The Listening Project

Pakistan is one of the last two countries where wild poliovirus remains endemic, along with neighbouring Afghanistan. To interrupt the transmission of wild polio, the group is focusing efforts on reaching all eligible children through repeated high-quality vaccination campaigns. Frontline health workers are the programme's most valuable asset in this effort, and over 60% in Pakistan are women. In certain communities, women can enter homes where men cannot, helping ensure access and building trust with families. Until now, there had been no systematic way to hear from female frontline workers rapidly and at scale or to implement solutions to polio eradication barriers based on their experiences. The Listening Project seeks to fill this gap.  

In particular, the Listening Project seeks to:
 

• Systematically listen to female frontline workers to understand their perspectives on the challenges facing polio eradication;
• Co-design solutions with female frontline workers to improve their experiences and overcome obstacles to deliver a polio-free Pakistan; and
• Identify pathways to supporting female frontline workers in their transition to post-polio careers.

The project is being implemented in the following three phases:  

Phase I: Listening
In August 2022, The Listening Project set out to systematically collect data from health workers at scale. An independent research company was brought on to conduct randomised, anonymous phone surveys of more than 2,600 frontline workers from 25 districts at the highest risk of polio outbreaks across the country. Through these surveys, the programme began to identify some of the most prevalent challenges facing frontline workers and their work to reach children with polio vaccines.

With this information, the programme then designed and conducted 14 workshops to hear directly from female frontline workers about their experiences and solutions to overcoming the most pressing barriers. In all, frontline workers provided more than 300 unique solutions to overcome key polio eradication barriers. The workshops also went beyond the polio programme, as women were encouraged to share their hopes for careers post-eradication, which included supporting other health programmes in their communities, poultry farming, and running online businesses.

Phase II: Rolling Out Solutions
In the next phase, the national and provincial emergency operations centres (EOCs) reviewed and prioritised the highest impact solutions to overcoming remaining barriers. These proposals ranged from higher pay for health workers to improved pre-campaign training to special considerations for women who are pregnant or breastfeeding.

As of the end of 2023, some of the solutions were being implemented, such as the development of new and tailored trainings for all frontline workers on key topics raised by refusal families, anti-harassment policy to better safeguard and support frontline worker teams, increased remuneration for all frontline workers to acknowledge their efforts for the polio programme, and official ID cards for all frontline workers to improve their credibility in communities.

Phase III: Preparing for the Future
The final phase of the initiative seeks to ensure that the hundreds of thousands of female frontline health workers in Pakistan have the tools and support to continue into other livelihoods once polio has been stopped for good. To best support this transition, the programme began piloting "upskilling" workshops in 2023, focusing on soft skills such as digital and financial literacy as well as a range of business skills. With support from expert external partners across the country, the polio programme is working to roll out upskilling sessions, trainings, and other support programmes designed to meet the needs of participants over the coming years.

Polio, Immunisation, Gender