Afghanistan Polio Communication Review - October 22 to 29 2013

"Public awareness was the key for the success we had - in the schools, the mosques - but now keeping polio-free is more important than becoming polio-free." - Governor of Kandahar, Afghanistan

This report from an Afghanistan Polio Communication Review assesses the efficiency and effectiveness of social mobilisation and communication strategies and makes recommendations to further improve the interventions that should be implemented in the 2013-2014 low transmission season, with a view to achieving Objective 1 of the Polio Eradication and Endgame Strategic Plan 2013-2018 to interrupt all poliovirus transmission by the end of 2014. Held from October 23-29 2013, the review gathered 7 people with backgrounds in communications, monitoring and evaluation (M&E), high-risk groups, media, and academia.

"Broadly, the Communications Review team found good reason to be cautiously optimistic about Afghanistan's potential to interrupt wild poliovirus transmission in the country in 2014. However, recent achievements in the South must be viewed in the context of an increasingly complex situation in the East, the ongoing pressures of cross-border importation from Pakistan, an impending national election, and politicization of polio vaccination by factions of the Taliban leading to significant pockets of chronically missed children on both sides of the border....While there are clear differences between the South and the East, there are also synergies. The polio communication programmes of both East and South need to work in the context of the National Emergency Action Plan and within a national programme structure that incorporates a media strategy, agreed indicators for tracking and measuring communication effectiveness and defined roles for social mobilization activities related to campaign quality. Within this national context they also have to adapt programming to local realities and conditions."

Major findings and recommendations are offered in sections of the report that focus on:

• Afghanistan's Immunization Communication Network (ICN), which "has become a respected part of an increasingly robust and impressive polio programme, particularly in the South." Yet "the ICN's impact will be limited. Why? Quite simply, male mobilizers cannot access mothers to seek out the newborn, sick or sleeping children, nor provide pregnant mothers with a package of information including the importance of colostrum and exclusive breastfeeding, of birth registration, routine immunization and young child feeding, of the need to wash hands with soap after disposing of the child's faeces or before preparing food, etc."
• Convergence, which "in the context of Afghanistan's polio communication programme is a two-way street. It means committing the infrastructure and finances of the polio programme to support and promote a wider range of child health interventions, and it means engaging NGO [non-governmental organisation] partners delivering health services and UNICEF [United Nations Children's Fund] sections working on other issues related to maternal and child health to focus their interventions in polio-priority areas and support and promote polio vaccination in their work. All of this is achievable with strong coordination and the commitment of dedicated human resources." One recommendation: Hire an external agency to develop a convergence toolkit of information, education, and communication (IEC) materials for non-literate audiences and fund materials where polio is not the primary message.
• High-Risk Groups - "It is no surprise to anyone working with high-risk groups in the region that open forums, meetings and discussions through mosques, Shuras and community elders councils are preferred for mobilization at the District and Village levels and high-risk groups are best reached through these community-level forums.....Immunizing children against polio is everyone's business and the more that can be done to ensure that polio is understood as a community good and a health service in demand alongside other much desired health interventions the easier it will be to reach hard to reach populations and the harder it will be to deny access."
• Monitoring and Evaluation - "Communications data collected during the campaign (from intra-campaign and supervisor checklists) are currently underutilized." One suggestion is that SMS (text messaging) data collection could be a useful tool for real-time management during polio immunisation campaigns, especially for managers to quickly view the performance of large numbers of campaign workers on the ground. This may also have the potential for post-campaign data collection. However, capacity for using SMS data collection tools by social mobilisers or cluster supervisors is "currently inadequate, thus limiting its use at the lower levels of the ICN. Nevertheless, it is possible to integrate the use of SMS over time..."
• Media and Information Education and Communication (IEC) - "Afghanistan has shown significant progress against previous media and IEC recommendations including rolling out the national mass media campaign 'Ending Polio is My Responsibility' and establishing a basic set of IEC materials including a recently developed but not yet deployed flip chart. Campaign awareness in Afghanistan has risen to >90% in the past 12 months." Recommendations in this area (media and IEC) include:
  1. Hire an external company with strong non-literate capacity to produce an expanded convergence IEC toolkit.
  2. Purchase megaphones for every communications cluster supervisor to announce when a vaccination team is entering the street. Expand use of mobile miking teams, particularly in large urban settings.
  3. Develop a cross-border media strategy with Afghanistan-Pakistan provincial teams.
  4. Due to data indicating that cost versus impact for TV public service announcements (PSAs) is sub-optimal relative to radio, explore reduction in TV expenditure and evaluate "source of information" accordingly.
  5. Request global/national partners to advocate telecommunication companies to release funding for SMS voice messaging to announce campaigns.
  6. Generate TV/radio programming/print coverage at provincial level in the local dialect via radio jockey/journalist workshops.
  7. Use professional agencies to paste posters/banners in urban settings and develop monitoring format for District Coordination Officer (DCOs) to ensure placement.
  8. Invest in permanent wall paintings (concrete barriers) and explore using schools to paint messaging.
  9. Hire a regional media specialist in the East as soon as possible.

Click here for the 30-page report in PDF format.