September 17-19 2007

This PowerPoint presentation was prepared for a September 2007 United Nations Children's Fund (UNICEF)-hosted meeting dedicated to examining polio communication efforts in Pakistan. In support of the final global push towards polio eradication, state-specific presentations were given by in-country communication and health practitioners working in Pakistan’s polio-endemic states (Sindh, Balochistan, and the Northwest Frontier Province). These were assessed by an external panel of experts in the fields of development communication, mass media, epidemiology, and anthropology, who provided communication programme recommendations based on data presented by the country teams, as well as data gathered on field visits to the endemic states. Communication strategies presented at this meeting were primarily focused on:

1. Analysing the results of programmes implemented through September 2007
2. Detailing activities on national and sub-national levels, specific to social mobilisation, community engagement, underserved areas, media, and political advocacy strategies
3. Suggesting communication strategy and programme refinements for the next 6- to 12-month period, designed to support Pakistan's polio eradication efforts

This presentation discusses polio communication issues in Pakistan's Northwest Frontier Province (NWFP) and federally administered tribal areas (FATA) and was given in two parts: the first discusses strategies for addressing rumours and building community acceptance for immunisation, and the second addresses the challenge of reaching the high-risk mobile population and the very young.


Immunisation coverage over the last year, on average, in children under 5 years across NWFP/FATA is reported at a level of 95% or above, with only 3 districts falling below this goal. Vaccinator and supervisor training attendance has also been recorded at 97%-99% on average. Coverage rates, vaccination teams, accessibility issues, and missed areas are also discussed at length.


Statistics for families refusing oral polio vaccine (OPV) are illustrated here in detail at the regional and district levels. In dealing with immunisation refusals, a few strategies implemented over the last year have included:

• Seminars held for religious leaders
• Press coverage and photographs of prominent influencers attending vaccination inaugurations used at an operational level
• Inaugurations conducted in Islamic Madrassas
• Jirga meetings held

Issues of concern remaining in NWFP/FATA include increasing trends in refusals, weak follow-up of missed children, low female involvement on vaccination teams, and a need to translate strong political commitment into action at the district level. Guidance was requested in defusing negative propaganda, resolving internal conflicts in certain areas, and negotiating demand-based refusals.


The team outlined a detailed future plan for advocacy and social mobilisation, as well as a range of supporting activities, such as:

• Holding awareness seminars for parliamentarians, nazims, and political agents
• Increasing access for at national staff into areas of concern, especially in southern region
• Strengthening local approaches for local issues
• Organising jirga meetings in the high risk areas within the districts

An overview of surveillance activities is given, illustrating a steadily decreasing trend in number of cases from 1997 (238 cases reported) to 2007 (5 cases to date). Surveillance challenges remain in early case detection and access to security-compromised areas. Routine immunisation (RI) and the expanded programme on immunisation (EPI) in Pakistan is also discussed.


Communication strategies, programme communication structure, and decision-making processes in NWFP/FATA are described in detail at the provincial and district levels. Highlights include:

• Meetings with high level government officials, district government heads, and religious leaders were held as an advocacy strategy.
• Media involvement was initiated at provincial-level immunisation campaign launches.
• Local FM radio was used to disemminate information.
• In response to negative rumours surrounding OPV, members of the media forum were taken to the field during the August round, positive polio fatwas (Islamic laws) were issued and coverage of polio activities was ensured in print and electronic media.

The planning process for addressing the challenge of reaching the high-risk mobile population and the very young involves a locally-developed social mobilisation plan and the sharing of this plan with provincial teams if additional support is needed. Mobile population vaccination strategies have included:

• Transit teams deployed on major crossing points
• Deployment of seasonal posts during periods of heavy movement
• Deployment of special motorbike teams

Cross-border strategies have been developed to address the reported 1.7 million children under 5 years of age that cross the Pakistan-Afghanistan border every year. Nine cross-border posts have been established, which vaccinated a total of 247,000 children between January and July of 2007. Teams on both sides have worked towards synchronising immunisation activities, which has been facilitated by collaboration between governments of each country and regular cross-border meetings. Strategies for reaching young children have included culturally-appropriate vaccination team deployment to houses in FATA and multiple vaccinations carried out during the traveling time of Hujra.


For the full PowerPoint presentation, please contact Kiyuri Naicker at knaicker@comminit.com

Technical Advisory Group (TAG) Meeting on Communication for Polio Eradication held in Pakistan, September 17-19 2007.