Polio Communication Review India 2008 - Phase 1: Uttar Pradesh, Meerut Sub-region Report

This report details the findings of the consultant team sent to the Meerut sub-region of Uttar Pradesh state in India to generate context-specific recommendations towards developing an effective communication response addressing the polio eradication problem of "missed" children due to migration patterns.

The methodology used by the consultant team included:

1. Analytical study of district- and block-level data.
2. Rapid Appraisal using qualitative techniques of enquiry, including: focus groups, in-depth interviews, and observations.
3. Consensus-building through meetings with key sub-regional partners to identify and agree upon priorities for action. These findings were then presented to United Nations Children's Fund (UNICEF) staff at the regional and national levels.

Strengths of the programme:

1. There is strong community awareness of polio and the polio vaccine dose.
2. Competent and motivated staff at all levels.
3. Strong UNICEF Social Mobilisation Network (SMNet).
4. Excellent recording and tracking system, with robust supervision.
5. Positive support from public sector officials.
6. Good team co-ordination at the field level.
7. Effective booth-day organisation with good use of children as messengers. Display boards at some booths show where maximum emphasis for immunisation needs to be placed. Posters are placed in locations to ensure maximum visibility.
8. Effective use of one-on-one and group interpersonal communication (IPC) by frontline workers.
9. Underserved outreach efforts are comprehensive and effective.
10. Engagement and mobilisation of religious leaders/teachers is impressive. Development of effective information, education, and communication (IEC) materials (i.e., showing links between health and religious texts); use of madarsas (schools) for polio classes; mosque announcements; and participation of Aapas (respected women who deliver talks related to religion, morality, and holy books) and other religious influencers.
11. Good system of informants and influencers.
12. Effective social mapping of resistant families, innovative concept of SMART (Specific, Measurable, Achievable, Relevant, Time-Specific) teams, and the directory of influencers is reflective of thoroughness of effort.
13. Special efforts to cover migrant children in 4-month period have been initiated, but could be taken further.
14. Commendable effort to cover brick kiln children with mobile teams can be expanded and strengthened.
15. Effective work with the press, including efforts to counter negative press.

Challenges faced:

1. Low routine immunisation (RI) coverage.
2. Human resource issues: vacant positions and inadequate numbers of positions sanctioned.
3. Linkage between sanitation and polio relatively weak in community perceptions, which is reflective of a reduced emphasis on the link from a programmatic perspective.
4. Growing linkage of polio with development issues; polio used as a bargaining strategy by some communities.
5. Continuing/persistent barriers to immunisation include: continued misconceptions about link to fertility and side effects of dose; questions on perceived "excess" efforts on polio; quality of free medicines doubted in some places; preference for private practitioners expressed; excessive medicine seen to be detrimental to health; and polio fatigue setting in.
6. Lack of interstate co-ordination and notification on migration.
7. Immunisation cards not valued and often misplaced by families.
8. Apathy towards accessing RI.
9. Transit teams have low morale and immunise relatively low numbers.

Key opportunities and challenges:

This report notes that at this juncture of the polio eradication effort, highly focused, specific interventions can make a significant difference. With a population generally familiar with the "2 drop" polio message but becoming fatigued with repeated rounds, a subtle shift in messaging can help sustain interest and enable the population to better understand health concepts such as immunity. Subtle messaging building on the "2 drop" concept can also be used to raise the cultural value and appreciation of the immunisation card and, if specially addressed to migrant workers, can enhance appreciation and willingness to utilise the months they spend in their home village to maximise the immunisation coverage their children have. Strengthening workplace immunisation programmes to capture missed children, mobilising brick kiln owners to ensure full immunisation and documentation of children present at kilns, advocating for policies that promote more comprehensive immunisation coverage, and increasing the role of multiple stakeholders in the polio eradication effort can all help make a difference in outcome.

The team made several recommendations after consultation with district- and state-level polio staff and partners, which can be found in the report.

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