Evaluation of the Strategies of Social Mobilization For The National Immunization Days (NIDS) in Niger

This report states that since 1997, Niger has embarked on yearly polio eradication campaigns to increase polio immunisation coverage. However, the country has been faced with a number of challenges. Upon the recommendation of WHO and the Inter-Agency Coordination Committee, a "mop-up" vaccination campaign to further reduce the incidence of polio was organised in January 2002 in 26 Districts out of 42 with the districts bordering Nigeria and Benin. Two mop-up sessions were also conducted in 12 selected districts in May and June, and National Immunisation Days (NIDs) were held in October and November of 2002.

A social mobilisation strategy was implemented by raising awareness, providing information to and communicating with the general public. Sub-strategies were developed to reach and involve local opinion leaders, animators, traditional communication networks, associations and NGOs, populations living in hamlets, camps, and tribes never touched by the NIDs. Print media, radio and television, and public and private theatre were used in strategies to reach these unreached audiences as well.

The overall goal of this evaluation was to assess the effectiveness of the social mobilisation strategies and activities that were conducted before and during National and Local Immunisation Days. The specific objectives were:

• investigate each sub-strategy used in social mobilisation since the onset of the 2000 NIDs and
  assess its impact on behaviour change among the population of Niger;
• undertake a rapid assessment of sources of information on polio eradication according to sex, age, and area of residence;
• examine educational material used by health workers for each social mobilisation strategy used during NIDs;
• formulate innovative, replicable, sustainable strategies that could be used to improve social mobilisation activities.

The evaluation used a five-pronged approach to assess the effectiveness of the social mobilisation strategies and activities during the NIDs. This approach consisted of the following elements:

• Reviewing of available literature on polio eradication and social mobilisation activities for immunisation in Niger.
• Process evaluation in order to measure how well social mobilisation activities were conducted.
• Caretaker survey: A questionnaire was designed to capture caretakers’ sources of information about NIDs in the past 12 months and recall of message topics disseminated during NIDs.
• Vaccinator and mobiliser survey: Two other questionnaires were developed to collect information on the training and experiences of vaccinators and mobilisers, the type of information that is communicated by vaccinators and mobilisers during the immunisation activities, and the extent to which vaccinators and mobilisers were able to reach special groups with NIDs messages in the past 12 months.
• Carrying out of qualitative methods: focus group discussions were conducted among male community members.

Findings

The focus group discussions revealed generally positive attitudes towards polio eradication and NIDs, although participants did acknowledge that in the past, there was greater opposition to these efforts. Changing attitudes were attributed to the intensive social mobilisation and sensitisation efforts, a recognition that polio immunisation promoted children’s health, and a perceived reduction in the number of new cases of AFP in the communities examined. The following are some of the observations from the focus group discussions:

• Radio, television, traditional leaders and town criers were the primary communication
  channels.
• There is insufficient knowledge about polio, the diseases against which children are
  immunised, and childhood vaccination in general.
• There is a lack of understanding (bordering on suspicion) as to the rational behind the coexistence of routine polio vaccinations and NIDs. Suspicions are accentuated by the fact that vaccines given during NIDs were free and that health workers actually come to the
  door to vaccinate children.

The evaluation states that the caretakers of the household survey were predominantly female, although there were more male caretakers in the rural areas. About 30 percent of the total sample was literate. Eighty-five percent of caretakers lived in households that owned a radio and 19 percent lived in households that owned a television. As expected, literacy level, and radio and television ownership were higher in the urban than in the rural locality. Both rural and urban caretakers preferred listening to the radio in the morning, about 45 percent preferred listening to religious preaching on radio or television, and about 23 percent to news in the national languages. Other findings included:

• Levels of exposure to NIDs messages disseminated through radio are high. Eighty-five percent of rural residents and 98 percent of urban residents ere exposed to NIDs messages disseminated through radio in the past 12 months.
• Channels such as television, posters and banners had a significantly wider reach among urban than rural caretakers. Whereas 11 percent of rural caretakers were exposed to NIDs messages on posters, 49 percent of urban caretakers were reached through this channel.

Conclusions and Recomendations

The evaluation highlights the strengths and weaknesses of social mobilisation strategies conducted in conjunction with NIDs during 2000-2002. The recommendations from the evaluation are the following:

1. Target advocacy and social mobilisation activities at the commercial sector.
2. Continue dissemination of NIDs messages through radio and traditional leaders; recognise and supervise town criers and extend their role to disseminating messages on routine immunisation
3. Expand role of the Social Mobilisation Sub-Committee so that it is active throughout the year and not just at periodic intervals related to the launching of NIDs. All NIDs supporters including members of the social mobilisation sub-committees need training on the basics of advocacy, interpersonal communication and key messages if they are to plan and carry out social mobilisation activities effectively.
4. Strengthen the planning process at the district level. In relevant districts, social mobilisation activities for polio eradication and Local Immunisation Days should be planned to coincide with the annual gathering of Nomads during the Cure Salée at Ingall.
5. Strengthen training on interpersonal communication for and supervision of communication activities of vaccinators and mobilisers. The results of the vaccinator and mobiliser surveys demonstrate that there is an urgent need to improve personal communication skills among mobilisers and vaccinators. Conduct separate/specific training sessions on social mobilisation and interpersonal communication for vaccinators and mobilisers.
6. At the end of training, assess vaccinators' and mobilisers' knowledge of key immunisation
   messages for caregivers; make accurate knowledge of immunisation messages a criterion for recruitment for NIDs.
7. Expand the evaluation of social mobilisation strategies to the national level, using scientific
   and probabilistic methods of sampling.