Communications Update Sept 2011

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