Reaching missed childrenLessons learned from polioSusan MacKay, Maya van den Ent , UNICEF P

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When it comes to missing children measles can learn a great deal from polio …

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Routine and campaigns – we’re missing the same children

BURUNDINAMIBIA

MALI

BENIN

LESOTHO

SENEGAL

GUINEA

S. LEONE

S. LEONE

NIGERBENINB-FASO

G-BISSAU

COTE D'IV

GAMBIA

TOGO

NIGER

COTE D'IV

BENIN

NAMIBIA

GHANA

0

20

40

60

80

100

Non-clients (no health card)RI Clients

• (Very) Low participation among non RI clients

• In some SIAs, > 80% coverage overall, but <40% among non-RI users

Polio SIAs and prior use of Routine

Hellinger et all (2012) Bulletin WHO

Where do we miss the most children?

Polio Sanctuaries

2.7 million children have not received a single dose. Many more are under-immunized.

Missed children disproportionately belong to minority groups.

Not all are in the sanctuaries. But if a data-driven, missed-children-focused approach can be honed in the sanctuaries, it can be applied elsewhere.

Every Missed Child, Report from the Independent Monitoring Board, June 2012

Polio SanctuariesVaccination status non-polio AFP cases

Who do we miss?

Risk profiling in Nigeria

Location: Rural 52%; Urban slums :28%Literacy: Mothers (98%) , fathers (83%) illiterateOccupation: 45% of cases are farmers; Trader 21%Nomads: 8% with 49% living close to nomadic communities

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We’re rapidly expanding our use of risk profiling and special investigations to better understand exactly who is most at risk

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Why do we miss them?

www.polioinfo.org

Reasons for missed children – both social & operational

DR Congo, Nigeria and Quetta Block (Pakistan) present the biggest challenges.

Share of refusals among all missed children in priority countries and select sanctuaries March 2012 Source: Independent Monitoring DataOvert refusals are

not the main reason for missing children in any country

Bauc

hi

Born

o

Jigaw

a

Kano

Katsi

na

Kebb

i

Niger

Soko

to

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Tota

l

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1% 3% 4% 5% 11% 6% 8% 10% 5% 6%

76% 78% 80%61%

66%89% 89%

55%

84%72%

23% 20% 16%34%

23%6% 3%

35%

11%22%

Hse Not Visited Child Absent Non-Compliance

NIGERIA: Reasons for Missed Children by State,High Risk States, July 2012

Inside Household Monitoring

Can we increase demand from parents so that they make sure their children are immunized?

In Nigeria 22% are at the family farm, 28% at social events and 28% are playing nearby the house P

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Personal selling(Volunteer Community Mobilization Network)

Can we innovate to bring the vaccines to where the children are?

Transit sites, border crossings, markets and other social gathering places give us valuable opportunities for both polio, measles and routineP

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Importance of social data – answering the ‘what’

September 2011

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www.polioinfo.org

Data driven approach to communications and social mobilization

Indicators

Sources: - Surveillance reports (non –

polio AFP cases)- Independent monitoring;- LQAs - UNICEF monitoring;

Importance of social research – answering the ‘why’

Rapid social research using FGDs and other qualitative techniques is proving vital for revising communication – and operational - strategies

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How to improve communication and social mobilization

Campaign awareness globally

Awareness & Knowledge of Polio - Pakistan

• Recent KAP study in high risk populations

• Only 6% heard of polio but don’t exactly know what it is

• Only 55% named polio vaccination as a way to protect from polio disease

• 20% still don’t know how to prevent polio

Example from Pakistan

Mass Media Campaign reaches over 110 million caregivers each month with at least 3 contacts – through TV, radio, print materials

How Far Would You Go to Eradicate Polio?

Vaccination is important. It’s everyone’s responsibility. Going the extra mile to

vaccinate your child/every child is heroic

Profiling Polio Hero’s: Mothers, Vaccinators, Athletes, Civil Society

National Punjab Sindh KP FATA Balochistan0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

63%

72%

Jan

July

Polio campaign awareness nationwide has increased almost 10% after 3 campaignsSource: PCM Data

Khyber Pakhtunwa

Sindh

Punjab

Federal Administrative Tribal Area

Balochistan

Karachi Central

Pishin

Quetta

Killa Abdullah

Refusal to accept OPV 2.0 - 8.08.1 - 10.010.1 - 51.0Missing Value

Delivery: Many parents who refuse the vaccine don’t trust child vaccinators. Male vaccinators also have trouble reaching women.

Trust: Some see polio vaccination as a Western strategy to target Muslims. Minority groups do not trust vaccinators who are not from the area.

Religion: Religious opposition is often linked to political positions that are at odds with the central government or “western” influences. Religious groups are linked strongly to political parties in Pakistan.

Overt refusals in Pakistan are limited to small pockets

What does COMNet do?

25,347

6,140

4,5814,963

Community Meetings

Schools and Madrassa’s support polio campaigns

Mosques announce polio campaigns

Influencers identified in microplans

EVERY MONTH:

January March April June July0

10000

20000

30000

40000

50000

60000

70000

0

10

20

30

40

50

60

70

80

58742

43041

25293 27272

41219

18614 16944 12612 14597 27934

32

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Refusals Reported & Converted in Pakistanduring Jan-Jul 2012*

Reported (#) Converted (#) Converted (%)* Source = PRIME Data

Ref

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What are the take home lessons for measles?

• Regular data collection (RCAs, IM, surveys) to identify awareness, motivation for vaccination, source of information and reasons for missed vaccinations

• Development of evidence based communication plans

• Systematically finding, understanding and addressing missed children requires considerable investment in collecting, analyzing and using social data

• An integrated approach to communications and social mobilization is required to ensure behavioral impact

Political advocacy, mobilizing decision makers and opinion formers

Branding, advertising & ‘edu-tainment’ with national, provincial and community

mass media

Community engagement and mobilization (meetings, forums, film showings and events)

Personal selling(Volunteer Social Mobilization Networks)

Point of service promotion (Vaccinator IPC)

integrated communicati

on action

COMBI Star adapted for polio eradication

What Measles can Learn from Polio

• Communication plans– Based on evidence

• Social data for action– Surveillance data– Independent Monitoring / Surveys– Focus Group Discussion – In depth Interview

• Measles to capitalize on polio investments

Anne Ray Charitable Trust

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