Social Mobilisation/Communication Polio Eradication Partnership - Pakistan

The interpersonal communication associated with each round of NIDs/SNIDs is central to this programme's SM/C approach. Each round begins with house-to-house days with temporary and permanent (EPI) fixed sites as back-up; this strategy assumes a general level of willingness at the doorstep, backed by voluntary action at the fixed site only where the doorstep oral polio vaccine (OPV) opportunity is missed. Pakistan's vaccinator teams (VTs) comprise two people, drawing heavily on local female health workers (LHW). In areas with limited LHWs, VTs include teachers, nurse trainees, and medical students. VT training in Pakistan follows the "cascade approach" developed by USAID's Basic Support for Institutionalizing Child Survival (BASICS). Once trained, VTs are divided into 'mobile teams' (house to house), temporary/fixed (EPI) site, and transit teams (railway and bus stations, toll gates etc.). Children who are 'missed' by vaccination efforts are marked on the back of the tally sheet by each VT and returned to at the end of each day.

Prior to these NID/SNID encounters, a variety of communication tools are used to reach out to Pakistanis, that is, to encourage them to participate by having their children vaccinated. Television (national, regional and cable) is commonly cited as the most effective medium in Pakistan for mass delivery of EPI and PEI messages, followed by posters and print media, with radio a limited last place. The popular singer Jawad has collaborated in promoting the campaign and in the production of a broadcast song. Information, education, and communication (IEC) materials, including posters, brochures, flyers, and hand-outs designed for selected social groups - Nazims, teachers and others - have also been produced. Posters provide basic vaccination pictures and dates, while brochures give more detailed information regarding the campaign. Social mobilisation activities are held around the NIDs/SNIDs; these activities include school rallies, inauguration events, megaphone announcements ('miking'), mosque announcements, and local 'influencer' meetings.

In the context of falling rates of routine immunisation in the late 1980s and early 1990s, and an increase in polio cases in 1993 to 1,803, Pakistan started fixed site NIDs in 1994. From 1994 to 2003, over 20 rounds were conducted (involving around 200,000 fixed site centres in each round up to 1999). In 1999, with an estimated 10-20% of the population being addressed missed by fixed sites, the programme strategy shifted to house-to-house delivery (backed up by 7000 EPI centres and 'temporary fixed sites'). In 2002, national coverage for Polio SIAs averaged around 94%. There were 98 confirmed cases of wild polio virus (WPV) in 2002 (2001: 119 confirmed cases); 70% of cases occurred in the 0-24 month age range. Resistance on the part of the populace to vaccination is generally believed to be low to negligible (0-2%); the rate of children uncovered by round runs at around 6-8%. The difference between the two figures is attributed to 'absence' ('missed children').

A 2003 evaluation found that "Although there appears to be a very high level of awareness across Pakistan of Polio as a disease and PEI as a programme, good and adequate mass media from the federal level are demonstrably failing to reach the population comprehensively both in terms of basic round information (by which household schedules can, among the willing, be adapted to VT visits), and in terms of a set of messages which make vaccination not only an acceptable but a necessary and cost-beneficial household commitment. Moreover, where missed children are the result of poor vaccinator access or motivation, or the result of household issues with OPV that are themselves negotiable rather than outright, the vaccinator team itself (with particular emphasis on the increasing reserve of LHWs) deserves much greater attention in sustained, incentivised communication training." Please consult the contact information section below to request a copy of this evaluation.