PEI Communication: Progress & Challenges - Afghanistan
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PEI Communication: Progress & Challenges - Afghanistan TAG 1- 2 June 2009, Cairo Presentation Outline Implementation of last TAG Recommendations Evidence-based communication - what does the data tell us? Strategic shifts & communication objectives

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Presentation Transcript

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Presentation Outline

  • Implementation of last TAG Recommendations

  • Evidence-based communication - what does the data tell us?

  • Strategic shifts & communication objectives

  • A dynamic mix of communication interventions

  • Outcome

  • Challenges

  • Way forward



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What Does Data Tell Us?

Social & Epidemiological Analysis


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Social Data – KAP Study Jan 2008

If we want caregivers to get children immunised with OPV, what do they need to know, feel and believe? Is awareness enough?


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Knowledge Gaps

Low knowledge of specifics, regarding polio as a disease or OPV

39.1%

65%

53.6%


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Perception

Low perceived threat—few people believe polio is an untreatable disease, which indicates low threat perception

Low perceived OPV efficacy, which might be linked to poor knowledge

43%

18.6%


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Missed Children Distribution 2009 – Children Absent or Silent Refusal?

Central

North

NE

Badakhshan

East

West

SE

South


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Communication Variables Silent Refusal?

&

Communication Objectives


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Communication Variables to Increase Demand Silent Refusal?

Knowledge of intervention

Barriers

Threat (susc / sev)

Child gets OPV

Intent to immunize child

Perceived norms

Perceived personal efficacy

Perceived efficacy of intervention


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Communication objectives Silent Refusal?

Raise awareness and fill specific knowledge gaps about polio and routine immunisation

Improve access to children in HRAs with targeted, data-driven community mobilisation

Communicate with and through women to reach newborns, sleeping & sick children with OPV

Address campaign fatigue and improve motivation of families and vaccinators

Reduce % share of ‘absent children’ among children missed in SIAs

Integrate communication planning and implementation into the SIA micro planning.

Build IPC skills of vaccinators, especially in HRAs

Improve cross-border communication – social mapping, common messaging and reaching mobile populations

Improve communication data collection management & utilisation


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A Dynamic Mix Silent Refusal? ofCommunication Interventions Focus - High Risk Districts


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Community Mobilisation Supporting ‘Option Three’ Silent Refusal?

Southern Region:

Kandahar – Panjwai, Maiwand, Shahwalikot, spinboldak, Daman, Kandahar urban

Hilmand – Nade Ali, Nauzad, Musa Qala, Sangin, Kajaki, Washer, Garamsir & Bust

Urozgan – Tirinkot, Dehrewood, Shahedehesas

Eastern Region:

Ningarhar - Jalalabad

Laghman – Mehterlam

Kunar – some border clusters

Western Region:

Farah – Bakwa, Balabaluk,


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Local Inaugurations at Sub-district Level Silent Refusal?

Local level ownership & community engagement:


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‘Cluster Jirgas’ with Elders and Mullah Silent Refusal?

Local level advocacy: using credible voices to influence families


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Address Campaign Fatigue: Silent Refusal? District & Sub-district Motivational events

Cricket, football and volleyball matches held in Kandahar, Khox and Nangarhar & Laghman – generating good coverage in local media

Special Events:

Above – Cricket Match for the

May NID in Jalalabad

Right – Cricket Match in Khost


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Communication With Women, By Women Silent Refusal?

Visibility events

TV

Teachers

Mullah

Visibility events

Teachers

TV

Community Elders

Women Courtyard

CHWs

Posters and Banners

Radio

CHWs

Women Courtyard

Mullah

Community Elders

Posters and Banners

FAMILIES

Radio





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Risk Communication: Metherlam, Laghman perceived susceptibility & severity of threat


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Post-campaign Community Mobilisation Reviews – Ongoing Process

Cluster focal points’ review meeting March 2009:

Mawlawi Nazeer, Cluster focal point of B3 during reporting of his cluster


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Improved Communication Data Management Process

  • Communication indicators added to PCA and ICM checklists

  • Data collection tools standardised

  • Training provided to national and provincial communication Focal Points in data entry, analysis and report generation using Epiinfo – STOP Team Volunteer


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Cross Border Communication Process

High visibility to border vaccination posts

Use of local Pashto media channels – BBC Pashto Service, local and community media channels, Shamshaad TV

Community based social mapping of border clusters in ER to identify spheres of influence & channels of communication to access them better



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Coordination in ER: Process

Number and % of CM undertaking Joint house visits with vaccinators during Jan 2009 NID

100%

87%

86%



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Missed Children Reduced in CM Districts during Jan 2009 NID Process

Inaccessible

due to insecurity

Districts with Social Mobilization


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Result indicator in SR: Comparison of Refusal in CM districts by rounds Oct 08 – Jan 09Data Source PCM

Zero refusals

New Families Repatriated from Pakistan



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Women Courtyard in SR ER – visits to health centres

  • 787 meetings attended by 6,578 women*

  • Women discussed with women & shared information about polio immunisation - 12,136 neighbourhood houses mobilized

  • Space created for women to dialogue with women on survival and health of children – including of course polio and routine imunisation

  • 68 refusal and not interested families ‘converted’ during mobilization

  • Courtyard Women accompanying male vaccinator teams in ER to open access into homes

    * Q 3 & Q 4 of 2008


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Media Outreach ER – visits to health centres

  • National Media:

  • Regular briefings

  • Polio Express brought out by MoPH

  • PSAs produced and broadcast in the field

  • Partnership with BBC World Trust: Produce and broadcast episodes in the highly popular TV drama serial ‘New Home, New Life

  • Local media:

  • Local radio, community radio, local TV channels

    For e.g. Azadi radio, Equal Access community radio, BBC Pashto service, Shamshad TV


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Challenges ER – visits to health centres

  • IPC Skills of vaccinators need continuous strengthening

  • High turnover of trained vaccinators – limits training gains

  • Ongoing training of monitors to collect communication data

  • Communication data collection and transmission from sub-district and provincial level

  • Inadequate documentation in the field of innovations & lessons learned

  • Difficulties in conducting micro surveys, KAPs and similar resarch due to modest technical capacity and ongoing insecurity

  • Develop relevant partnrships to reach mobile and nomadic populations


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Next Steps ER – visits to health centres

  • Strengthen partnerships including with NGOs, YICC (youth), pvt media and women’s groups in KDH, Hilmand and Farah

  • Strengthened monitoring of Integrated community mobilisation in HRAs (SR, ER & WR)

  • Implement Research Plan

  • Hold national Polio Communication Review in October 2009

  • Long term IPC capacity building of vaccinators

  • Strengthen communication data management and standardise reporting


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Research Plan ER – visits to health centres

  • Micro survey to track ‘absent children’ : members in order to analyse trends among 'missed children', esp 'absent' or 'not at home’

  • Post training evaluation- Interviews- Field observations- Interviews with families- Role play


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Thank you ER – visits to health centres