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Observations from the field


Observations from the field

Hi Everyone,

We are about to open a new space for discussion and/or information sharing. CI will be taking the lead on this by incorporating occasional - and brief! - updates from field trips together with equally brief and occasional reflections on issues that seem to be emerging or important. Some of the people who participate as consultants in upcoming communication reviews and or assessments will also be sharing brief pieces focused on a communication issue they saw during their field experiences. We encourage and look forward to your engagement with any of these pieces and hope to build the size of this group over time.

Let me begin with a brief update on the recent Pakistan TAG.

Communication Highlights from the recent Polio Technical Advisory Group (TAG) Meeting in Islamabad Pakistan

Below is a quick synopsis of communication of communication related findings and recommendations from the TAG which I participated in last month (March 21 and 22). The full report should be coming out soon and will by summarized on the CI Polio website. In the meantime I thought some of you might be interested in a sneak peek. This is being followed up with a full communication review organized by UNICEF Pakistan with CI providing support and international expertise. Watch for our summary of findings findings from that review once they are finalised.

Overall, the TAG was alarmed with the fact that Pakistan and Nigeria keep on reporting high number of polio cases despite the fact that the world has reported the least number of polio cases over the last 4 months. The TAG also noted with concern that Pakistan (along with Nigeria and Afghanistan); is driving the global WPV transmission which is reinforced by the fact that about 50% of the global cases in 2012 are reported from Pakistan. Transmission of WPV in Pakistan remains essentially linked to the transmission zones and the dramatic upsurge in 2011 is due to the fact that not enough children were immunized especially in the high risk areas. Transmission persists in these zones due to

• Inability to access children for immunization due to conflict
• Continued problems with the quality of SIAs and hence with the consistent failure to reach children with vaccine.

It was noted that the average polio case in Pakistan is a child that is under 2 years of age, under-immunized, from a Pashto speaking family, and lives in a high risk district, an immediately neighbouring district, or a migrant/minority area.

It is essential to immunize more children more consistently with special focus on the high risk districts in the transmission zones and amongst mobile and under-served populations.

It was recognised that there were some signs of early though marginal progress including enhanced oversight at the national and provincial level, improved engagement of district administration and the establishment of clear indicators and milestones. There is evidence that enhanced oversight has resulted in improved process indicators in some of the high risk districts, marginal improvement in the coverage rates as measured by the LQAS, somewhat better identification of program blocks and measures to overcome those blocks. The placement of the communication network (COMNet) and gradual improvement of access in FATA over the last 6 months also signal signs of progress.

However, despite all these improvements the gains remain marginal and there are a number of serious issues and risks which place Pakistan in danger of being the last reservoir of wild poliovirus on the planet. These include failure to:

• implement the augmented A-NEAP in a timely and complete fashion
• further improve campaign quality in High Risk Districts especially failing districts like Pishin and Gadap
• make use of every opportunity to reach children in FATA and neighbouring Khyber Pakhtunkhwa
• create demand & acceptance in highest risk areas/groups especially amongst Pashtuns

In general the augmented NEAP provides a platform to take Pakistan to polio eradication; the challenge is to fully and consistently implement the NEAP.

Communication Related Recommendations
• Immediately scale up special operational and communication strategies for high risk groups (Pushtun strategy; Migrant & mobile populations strategy; Transit strategy - implementation plan by April).
• The engagement, motivation, training, and support of vaccinators should be a priority especially in high risk areas.
• A system of recognition of high performing vaccinators should be instituted to recognize the contribution made by dedicated individuals.
• Disaggregate indicator data to better define problems at different implementation levels.
• Special investigation process to define the operational & social reasons for missing children & to inform corrective plans (by May).
• Partnerships for service delivery ('in sourcing') should be used for communications, immunization and monitoring.
• TAG endorsed the outline of the media action plan and urged its rapid roll out.
• Communication strategies, including through ComNet, should be explicitly & closely linked to social data from KAP, IM and other sources.
• Communications & operations teams must operate in conjunction in planning, implementation, & monitoring.
• Social information from special investigations of the reasons for missing children should be used to inform actions in response.
• Potential synergies should be explored between the PEI and EPI. These include: a) harmonization of polio and Routine Immunization Microplans; b) awareness & demand creation through interpersonal & other communication channels used for polio; c) monitoring of the routine immunization sessions & vaccine availability during the polio activities monitoring including the community surveys.
• Operations research especially looking at the impact of innovations.
• Social and communications research especially in high risk groups.

These recommendations have been reported to the Prime Minister's Task Force on Polio Eradication and will be monitored by the government of Pakistan, polio partners in the country and other bodies such as the International Monitoring Board. A communication review will conducted at the end of April with a report and further recommendations due before the end of May.

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