Post00296 SOCIAL MOBILIZATION TIPS 3 November 2000
CONTENTS
1. TIPS:SOCIAL MOBILIZATION AND COMMUNICATION SUPPORT FOR POLIO ERADICATION
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1. TIPS:SOCIAL MOBILIZATION AND COMMUNICATION SUPPORT FOR POLIO ERADICATION
This useful contribution from Ellyn Ogden, USAID, kindly shared with
Technet Forum, could be useful in your setting as you work towards reaching
your programmatic goals on way to global polio eradication.
The moderator's apologies for the posting delay.
Date: Thu, 27 Jul 2000
To: Technet Moderator
From: "Ellyn Ogden"
Subject: More Tips
Allan:
At urging of many colleagues in field, I've drafted a document called
"Helpful Hints on Social Mobilization for Polio Eradication." These hints
are based on findings from my own observations from grab samples conducted
during NIDs/SNIDs (8 NIDs/SNIDs/Reviews from 3 regions over past 24 months)
and from discussions with people at all levels in field.
I would appreciate it if you would please distribute attached document
via Technet. I encourage people to add their own ideas and suggestions to
those I've proposed.
Ellyn W. Ogden, MPH
USAID
Worldwide Polio Eradication Coordinator
___________________________________________________________________________
HELPFUL HINTS FOR SOCIAL MOBILIZATION AND COMMUNICATION SUPPORT FOR POLIO
ERADICATION
First Issued: February 2000
Revised: July 11, 2000
Drafted by: Ellyn W. Ogden, MPH
USAID, Worldwide Polio Eradication Coordinator
INTRODUCTION
Efforts to date have succeeded in immunizing the majority of children
(80-90%) against polio, a remarkable achievement in the many countries that
are resource-poor and/or in conflict situations. Country teams, as well as
thousands of in-country staff and volunteers, deserve a lot of credit for
their accomplishments so far.
Nonetheless, much work remains. We need to give extraordinary attention to
the details of the supply and demand barriers to reaching zero-dose
children if we are to interrupt virus transmission within the next 24
months.
In addition, we must all be mindful of the needs to minimize any negative
impact that polio eradication may have on health systems and to use all
opportunities to improve overall immunization and health services whenever
possible.
This document is intended to help fine-tune local planning for polio
eradication by providing a list of helpful hints for social mobilization.
Early and detailed local planning is critical. Developing a year-round
plan that covers both polio and routine immunization is ideal.
This is a living document. People can add to it to reflect their own
experience. If you add suggestions, please add your name and date after
the entry and continue to circulate it.
OVERVIEW OF TERMS
Cost-effective social mobilization and communication use the best channels
for sharing appropriate messages with a target population.
CHANNELS OF COMMUNICATION USED FOR POLIO ERADICATION INCLUDE:
* mass media such as TV, radio, posters, banners, print articles in
newspapers, microphones/ loudspeakers mounted on cars or rickshaws
("miking"), and
* interpersonal methods such as meetings with community and religious
leaders, information provided by health workers or volunteers to
caregivers, and talks and discussions at meetings of technical and
professional organizations.
MESSAGES CAN BE USED TO:
* advocate and motivate people to support polio eradication and the
strategies that are being used;
* provide information about where, when, and how vaccination is
scheduled and who is eligible and why;
* address common barriers and constraints to reaching every child;
and
* preempt misinformation that may crop up about the safety of the
vaccine.
MESSAGE TOPICS ON POLIO ERADICATION FOR KEY TARGET POPULATIONS
POLICY AND DECISION-MAKERS NEED TO KNOW:
* the magnitude and severity of the polio problem in their country or
their constituency;
* the annual expected savings to the Government once polio is
eradicated;
* the benefits of polio eradication activities to other areas of
public health (e.g. vitamin A coverage, improved surveillance);
* the steps necessary steps for achieving certification;
* the human and financial costs of eradication;
* a realistic timeline for eradication and for reaching important
benchmarks (e.g. interrupting transmission; finalizing containment;
maintaining surveillance at certification standards); and
* their roles throughout the year and what actions they can take to
improve performance (e.g. monitoring, agreeing to policy changes, making
speeches, releasing funds.)
CAREGIVERS NEED TO KNOW:
* when the NIDs/SNIDs are scheduled (day, times, hours of operation);
* where immunization is being provided (fixed sites; mobile teams;
house to house; workplaces; bus/train/airport stations; at national border
crossings);
* who is eligible/eligibility criteria (all children under five
regardless of previous immunization status, nationality or country of
origin, religion, socioeconomic status, caste, or registration status.)
* the vaccine is free of charge;
* the vaccine is safe - even if taken many times;
* sick children should be immunized too;
* polio vaccine prevents polio (the drops will NOT make the child
healthy or prevent against other illnesses);
* NIDs vaccination does not replace routine immunization.
* when each child is due for his next routine immunization;
* (if vitamin A is in NIDs,) when and where to bring their children
to receive subsequent doses of vitamin A; and
* to immediately report all cases of new floppy paralysis (AFP) in
previously healthy children under age 15 to the nearest health facility
with a refrigerator (communities and traditional healers or quacks should
also be told).
FOR AFP MESSAGES EMPHASIZE:
* NEW cases;
* Speedy reporting (need to collect stool samples ASAP); costs
incurred by the parent for bringing a child to the health post/surveillance
officer will be reimbursed if the stools are collected;
* Not to overlook the pre-walking children/infants: Report AFP if a
child/infant is experiencing weakness in their limbs -- unable to sit up or
crawl -- when they previously could. (As the eradication program becomes
more successful, cases will likely shift to these more susceptible, younger
age groups.)
* Depending on the country, it may be possible to include information
about the rehabilitation services that are available to children that turn
out to have polio as a means getting them identified faster.
Note: If basic communication between NIDs workers and caretakers is to
take place, programs must ensure an adequate number of health staff and
volunteers. Without this, NIDs workers will naturally focus on getting
drops in as many children as possible, and they may skip communication with
caretakers.
COMMUNITY AND RELIGIOUS LEADERS NEED TO KNOW:
* all of the above;
* how they can help mobilize their community and reassure parents
about the safety of the vaccine and the need for every child in the
community to be immunized;
* the immunization status of their community's children
* that they should help report to senior health officials if any
stock-outs of vaccine, vaccinators are not at post, vaccinators are rude or
unprofessional, or any other problem with their services arises;
* in conflict situations, extra effort may be needed to gain the
trust and confidence of each faction in order to gain their full
cooperation.
HEALTH WORKERS NEED TO KNOW (VIA TRAINING, MATERIALS, AND SUPERVISION):
DURING NIDS/SNIDS
* that they are an important source of information and that their
polite behavior, positive attitude, and words of encouragement and praise
will increase participation in NIDs/SNIDs as well as routine immunization.
* accurate information about the vaccine (safe, effective, prevents
polio); eligibility criteria for vaccination; and the routine vaccination
and vitamin A supplementation schedule.
* what to say and what NOT to say
THINGS TO SAY
* Thank you for bringing the child/children.
* It is an important to vaccinate your child. You are helping
prevent your child and other children in the community from getting polio.
If you vaccinate your child against DPT and measles you will prevent those
diseases too.
* How old is your child? Remember to get your child immunized on
schedule. Return [when] for the next routine immunization.
* The next NIDs/SNIDs are scheduled [when].
* Do you know of anyone in the community who is NOT participating?
If so, why?
* Are you aware of any new cases of paralysis in previously healthy
children?
THINGS NOT TO SAY
* These drops will make your child healthy.
* If the child is sick s/he doesn't need to be immunized.
* Don't feed the child until 30 minutes after vaccination.
DURING HOUSE-TO-HOUSE/CHILD-TO-CHILD IMMUNIZATION
Say and do all of the above, plus:
* ENTER each dwelling, schools, business, and ask for all eligible
children. Ask specifically about infants and sick children. In some
countries either girls may be excluded or boys may be considered too
precious to risk any side effects of immunization.
* Ask if there are any children who usually live in the place who are
not currently here; find out when they are expected to return.
* Go to areas where children are frequently missed: slums, high-rise
buildings, geographically hard-to-access areas. It is particularly
important for vaccinators, mobilizers and animators/"mikers" to be seen and
heard in these areas.
* Use local languages.
* Assure community participation by using guides from the community.
They should accompany the house-to-house teams into the dwelling,
facilitate communication, and help overcome reluctance if necessary.
Schoolchildren, teachers, TBAs/midwives, heads of village health councils,
village elders or others nominated by the community all make good guides.
MESSAGE DEVELOPMENT/OPERATIONS RESEARCH
Additional message development and refinement should be based on the
epidemiological data (characteristics of children with polio: gender, age,
location, previous vaccination status, religious/ethnic background, country
of origin, language spoken in the home, etc.); exit interviews/focus
groups/debriefing with vaccinators or other rapid research. If possible,
messages and materials should be pretested for local acceptance,
interpretation and persuasiveness.
CHANNELS OF COMMUNICATION
MASS MEDIA
* Coordination between the national and state/provincial levels is
critical to avoid duplication, assure mutually reinforcing activities, and
assure technically sound messages that are consistent at all levels.
* In most countries, radio reaches more people than TV.
* Radio and TV are likely to be more influential than print materials
(newspaper, posters, leaflets).
* Use radio and TV to provide time-sensitive information about the
NIDs: when, where, who is eligible, and what to expect (house-to-house,
go to fixed site, look for vaccinator with the 'official' armband, etc.)
* If there are special challenges, mass media can address these
issues too, in collaboration with technical experts, e.g. stress the need
for infants to participate, ethnic or religious minorities, etc.
* Although there is much variation among countries, TV may reach only
a small percent of those who are at highest risk. Usually it reinforces
participation among people who already seek immunization services.
Although the messages should be attractive, in local languages, technically
appropriate, and in a variety of formats (public service announcements,
news broadcasts, health reports, etc.) the time and resources spent on TV
should be a relatively small part of the budget and person-time. One target
group TV does reach is the "elites" and "middle class" and their household
help (gardeners, housekeepers, nannies), who may be reluctant to
participate in the NIDs. TV also reaches many politicians and other
decision-makers.
* Radio often reaches many more people. Public service
announcements, radio dramas, news reports, health and science reports and
even sports/celebrity reports can be very effective. Radio contests and
quizzes can be popular ways of increasing awareness about polio and EPI.
Whenever possible, information should be provided in local languages, by
locally recognized voices, e.g. celebrities, sports figures. Humor often
motivates better than scare tactics.
* Printed materials such as billboards, newspaper ads, leaflets, and
banners should contain both text and pictures. Information should be
provided in local languages. The main value of these is to create a
festive atmosphere and serve as reinforcement to information heard through
other sources (radio, TV, miking, street theater.) To meet this objective,
a detailed dissemination plan is needed to make sure the materials are
available at the local level prior to the NIDs, especially in areas of poor
past performance.
* Posters are proving to be the least useful method of providing
information -- and one of the most expensive, so limit the use of posters
and other printed materials. Most of the highest-risk populations are non-
literate and are better reached through interpersonal channels. Posters
are expensive to produce and disseminate, logistically difficult to
distribute in a timely manner, and rarely posted where they are seen by key
target groups. If they must be used, posters should be in local languages,
contain information that is relevant beyond a short time, e.g. the routine
immunization schedule, all NID dates for the coming year, messages about
AFP reporting. Leave a space to write in the location of the closest place
of vaccination.
INTERPERSONAL COMMUNICATION
Face-to-face discussion is considered to be the most effective method of
convincing people to do something. Hearing about an activity from someone
you trust or their emissary encourages participation.
* Every district and national microplan should include meetings
between the immunization staff and community and religious leaders, who in
turn can encourage their 'congregation/followers' to participate.
* Every community should identify a guide to accompany teams during
house-to-house immunization.
* Send mobilizers, animators, people with megaphones and mikes to
places where people may not have heard about the NIDs or immunization
activities. They should have a brief script to read (with enthusiasm; in
appropriate languages) and be instructed to move and speak slowly enough so
that the people can hear the complete message.
* Bad attitudes of health worker are one of the main reasons people
stop using public sector health services. A good attitude and words of
encouragement from health workers during NIDs can have a lasting payoff for
other health services. In some countries, the vaccinator may be the only
person from the health sector who has ever visited some villages - it is a
tremendous opportunity to encourage the use of other services.
MOBILISATION AND COMMUNICATION FOR SPECIAL CIRCUMSTANCES
MOBILIZATION AT THE BORDERS
Border crossings are frequently noisy, busy and chaotic. Early planning is
needed to coordinate activities for each country participating.
* Synchronize activities for 3-4 days.
* Prepare a "gateway" sign at the approach to all roads crossing the
border. The sign should include the following information in local
languages: Wipe out Polio. Polio immunization is provided free to all
children under 5 from any country. Prepare to stop for vaccinators. STOP
for DROPS (visual/pictures). Every Child Counts.
* If possible, put bricks/stones, etc. in the road to slow down
traffic and make screening easier. If appropriate, have the police stop
the vehicles.
* Have many vaccinators on the road with vaccine. An assistant can
mark tally sheet and provide Gentian Violet. Vaccinators and assistants
should wear identifiable clothes (such as an apron, armband, hat, or
teeshirt).
* Have mobilizers with megaphones/mikes making regular announcements.
CONFLICT COUNTRIES
* Use of international media is important to broadcast information on
"Days of Tranquility," encourage all factions to observe "safe passage" for
vaccinators, or to observe an informal "truce."
* Use locally influential and credible sources to liaise with various
factions and provide information, e.g. NGOs, Red Cross, religious leaders.
MYTHS AND RUMORS
* In some countries there are rumors and myths that the vaccine
causes sterility, mental illness, or HIV/AIDS. Other misperceptions
circulate as well. Countries should have a plan for addressing these
issues should they arise (see more on this below.)
* Have a contingency plan or information sheets readily available in
the event of a problem.
* Use networks rather than frontal attacks, e.g. visit national
religious coalitions such as a Council of Bishops rather than confront a
single religious leader.
* Use photos of recognizable icons if appropriate, e.g. Mother
Theresa giving polio drops.
PARTNER RECOGNITION
* Logos for all partners should be included on any social
mobilization materials developed. Not only does it give credit where
credit is due, but it helps motivate continued donor participation. These
should be less than 10% of the visual space.
* Partners should contribute to some sort of recognition for health
workers and volunteers, e.g. a certificate of appreciation or a newspaper
ad stating the government's and partners' thanks for their hard work.
Anything public should also note the progress made [feedback], but also
state that still more work is needed [avoid complacency] until
certification is achieved.
* Items such as teeshirts, caps, and aprons are good for motivating
health workers, for identifying the wearer as a member of the campaign and
for helping create a festive atmosphere. These items do little to convince
caregivers to vaccinate previously unvaccinated children. Limit these to
the minimum necessary and least expensive available in the country. These
are the types of items that private companies may be pleased to donate-as
long as their name and logo appear.
RESOURCE UTILIZATION
* When developing microplans for social mobilization, partners should
scrutinize the budgets and ask the following: Are the most cost-effective
approaches being used? Do the messages address the barriers and
constraints? Have messages and materials been pretested? Are these
activities given enough human and financial resources to get the job done?
Are we using the most effective channels of communication? What is the
level of effort required for conducting the mass media and interpersonal
activities? Is the balance right considering the needs of the program?
Are there new partners that can cover the costs, e.g. the commercial
sector?
* Has the program made the best use of animators at the local level?
Are there enough and are they well distributed? Did they start on time?
* Have government media channels been approached and linked into the
overall planning? Are the materials they are producing technically
appropriate? Are they distributed on time? Do they duplicate other
efforts?
* How are resources and results being used at the national,
state/province or lower level? What mechanisms are in place to assure
financial accountability and programmatic results? The ICC should address
these issues.
MONITORING
Grab samples done by supervisors and independent observers should include
questions on social mobilization such as:
* How did you hear about the NIDs? Who, what, when?
* Do you know when the next NIDs are?
* Do you know why these drops are being given?
* Do you know anyone who has not brought their child to be immunized?
If so, why haven't they?
* When should this child (if appropriate) return for routine
immunization?
* Do you know of any newly paralyzed child? (may need to probe)
Supervisors should understand these strategies and be able to re-direct
activities as needed at the district level and have access to the national
social mobilization coordinator if possible.
IDEAS TO PREVENT AND COMBAT NIDS FATIGUE
* Provide feedback to vaccinators.
* Tell them they have done a good job.
* Give them a challenge (look for more infants).
* Gather them together to debrief and offer ideas for improvement.
* Give public recognition (via radio, newspapers, public meetings).
* Send a letter to MOH and sub-national level praising their work.
* Encourage teamwork.
* Have teams sign a piece of paper certifying they have reached every
eligible child on their map.
* See how many pregnant women they can find during their house-to-
house activities and give praise for going back with TT.
* Sponsor radio listenership contests where people send in the name
of their vaccinators or surveillance officer for a drawing.
EVALUATION
At the end of the year's NIDs , it is useful to conduct a more extensive
review of what worked and what didn't in order to inform the next round of
planning.
____________________________________*______________________________________
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10 October 2000
To TECHNET Forum
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