Maternal and Child Survival Program Polio Communication Program Summary

"This work has been integrated so that each component reinforces the other - expert advice is supported by ongoing research and an evolving and widely disseminated knowledge base. This combination...will leave a legacy of policy advice, research, and disseminated knowledge."

The Maternal and Child Survival Program (MCSP) is a global 5-year cooperative agreement funded by the United States Agency for International Development (USAID) to introduce and support scale-up of high-impact health interventions. As part of this work, since 2014, MCSP has supported the global effort to eradicate poliomyelitis by providing expertise, research, and knowledge dissemination in communication. This end-of-project report details the nature of the work carried out by The Communication Initiative (The CI) through MCSP.

The work has been structured around the following main areas:

Providing expert technical advice on polio communication, including to endemic countries - examples:

• Supported a communication expert to participate as a member of Technical Advisory Groups (TAGs) in Afghanistan and Pakistan - During the 5-year time frame, there were 11 TAGs, which looked at the overall polio programmes in each country and made recommendations toward strengthening all aspects of polio work. For instance, TAGs have made recommendations to:
  • Improve the use of social data for planning communication activities at local levels, resulting in the development of new planning tools, such as challenge mapping in Pakistan and clustered missed children identification in Afghanistan;
  • Develop and implement strategies for using social media to respond to rumours, reduce the impact of false information, and disseminate accurate immunisation information, leading to the establishment of a social media cell in Pakistan and increased social media capacity in Afghanistan; and
  • Establish new communication approaches and materials for use in areas where security has compromised access, resulting in a range of new strategies and materials specifically designed for circumstances such as those in which house-to-house campaigns are prohibited.

  Each TAG produces a report, all of which are summarised on The CI's Polio Network website.

• Led or co-coordinated 3 Pakistan and 2 Afghanistan communication reviews. For example, reviews organised with the United Nations Children's Fund (UNICEF) Pakistan in May 2018 and April 2019 focused on social mobilisation, data use at local levels for planning, and improved communication interventions to reduce missed children. As reported here, the recommendations from the reviews were incorporated into annual polio communication work plans for UNICEF and into national emergency action plans, which guide national programme strategies and direction.
• Sent communication consultants to participate in 6 outbreak response assessments (OBRAs) in the Horn of Africa, Madagascar, and Lao PDR. Using the latter OBRA as an example, MCSP's involvement focused on developing the communication and social mobilisation elements of the response plan, with special reference to communication with a marginalised group, the Hmong, among whom the outbreak was centred.

Supporting peer-reviewed research to increase representation of practitioners in journal literature and conducting original research into under-researched areas - examples:

• Published peer-reviewed papers capturing field experiences from the perspective of polio practitioners in Africa and Asia - For example, in 2016, MCSP called on researchers, policymakers, and programme managers from a range of countries to submit papers that address critical issues related to the communication lessons and legacy of the Global Polio Eradication Initiative (GPEI) and the relationship between polio and routine immunisation (RI) programmes. This initiative generated 11 papers, 9 of which were published in the open-access journal Global Health Communication, and all of which were summarised and posted to The CI's Polio Network website and disseminated in a special edition of The CI's flagship e-magazine, The Drum Beat.
• Conducted 2 original research projects:
  • One, on household health decision-making in Nigeria, involved surveys of 3,306 respondents in 1,653 households in Sokoto, Kano, and Bauchi states of northern Nigeria. In addition to being shared in the form of a report and a peer-reviewed paper, this research was presented to the USAID Mission in Nigeria, the Nigerian government through the National Primary Health Care Development Agency (NPHCDA), the World Health Organization (WHO), and UNICEF. The research challenged long-standing polio programme assumptions on the importance given to religious leaders' opinions on health and offered new insight into community reactions to polio campaigns in areas where government services were limited.
  • Another project examined how different communities in Ukraine use social media to communicate and search for health information by applying a unique qualitative approach based on manual search and monitoring of popular and thematic social media spaces on Facebook and Vkontakte networks. The study was presented in Kyiv to government and polio partners, and its findings were incorporated into social media strategies for polio and RI.
• Wrote a number of publications for direct publication to The CI's polio Network website that attempt to capture polio lessons - For example, Influencing Change: Documentation of CORE Group's Engagement in India's Polio Eradication Programme captured lessons from CORE Group's experience with India's Social Mobilization Network from a practitioner's perspective.

Disseminating polio communication knowledge - examples:

• Engaged networks of people and organisations with an interest in social and behaviour change communication (SBCC) and, more narrowly, those working directly on polio and/or immunisation communication through The CI's website and online processes.
• Developed and expanded The CI's Polio Network website, a public, searchable platform receiving an average of 68 visitors per day with over 284,000 page views since July 2014.
• Created and posted over 700 summaries of polio knowledge to The CI's Polio Network website.
• Further disseminated that knowledge through newsletters, with 25 Immunisation, Vaccines and Polio: DB Clicks being sent out to an average of 11,000 subscribers and 18 special polio editions of The Drum Beat going out to approximately 47,000 subscribers each.
• Published 43 editorials sharing expert opinion from leaders in the field.
• Coordinated a process that brought USAID-funded polio partners together to share and consolidate polio communication lessons among themselves through in-person meetings.
• Facilitated dissemination and discussion of those findings in public spaces, such as the International SBCC Summit held in Indonesia in 2018 with peers from other sectors and agencies.
• Held training workshops on research methodology in Nigeria, the United Kingdom (UK), and the United States (US), and on social media analysis in Ukraine and the US.

"Looking to the next 5 years, the GPEI strategy underlines the importance of improved community engagement and communication for successful eradication...[which] will require ongoing expert technical advice, research, and knowledge sharing." To that end, based on the 5-year MCSP experience to date, the report offers recommendations for the GPEI related to:

Strategy:

• Build and/or strengthen strategic alliances and partnerships with national organisations in order to: strengthen capacities for delivering polio vaccine (for instance, through non-governmental organisations (NGOs) delivering basic health care), coordinate the delivery of other services that meet local priorities, and build broad-based social support for polio immunisation.
• Focus more attention on ongoing and consistent engagement with communities in order to build and maintain local commitment to polio immunisation.
• Improve responsiveness to other development issues and problems identified by communities and countries in order to combat frustration with the singular focus on polio eradication.
• Establish and/or expand sophisticated and responsive social media capacities using "natural" or pre-existing networks (rather than creating polio-specific networks) that are based on proven SBCC approaches in order to quell the social media rumours and false information that can quickly spread, causing panic and significant spikes in refusals.
• Review and filter the enormous amounts of communication data that the GPEI generages in order to make these data even more useful for planning and monitoring, especially at the local level.

Process:

• Ensure that non-GPEI partners continue to play a role in ensuring strong expert technical advice to TAGs and communication reviews in order to ensure that these bodies function independently in providing oversight.
• Continue to support the exchange of lessons and experiences among those working directly on polio eradication in order to inform and guide responses across a range of emerging issues.
• Develop a flexible research agenda in order to respond to gaps in research on issues such as working in conflict-affected areas, better understanding the decision-making processes of marginalised groups, developing methodologies for quickly assessing emerging issues at local levels, and assessing overall social dynamics without assuming that polio is, or should be, a major priority for caregivers.