Pakistan Recommendations Report

This PowerPoint presentation was prepared for a September 2007 United Nations Children's Fund (UNICEF)-hosted meeting dedicated to examining polio communication efforts in Pakistan. In support of the final global push towards polio eradication, state-specific presentations were given by in-country communication and health practitioners working in Pakistan’s polio-endemic states (Sindh, Balochistan, and the Northwest Frontier Province). These were assessed by an external panel of experts in the fields of development communication, mass media, epidemiology, and anthropology, who provided communication programme recommendations based on data presented by the country teams, as well as data gathered on field visits to the endemic states. Communication strategies presented at this meeting were primarily focused on:

1. Analysing the results of programmes implemented through September 2007
2. Detailing activities on national and sub-national levels, specific to social mobilisation, community engagement, underserved areas, media, and political advocacy strategies
3. Suggesting communication strategy and programme refinements for the next 6- to 12-month period, designed to support Pakistan's polio eradication efforts

This set of slides was presented by the expert panel at the conclusion of Pakistan's polio communication review meeting, and comprises a set of programme recommendations focused on: maintaining polio eradication achievements; focusing strategies in high-risk areas; strategic approaches to communication activities and training; human resource needs; and follow-up to communication activities. Some of the specific recommendations in each of these areas are highlighted below:


Maintaining Achievements

It was noted that high overall immunisation coverage needs to be sustained across the population, through message development geared towards emerging concerns. It was also suggested that more accurate quantification and location of missed children is needed in areas in which accessibility is compromised due to security concerns.


A high level of political commitment to the programme was observed, and the panel suggested this be translated more effectively into action in the remaining endemic provinces in order to improve ownership in the programme. In addition, they felt that the elements of the PEI's broad-based media campaign should be assessed to guide allocation of resources and implementation of activities.


Focus Strategies in High-Risk Areas (HRAs)

It was felt that communication activities should be emphasised in high-risk sub-districts, and that data-driven communication strategies should be strengthened at the sub-district level through the following cycle:

• Use of control room and post-campaign monitoring (PCM) data to identify shortfalls in immunisation activity performance and to analyse trends
• Inclusion of previous social mobilisation and communication (SM/C) activities in trend analysis
• Assessment of intervention impact and development of indicators by which to assess future impact
• Modification of SM/C activities according to impact
• Conducting of programme activities
• Linking of impact data from SM/C activities to trends

Strategic Approach to Communications

Given the high number of communication activities that are being conducted in Pakistan's PEI programme, the expert panel felt a need for the next phase of the programme to become intensified through an evidence-based strategy. A model for this approach was diagrammed, and included components such as: a desk review of surveillance, PCM, and previous intervention data; trend analysis to identify reasons and patterns of unvaccinated children; identification of a locally appropriate strategy; implementation and monitoring of the agreed upon communication strategy; implementation of vaccination activities; and data collection and subsequent analysis to inform the next round.


Examples of how this model would work were given related to instances of “No Team” (where teams have inadequate access to households with children under 6 months) and “Refusals” (in which families are refusing to vaccinate their children for any number of reasons).


Training

The review panel felt there were gaps in vaccinator team performance related to access to households, quality of data recording and collection, monitoring and supervision, and social mapping. They suggest that the programme build on existing training modules and resources to include the following:

• Use of previous SIA data relevant to the area of the teams being trained
• Analyses and plotting of local realities (e.g. areas of low coverage or refusals) and use of social maps
• Strengthening of vaccinators' interpersonal communication (IPC) negotiating skills using household case studies
• Building of morale by providing a programme overview and global updates

The panel also emphasised the importance of monitoring the impact of improved trainings.


Human Resources

Provincial Level: The panel observed a gap in strategic communication capacity and leadership at the provincial level, and recommended that bridging this would require the creation of three long-term Programme Communication Specialist Posts. These posts would fill an independent critical analyst role working in conjunction with the provincial teams, and liaise with the federal teams to report on progress and impact of communication strategies. They described these individuals as people who had data analysis and communication strategy development skills with a focus on high risk districts, and that they should be experienced in monitoring and evaluation, as well as the polio programme.


District Level: The panel felt that the existing role of the District Health Communication Specialists was an important one, and recommended that it be ensured that all high-risk districts have one appointed. They also felt that these positions should be provided regular training on communication strategies and structured to fully utilise the expertise of the provincial specialist.


Follow-Up to Communication Activities

There were two main areas in which recommendations were noted related to the improvement of follow-up activities. The first would link the newly appointed Provincial Communication Specialist posts to partners through regular team leader meetings and a report-back mechanism for communication activities. The second involved expanding the mandate of the Technical Advisory Group (TAG) on polio eradication to include a communication expert focal point and a channel through which the Provincial Communication Specialists would be able to report directly to the TAG.


Click here to download the full PowerPoint presentation.


Click here to download a more detailed report of the recommendations as a Microsoft Word document.