Communication Support for the Pakistan Polio Eradication Initiative

This PowerPoint presentation was part of a June 2005 joint United Nations Children's Fund (UNICEF)/World Health Organisation (WHO) meeting dedicated to examining communication in the context of the final global push to eradicate polio. At this meeting, country-specific presentations were made by communication practitioners in 16 of the 21 countries which have experienced cases of wild poliovirus in 2004 and/or in 2005 (to June). The total number of global poliovirus cases increased from 784 cases in 2003 to 1,255 cases in 2004, with 1,004 cases reported to August 9 2005 (548 for the same period in 2005). Communication strategies presented at this meeting were primarily focused on:

1. Analysing the results of programmes implemented to June 2005, and
2. Detailing the planned communication programme for the next 6 to 12 month period, designed to support a reversal of the above trend and achievement of the goal of eradicating polio worldwide.

According to this presentation, Pakistan (one of 6 polio endemic countries), has experienced a consistent decrease in the number of poliovirus cases since 2003 as follows: 103 cases (2003), 53 cases (2004), and 10 cases to June 2005 vs 16 cases for the same period in 2004 (a 40% decrease). The communication strategy is two-fold, and is designed to:

1. Maintain high levels of polio immunisation coverage in the general population via broad advocacy and programme support communication, ensuring ongoing policy, awareness and commitment from the national to the community level; and
2. Provide intensive, targeted support activities based on the premise that, in order to effect the eradication of polio, the communication strategies must reach the persistent, low-level transmission virus reservoirs that are typically characterised by: impoverished families, living in multi-family homes, parents with no formal education, and children under 2 years old.

Mass media in Pakistan is utilised extensively to ensure wide coverage, with celebrity polio ambassadors including entertainers, sports figures, religious figures and political leaders making both personal and media appearances. Television has been reported as the most trusted source of information among all the mass media, and reaches over 89% of the population.

Messages are data driven. For example, one focal message designed to increase the proportion of caregivers understanding that oral polio vaccine (OPV) is safe for a child with fever or diarrhoea resulted in an increase of from 70% to 80% of those surveyed (from Dec 2004 to May 2005).

Polio programme communication has been gain-framed, using positive messages and vivid materials with a recognised "two-drop" logo and tag line, which have a reported 86% unprompted recognition. Materials are available in local language print and electronic media, with regionally appropriate images. The logo has also been incorporated into the Expanded Programme of Immunisation (EPI) messages.

In high-risk districts, process indicators include micro-planning, training, supervision and increasing the number of women vaccinators. Outcome indicators focus on coverage and known/suspected presence of the polio virus. District specific plans are developed with federal team assistance, and increased numbers of social mobilisation personnel including Communication Campaign Support Persons (CCSPs), Grassroots Mobilisers (GMs), Social Mobilisation Teams (SMTs), and women vaccinators. Specific activities are designed to reach female child caregivers, 55% of whom have been identified as being directly involved in decision making for the immunisation of their children.

Research methods and indicators are detailed in this presentation, including federal communication monitors, 3rd party campaign monitors, micro-studies and intensive coverage surveys in high-risk districts. A three phase National Research Effort is currently underway, with the final phase (Phase Three) to be completed in September 2005. Final evaluation indicators from this research will be used to evaluate the programme to date, and to guide activities in 2006.

The detailed research methods and indicators in this presentation include assessments as to whether discussions regarding OPV have been held (55% have discussed OPV with people in their community), and with whom; exposure to Polio Eradication Initiative (PEI) messages (nearly 70% report interpersonal as one source of polio/OPV information); attitude toward the safety of OPV (93% feel OPV is safe), and many more.

An evaluation of the High-Risk Strategy, comprising activities focused on reaching female child caretakers to improve access to children under one year of age is also detailed.

Finally, a summary of the follow-up to the Peer Review Panel recommendations from the prior year meeting held in New Delhi, India is provided (see also 2004 Peer Review Group Comments [PDF]).

In summary, this presentation indicates that there have been improvements in all aspects of both the campaign and surveillance over the past two years, as well as a steady decrease in virus transmission. A key remaining challenge is the acknowledged immunity gap in children under one year of age. All activities are directed towards increasing coverage in this group, including recognition that mothers are an important missing link in accessing these children.

National Immunisation Days (NIDs) are planned for June, August and September 2005, with Supplementary NIDs (SNID's) planned in November 2005. Four NIDs and 2 SNIDs are planned for 2006. However there is still a funding gap for both 2005 (US$1.7 million) and 2006 (US$3.6 million), reflecting the US$600,000 per NID cost, which must be filled in order for these planned activities to take place.

Click here to download the full PowerPoint presentation as a PDF file.