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Decontructing Social Resistance to the Polio Eradication Campaign in India_5.15.11_Dasgupta
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Decontructing Social Resistance to the Polio Eradication Campaign in India_5.15.11_Dasgupta


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  • 1. Deconstructing Social Resistance to the Polio Eradication Campaign in India: A Social Determinants FrameworkRajib Dasgupta
    Rajib Dasgupta [JNU/JHSPH]
  • 2. Social Determinants of Program Implementation: The western Uttar Pradesh context
    • Robust coverage at district level: a false sense of security
    • 3. Less visible clusters of under/un-immunized children
    • 4. Such clusters, however minuscule, sustain circulation of WPV
    • 5. High urbanization rates; large populations of urban poor
    • 6. Negative correlation between higher rates of urbanization, and, poverty and literacy
    • 7. Poor marginalized communities in peri-urban slums
    • 8. Up to 50% or more of the population in some urban local bodies reside in slums
    • 9. Growing economic activities and in-migration
    • Wild polio virus cases significantly clustered among Muslims [largest minority religion], 55-70%
    • 10. Distinct social resistance among Muslim communities for polio vaccine during ‘pulse’ rounds
    • 11. % of Muslim population: 4 times higher in endemic districts
    • 12. 45.2% of urban Muslims in slums vs. 18.4% in the general population
    • 13. Lowest proportion of Muslim children beneficiaries in other flagship programs: Integrated Child Development Services (1.9%) and Mid Day Meal (13.8%)
    • Moradabad District: proportion of urban Muslim population is 36.5%; 30.54% urban population in the district
    • 14. J P Nagar District: 40.5% and 24.5%
    • 15. ‘Excess’ illiteracy among urban-Muslim women in Moradabad: 10%
    • 16. Head Count Ratios (HCR) for urban Muslims in UP up by 6 points in 61st Round of the NSS
    • 17. Gap in poverty incidence between Muslims and ‘all others’ in urban UP -- up from 27 points in 1987-88 to 38 points in 2004-5
  • 5
    Children not Receiving OPV During SIA
    • ‘Missed’
    • 18. Children accompanying parents to their workplace, mostly agricultural fields
    • 19. Complacent : waiting someone to come home and deliver
    • 20. Visiting relatives and social functions
    • 21. Adverse past experience
    • 22. ‘Reluctant’ -- due to (acute and chronic) illness and the newborns
    • 23. ‘Resistant’
    Dasgupta et al (2008)
    Rajib Dasgupta [JNU/JHSPH]
  • 24. 6
    Circulating Rumors and Misconceptions
    Chaturvedi et al (2009)
    Rajib Dasgupta [JNU/JHSPH]
  • 25. A low-profile and highly local spate of rumors starts gathering right before an NID/SIA.
    Nature and content of rumors keep on changing with time and locale.
    Rumors often supported by one or more of the following:
    • Locally circulating religious leaflets and magazines, often disowned by the sources
    • 26. Locally restricted announcements through static and mobile (rickshaw bound) public address systems
    • 27. Address by a religious leader after a prayer ceremony
    • 28. Quasi-confirmed religious edicts, often disowned by the sources
    • 29. Rational constituents of the society try to reach for the source
    • 30. Sources go out of bounds or dissociate themselves from the episode
    • 31. Public retraction/contradiction never available
    • 32. At best, the sources adopt a neutral stand
    • 33. By this time, the damage is already done.
    • 34. Despite this, majority of the families in minority areas support SIAs
    • 35. A significant number of parents among them, mostly from extremely marginalized sections, get decisively influenced by the rumors and continue to defeat SIAs
    • 36. Though miniscule at the macro level, they may be able to sustain low level of transmission of WPV.
    • 37. Underlying generalized lack of trust , and,suspicion
    • 38. Through social osmosis, these rumors reach untargeted audience as well, and some economically and socially marginalized clusters from the majority community also get influenced
    • 39. However in this case, seldom translate into a significant and lasting resistance to SIAs
    Chaturvedi et al (2009)
    Rajib Dasgupta [JNU/JHSPH]
  • 40. Interpreting Social Resistance
    • Social resistance to be interpreted in the light of deprivation and disparity
    • 41. Minority communities suspicious of highly visible, quasi-vertical and repetitive pulse polio program
    • 42. Contents and concerns of rumors: ‘cultural wisdom’ of a ‘community under siege’
    • 43. Religion a ‘confounding’ of sorts; a bargaining point among other communities and better-off states too
    Rajib Dasgupta [JNU/JHSPH]
  • 44.
    • Sachar Committee
    “The ‘identity crisis’ combined with the apparent lack of commitment on the part of the Government often results in a perverse response even to well intended programs. The poor rate of success of the polio
    vaccination drive in Muslim majority areas is one such response arising out of the fear of an alleged plot to reduce the Muslim birth rate.”
    • Index of Social Progress [Muslims] for Badaun, J P Nagar and Moradabad Districs: 0.37, 0.42 and 0.43 respectively; national average [all religions] 0.50
    • 45. Insecurity and crisis of identity true for all minority socio-religious categories -- ‘Hindu’ face of the state?
    • Health workers (and doctors) commonly resort to social norms of differentiation among clients through ‘labeling’ and categorization
    • 46. Policy terrain can itself be exclusionary by using labels such as ‘hard to reach’
    • 47. Hard to reach, or hardly reached?
    • 48. Nature and characters of citizenship and legality in rural and urban societies
    • 49. Structural inequities of urban health systems
    • 50. Complex intersections with poverty, gender and culture
    • 51. Assimilative nature of campaigns can be a core process of alienation
    Issues of Social Exclusion and Inclusion
    Rajib Dasgupta [JNU/JHSPH]
  • 52.
    • ‘Under-served strategy’ from 2003: Decreased resistance and increased seropositivity
    • 53. Reaching newborns
    • 54. Reliable and responsive primary healthcare services
    • 55. Community dialogue; complementary to social mobilization
    • 56. Services in slums and peri-urban areas
    • 57. Community fatigue and implementation fatigue
    • 58. Engaging with ‘otherness’
    • 59. Making micro-planning meaningful
    Rajib Dasgupta [JNU/JHSPH]
    Key Last-Mile Challenges . . . .