Presented at: The Technical Advisory Group (TAG) Meeting on Communication for Polio Eradication - New Delhi, India

This PowerPoint presentation was part of a March 2007 United Nations Children's Fund (UNICEF)-hosted meeting dedicated to examining polio communication efforts, in the context of the final global push towards polio eradication. State-specific presentations for India's polio-endemic states (Uttar Pradesh and Bihar) were given by in-country communication and health practitioners. These were assessed by an external Technical Advisory Group (TAG) panel of experts who provided communication strategy recommendations based on evidence presented and data gathered on field-visits to endemic states. Communication strategies presented at this meeting were primarily focused on:

1. Analysing the results of programmes implemented to March 2007
2. Detailing activities on national and sub-national levels, specific to social mobilisation, community engagement, underserved areas and media and political advocacy strategies.
3. Suggesting a planned communication programme for the next 6- to 12-month period, designed to support India’s polio eradication efforts in the event of a resurgence of cases and/or population and programme fatigue.

This presentation, given jointly by the Ministry of Health and Family Welfare and UNICEF, provides an overview of the partnership between the National Rural Health Mission and the polio communication campaign. It illustrates the progress made in meeting polio communication objectives, specifically in relation to the communication milestones set at the Geneva High Level Stakeholder’s Meeting in February 2007.

The National Rural Health Mission (NHRM) focuses on the following key areas:

1. Special focus on 18 Indian states.
2. Improving the availability and quality of health care in rural areas.
3. Synergy between health and determinants of good health.
4. Capacity building.
5. Involving the community in the planning process.

For 2005-2012, the NRHM identified a list of disease reduction outcomes, including Dengue mortality, tuberculosis cure rates, Malaria mortality and polio eradication. The NRHM Universal Health Care approach relies on community involvement, capacity building, flexible financing, monitoring processes and human resource management.

The NRHM Communication Strategy utilises a combination of mass media, multi-media and information, education, and communication (IEC) tools to ensure focused content delivery and an enabling environment for social mobilisation and health providers. The newest cadre of village-based grassroots healthcare workers in India are known as ASHAs (Accredited Social Health Activists) who form a sizable workforce of over 400,000 individuals, half of which are positioned in polio-endemic states of Uttar Pradesh (UP) and Bihar. Communication tools are being developed for use by ASHAs which promote child tracking, polio eradication and a range of other health priorities (including "FactsforLife" booklets and television series).

The outcomes of the February 2007 Geneva consultation include a clear commitment by the Government of India to polio eradication (instead of polio control), acceleration of supplementary immunisation activities (SIAs) in the first half of 2007, and a 24-month timeline of communication milestones in hopes of eradication by end 2008. Progress against the discussed milestones to date was illustrated by the following activities:

• March polio communication TAG Meeting in Delhi
• Multi-level, multi-channel communication strategies based on epidemiological, operational and social data.
• Active media plan at district level in UP and district and state levels in Bihar.
• High-risk areas identified in both endemic states.
• Extensive community mapping.
• Undertaking of qualitative and quantitative studies regarding the effectiveness of “add-ons.”

Key elements of the current polio communication strategy in India as presented here include:

1. Social Mobilisation Network (SMNet)
2. Intensive engagement with underserved networks and institutions in UP and Bihar, specifically within the minority Muslim community
3. IEC Materials.
4. Mass media and media management.
5. Advocacy and partnerships.

In the past four months, two qualitative studies (undertaken by Jamia Millia Islamia and the IndiaCLEN Program Evaluation Network) examined community perceptions towards accelerated rounds, "add-ons" and other aspects of the polio campaign. It was found that community members generally seemed to reject the idea of accelerated rounds, responded well to coupling vaccination with other health incentives and remain suspicious of the motivations behind the campaign.

In summary, the strategic communication focus of the NHRM in 2007 will be on the following:

• Communication emphasis on endemic areas of UP and Bihar
• Use of analytical tools and strategies to reach younger children faster
• Adoption of dynamic approaches that will allow the program to adjust to challenges and opportunities.

To conclude, the following question was addressed to the TAG panel: "What communication gaps urgently need to be closed in order to effectively contribute to stopping transmission?"

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