Communications Update

1
Communications Update

• Polio TAG Meeting for
• Pakistan Afghanistan
• Cairo, Egypt
• 3-4 February, 2008

2
Recommendations

• Maintaining Achievements
• Continue media campaign to achieve high level
  awareness
• Assess impact of the current strategy
• Strengthen provincial communications capacity
• Focus on high risk areas
• Fill district communications positions (DHCSOs)
• Ensure district plans in place
• Training of DHCSOs
• Improving training
• Building on existing tools

3
Actions taken since Oct 07 Muscat Technical
Consultation

• Recruited 4 international communications officers
• Focused on district level communications planning
  (HR)
• KAP study/refusal study completed
• Agreed national communications indicators
• Revised monitoring checklists used during Jan NID
• New training video finalized distributed
• External media consultant generating increased
  positive coverage
• New Polio True Stories being aired during/between
  SIAs
• PM flag ceremony

4
Focus on high risk areas
5
Probability of WPV Transmission in 2007
Placement of District Comms HR

• 18 in place
• Staff turnover
• Difficulties getting right staff
• Interviews taking place next week in Sindh

High risk district focus 25 DHCSOs in 22
districts 21 mobilizers
6
Training of district teams in social mobilization
to build capacity

• Sindh, NWFP teams trained plans for Balochistan
  February
• Improving social mapping
• Working with the local media
• Understanding importance of data-driven approach
• Developing district/UC specific plans
• Reviewing plans after each campaign
• Instilling ownership of communications at
  district level

7
Data driven approach

• Use of social data mapping of high risk
  populations (nomads, minorities, refugees)
• Use of refusal data categorization of
  refusals/locations
• Focus group research to inform messages
• Community attitudes study
• Epidemiological/campaign data to identify high
  risk areas, populations

8
Area Incharges
Nimra

S.M.Taufiq Road
Teen Hatti
Dak Khana
Nerang Cinema
Arsalan
Wajahat
Khalid Bin Walid
A.Ghani
Imam Bargah
shan
Imam Bargah
Jamia Masjid Sadiqa
Ghazala
Lyari Express way
Jamia Al-Habib.
Nomadic Like
Ashraf Masjid
Refusals
Jhanda Chok
Pathan
F.Site
UC 3 SUPER MARKET
Service Road.
Service Road.
Building
Rehmania
UC Nazim
Gharib Nawaz
Minority
Hussain Brelvi Road
Sami Clinic (F.S)
Mohammadi Masjid
Lyari River
Haq clinic ( F.S)
UC 3 Liaquatabad Z.S Raees.
Janat-ul-Baqi Masjid
Mohammadi
Thana Super market
Madina Masjid.
Gujar Nala
UC 9 L.Abad
UC 2 L.Abad
9
District specific plans in place

• 78 of participating districts in NWFP/FATA
  submitted issue specific plans ahead of SIA
• 100 of HR districts in Balochistan have plan in
  place
• No data yet received from Jan campaign in Sindh,
  Punjab

10
Locally appropriate activities

• Holding Jirga meetings tribal areas, NWFP
• 1000 refusal children immunized following a
  meeting of key tribal elders (Mohmand Agency,
  NWFP)
• Involving Religious Leaders and influencers
• In Balochistan, key religious leaders involved in
  resolving refusals before during campaign
• Meeting of key stakeholders of FATA religious
  leaders, Maliks, MNAs for their solutions
  recommendations
• Bajour jirga to allow access for teams and
  improved demand
• Involving prominent private pediatricians -
  Karachi
• Involving schools
• Information dissemination through school
  children, inaugurations, school assemblies,
  rallies (ie Beaconhouse School in Peshawar)

11
Overcoming the District Specific Challenges
12
Refusal Trends in key districts, 2007
13
Refusal trends in NWFP
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Overcoming Refusals in Bajour

• Local jirga
• Previously resistant religious leadership
  converted to be proactive supporters
• Increased positive media coverage

15
Overcoming the Challenges
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Finalizing indicators tracking progress
17
Pakistan communications indicators

• Bar Char/line graph of refusal reasons for
  missed children
• Prior knowledge of campaign PCM for NIDs
• Source of information about campaigns
• Number of refusals by round all NIDs
• Coverage of key population groups
• nomads, under 6 months, ethnic / religious
  minority groups, children in security compromised
  areas

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District ownership of programme

• Collected through compilation of
  pre-campaign monitoring checklist
• of districts inaugurating the campaign
• Nazims/DCOs/MPA/MNA attending DPEC meeting
• of EDOs chairing the evening meetings
• supervisors having appropriate automobile for
  monitoring SIAs
• of recorded NA children vaccinated in catch up
  phase

19
District ownership Jan NID
20
Process indicators

• of high risk districts with plans in place
  linked to specific issues
• Number of activities conducted against planned
  activities
• Number of personnel deployed to high risk
  areas/populations ( DHCSOs/ mobilizers in place
  against planned)

21
Summative data

• Trend analysis of communication coverage / epi
  indicators correlated with communication
  interventions
• Trend analysis of coverage (missed children,
  refusal, immunity gap), in high risk areas
  (district/UC) where communication activities have
  taken place
• Children immunized through special initiatives
  (nomads, security compromised, etc) as of the
  district/provincial target

22
End 2007 KAP Study

• Purpose to assess understanding of community
  perceptions, attitudes, practices of programme,
  trust in information sources
• 12 districts/5UCs from each/7communities randomly
  selected
• Lahore, Rawalpindi, DGKhan, Nowshera, Bannu,
  Bajour, Jacobabad, Sukker, Omerkot, Hyderabad,
  Jaffarabad, Quetta
• Tracking against baseline and 2 tracking studies
  undertaken from 2003-05
• Sample size 2096 households

23
Understanding of prevention measures
SoSec Nov 2007
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Effectiveness of communications - over time
25
KAP results
26
KAP results
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Refusal study

• In 6 key districts Quetta, Pishin, Killa
  Abdullah, Peshawar, Mohmand, Swat
• Service delivery an issue
• Health workers spend little time with houses
• Inappropriate teams
• Poor IPC skills of teams
• Accessibility of teams an issue
• Perception that teams not being monitored or
  supervised
• Teams filling fictitious data

28
Refusal research

• Need for more involvement of religious leaders,
  Maliks
• Ongoing mistrust/misconceptions of vaccine
• Need for comprehensive monitoring strategy
  involving local influencers, elders
• Need to involve traditional healers (hakims)
  further spreading infomation against campaign
• Need for more intensive mass media

29
Ongoing media - focused
30
Pakistan media analysis April to January
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Proactive Media Activities
Engaging national media channels to support
PEI/EPI Mapping targeting popular
appropriate programmes Embedding journalists with
teams during campaigns Briefing of radio
RJs Programming is supported by local
programming Local language programming Local
influential persons as guests on shows Regular
immunization coverage secured on 12 TV channels
with Nationwide coverage via cable/satellite, 4
Local language TV channels 12 local FM radio
stations give media coverage to PEI Local cable
operators
32
Exceptional Media Coverage

• Polio Week celebrated on Radio 1 FM91
• Karachi, Lahore and Islamabad hourly live
  interviews from the field supported by in-Studio
  interviews
• Free messages for 7 days
• Endorsements throughout all shows
• Lakki 88 (Pushto)
• Local language programming throughout the
  campaign, including coverage of local Jirgas
• FM 104 (Pushto)
• Local language programming and updates,
  particularly from Mardan
• FM 101 (Nationwide Radio Station)
• Messages endorsements throughout programming

94 of KAP survey respondents get info from
electronic media (TV/radio) - SoSec Nov 2007
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Data driven mediaPolio True Stories

• Assessment of AFP case investigation forms
  other data to inform stories
• Build issues from data into messages polio/EPI
• Development of Polio True Stories TV
• Expansion to radio print True Stories
• Polio True Stories being shown during
  advocacy/training meetings for motivation
• True stories being used to resolve refusals
• Local languages (Pashto) use in Afghanistan
• Now being aired between campaigns

34
Challenges issues

• Maintaining commitment/sustaining engagement of
  district management
• Overcoming access issues deteriorating security
  situation
• Increasing refusals in a few key areas
• Ongoing negative media competing priorities
• Recruiting locally appropriate teams

35
Challenges

• Difficulties in securing trained human resources
  (communications) in high risk areas
• Increasing team fatigue/motivation

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The Way Forward

• Continuing focus on locally appropriate
  activities - all high risk districts with issue
  specific plans
• Tracking progress/trends against agreed
  indicators
• Proactive engagement capacity building of media
  
• Sustained media - focus on routine EPI/PEI
• Ongoing recognition of team performance/vaccinator
  motivation study to look at ways of improving
  service delivery
• Ongoing capacity building to improve data driven
  approach to communications planning
• Holding post-campaign reviews provincial level

37
Future Communications Review process

• Inclusion of communications expert on TAG/during
  discussions
• No large-scale separate review
• Provincial based reviews involving possible
  international experts/provincial colleagues led
• Chaired by provincial government

38
Thank you
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Use of EPI Data

• Non polio AFP data by
• Immunity gap - of 0 dose children and average
  doses/child by zones
• Age (lt1 year, 1-3 yr, 3-5 yr)
• Social / demographic Polio case profiles by
• Age (lt1 year, 1-3 yr, 3-5 yr, gt5 yr)
• Social / demographic who is being regularly
  missed, and where they are located