Independent Monitoring Board of the Global Polio Eradication Initiative: Eighth Report - October 2013

"Insecurity, targeted violence and bans; communications and social mobilisation; management and oversight of the global program - these are make or break issues for global polio eradication."

This eighth report follows from the ninth meeting of the Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative (GPEI), held in London, United Kingdom (UK), from October 1-3 2013. At this meeting, the IMB met representatives of the remaining polio-endemic countries (Afghanistan, Nigeria, Pakistan), as well as those from countries suffering major outbreaks (Somalia, Kenya). Representatives from Israel were also called to the meeting. Those from Ethiopia and West Bank and Gaza Strip were unable to attend. The IMB assessed 3 broad areas of the GPEI's performance - one finding was that, in 2013, endemic cases have decreased, but major Horn of Africa outbreak puts the global total up. It also addressed "three topics of crucial importance across the global program:

• Insecurity, targeted violence, and impositions of vaccination campaign bans, the nature and intensity of which are unprecedented - and which now represent the single most difficult barrier to stopping transmission globally;
• Communications and social mobilisation - the major focus of the IMB's previous report, and an area in which performance still needs to be sharpened;
• Management and oversight of the global program at its headquarters (and regional office) level, which are creating impediments to the chances of stopping polio transmission that need urgent action."

In the area of communication and social mobilisation, which the IMB has prioritised as a game-changer, the report notes that the programme's front line involves "tens of thousands of interactions between vaccinators and families on every day of a polio vaccination campaign. Families are not passive recipients of polio drops for their children. They may not open the door, may choose to hide their children away, refuse the drops point-blank, or make excuses. They can fall victim to rumours against the vaccine - or they can talk positively about it, and ensure that community leaders know that it is something they want. They can choose to stay at home on the day they know the vaccinators will call, to ensure that their children are not missed."

It is noted here that a "community engaged with the wish to protect their children is a community that will eradicate polio." Especially in cases of insecurity and inaccessibility, described here as the major barrier to eradication in a number of the remaining endemic sanctuaries, "it is vital that the program is perceived as neutral. Here the most skilled and innovative communication methods are required. In other sanctuaries, community demand just needs to be tapped."

Looking ahead in the area of communication and social mobilisation, the IMB recommends:

• Achieving operational excellence with a cadre of 19,000 social mobilisers, which means helping each recruit become one who is able to engage local actors in the community, build trust, and gain access. "The aim is to build a workforce of self-starters who use their own knowledge of local context to find creative ways to open doors, who can find ways to build demand, and who develop innovative solutions to seemingly intractable problems. The best of them instinctively know the value of listening as well as talking. Increasing the number of women in this workforce will inevitably increase their success."
• Generating high-quality data, described here as "crucial in the social mobilisation network - both to its national and international-level managers, and to those at the front-line....These data need to capture population and household sentiments as well as mobilisers' activities. They need to inform action, by being operationalised as macro- and microplans. Systems to gather and record data on attitudes and motivation of families and communities must be prioritised. So too must such data's incorporation into dashboards and surveillance tools, which give them equal prominence to epidemiological data....[G]ood qualitative data is important to ensure that demand creation fits well with community needs."
• Putting more emphasis on proactively identifying and addressing early communications risks.
• Recognising a neglected area: the potential benefit of gender-based strategies. "The impact of fostering the nurturing instincts of women and the protective instincts of men could do much to break down barriers that are currently impeding vaccination of many children. This is all part of the ongoing quest to find new solutions to longstanding and recurring problems in areas affected by polio, particularly if they shift the focus from providing information to generating demand."
• Carefully designing communication, which is characterised in the report as an essential ingredient in the motivation and support of frontline polio workers.
• Working with a diverse range of partners, especially those with sophisticated local knowledge matched with expertise and experience on a wider scale so that polio vaccine, given alongside other health and public services, "shifts from a negative and isolated vertical program to becoming part of a package of care which is valued and sought after by communities and their members. Aligning what communities need with what they want is the ultimate goal of this field of endeavor."
• Galvanise the potential for greater links between polio and other programmes, such as the opportunity to work far more closely - in both delivery and communications - with the measles and rubella initiatives.

In conclusion, the report notes that the goal of stopping polio transmission by the end of 2014 "now stands at serious risk." Fourteen recommendations are made, including recommending that all means be used to ensure that the polio programme in every country is known to be politically neutral.

Click here for the 60-page report in PDF format.