Purple Pinkies

Dr. Roma Solomon, DirectorMr. Manojkumar Choudhury, M & E Officer

CORE Group Polio Project India

CORE Group Spring Meeting 3 May , Wilmington, DE

Social Mobilisation for Hard to Reach Populations

• Brief introduction through narrative & slides• Role Play• How we reach the unreached• Using LQAS for improving social mobilisation

activities• Short film – ‘A drop of dialogue’

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Polio Eradication: Historical Context

19882008

Last type 2 polio in the world in India

2012: 14

Monovalent 1 & 3 Bivalent

Progress in Polio Eradication1988 – 2012

2009

Source: WHO 17 04 2012

1988

125 endemic countries 1000 cases per day 350,000 cases per year

20101292 cases -20% reduction since 2009; 99% reduction since 1988

Type 1

Type 3 4 endemic countries(India, Nigeria, Pakistan, Afghanistan)

1604 cases/year

201246 cases; 43 in endemic & 3 in non-endemic countries

THE CORE GROUP POLIO

PROJECTINDIA

1999 - 2012

IMAGINE THE

• 394 million people live in U.P., Bihar & W. Bengal• 500,000 children are born every month in U.P and Bihar • 2.3 million vaccinators used in one National Immunization Day• 500,000+ vaccinators cover about 45 million children in each SNID• 900 million doses of OPV were used in 2011• 9,125 community mobilisers visit over 3 million families each

month in the three states• In 2011, the SM Net tracked 30,000 migrant families and helped

vaccinate 1,814,266 children on the move in transit and border areas.

Field OperationsSmall mop-up in India

4,200,000 children under age 5280,000 vials of vaccine

50,000 square miles37,000 vaccinators4,000 supervisors2,500 mobilizers2,000 vehicles

18,000 vaccine carriers/ice/markers/chalk/tally sheets

3 days

Two National Immunization Days (Booth-based)

Much fanfare in a campaign mode

172 million children under 5 immunized in every NID

But

More than 15% children continued to be missed in every Round…

1999 House to House

strategy introduced

Stiff resistance

encountered

Community Resistance grew in W. Uttar Pradesh, 2001

Communities believed that…o Polio immunization led to impotencyo It was a family planning program o Different color of polio vaccines were

used for different communities

Hindu and Muslim mothers in Western U.P. felt strongly that polio program targets a specific community

Muslim mothers reported the

highest rates of hearing

rumours/concerns about OPV(Unicef KAP study)

Shift from extensive mass awareness approach to

addressing specific conditions/needs of

specific groups

Communication response initiated

CORE volunteersfrom schools, nursing schools & NGOs in High

risk areas of Uttar Pradesh tackled resistance to OPV

Increase in female vaccinators

Community Mobilisation Coordinators (CMCs) were Born

• Selected from the same communities

• To overcome resistance and

• Sustain community participation for polio eradication and routine immunization

Unicef & CORE set up the Social Mobilisation Network in Uttar Pradesh, deploying hundreds of CMCs in High risk

areas to tackle resistance

Each CMC covers 400-500 houses

Focus on skill building of

communicators(CMCs &

Vaccinators)

Analysed ‘Resistance' to develop ‘Negotiation' strategies

Shift from instructive to negotiation approach

Shift to localised mobilisation activities

• Government mobilization– Formation of district core groups on polio & RI– Involvement of other departments like education,

women & child welfare, etc.• Religious and opinion leaders’ mobilization

– Regular and continuous meetings – Izthema meetings (Meetings of Muslim ladies)

• Targeted IPC & mother/influencer meetings with resistant families/pockets

Hard to Reach??

How Do We Reach?Let me count the ways…………….

CMCs visit each pregnant woman and give Congratulation Card after child birth

By focused IPC for Communities

Mapping & RegistersProviding Immunization status of each child to

vaccination teams

CMCs track polio immunization status of children under 5 years

Health Camps

Children's Rallies

1. Greater involvement of religious leaders 2. Formation of state ulemas committee3. Appeals from religious institutions and leaders

9 million people exposed to polio messages during religious congregations in 2010

Billboards, posters, etcfor brick kilns, construction sites, & transit teams

Wherever you go, make sure

your child receives OPV

Snakes and Ladder Game

Message booklet

Flip book

Flash Cards

StreamerFlash Cards

Leaflets on Diarrhea Management and Routine Immunization

• Booth day– Bulawwa toli – child mobilisers– Decorated polio booths inaugurated by local

influencers– Visit to X houses

2009

Who was sustaining transmission?

Very young: Definitely

Migrants: Yes

Older children: Maybe(?)

Status of Wild Poliovirus Cases – UP Year 2009*

* data as on 19th Jun 2009

75% cases below 2

yrs of age

Emphasis on Birth Dose

Migrants1. Brick Kilns

Children of parents working in brick kilns

2. Construction sites

Children of parents working on construction sites

3. Slums

Migrants in urban/peri-urban slums

4. NomadsCommunities who travel from place to place for

livelihood, setting up temporary homes on empty tracts of land near railway stations, market places, etc.

Often work as blacksmiths, basket weavers, puppeteers,

acrobats, fortune-tellers, singers and dancers.

CMCs conduct special IPC sessions with migrant families on the importance of polio & routine immunization

Barbers, shopkeepers, etc. engaged as informers on migrant groups

More than 4000

informers enrolled

Soap strips distributed to promote hand washing behavior

2010

80% polio cases contributed by only 2% (107) of India’s

blocks

Revised Communication Package for Polio Developed

Revised Communication Package for the very High Risk Blocks

Get 2 drops of OPV + polio

plus messages

% Resistant Houses (XR) in UP - CMC areas

2007- 2011

Source:Tallysheet

Mapping for MonitoringRelevance and Use

•Lack of detailed maps in rural & urban areas•Need to map growth momentum•Desire of wider audience to view the location and data concurrently

CORE Work Area Map of Ward 46, Howrah, W.BengalBooth Locations

Web based Booth-specific Information

25th Feb. 2012 India declared Non-endemic

country

2011 Rukhsar from

W. Bengal, the only case

Each child receiving polio drops gets the

left pinky marked with

purple indelible ink