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

Deconstructing Social Resistance to the Polio Eradication Campaign in India: A Social Determinants FrameworkRajib Dasgupta
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Rajib Dasgupta [JNU/JHSPH]

Social Determinants of Program Implementation: The western Uttar Pradesh context
Robust coverage at district level: a false sense of security
Less visible clusters of under/un-immunized children
Such clusters, however minuscule, sustain circulation of WPV
High urbanization rates; large populations of urban poor
Negative correlation between higher rates of urbanization, and, poverty and literacy
Poor marginalized communities in peri-urban slums
Up to 50% or more of the population in some urban local bodies reside in slums
Growing economic activities and in-migration

Wild polio virus cases significantly clustered among Muslims [largest minority religion], 55-70%
Distinct social resistance among Muslim communities for polio vaccine during ‘pulse’ rounds
% of Muslim population: 4 times higher in endemic districts
45.2% of urban Muslims in slums vs. 18.4% in the general population
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
J P Nagar District: 40.5% and 24.5%
‘Excess’ illiteracy among urban-Muslim women in Moradabad: 10%
Head Count Ratios (HCR) for urban Muslims in UP up by 6 points in 61st Round of the NSS
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

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Children not Receiving OPV During SIA
‘Missed’
Children accompanying parents to their workplace, mostly agricultural fields
Complacent : waiting someone to come home and deliver
Visiting relatives and social functions
Adverse past experience
‘Reluctant’ -- due to (acute and chronic) illness and the newborns
‘Resistant’
Dasgupta et al (2008)

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Circulating Rumors and Misconceptions
Chaturvedi et al (2009)

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
Locally restricted announcements through static and mobile (rickshaw bound) public address systems
Address by a religious leader after a prayer ceremony
Quasi-confirmed religious edicts, often disowned by the sources
Rational constituents of the society try to reach for the source
Sources go out of bounds or dissociate themselves from the episode
Public retraction/contradiction never available
At best, the sources adopt a neutral stand
By this time, the damage is already done.
Despite this, majority of the families in minority areas support SIAs
A significant number of parents among them, mostly from extremely marginalized sections, get decisively influenced by the rumors and continue to defeat SIAs
Though miniscule at the macro level, they may be able to sustain low level of transmission of WPV.
Underlying generalized lack of trust , and,suspicion
Through social osmosis, these rumors reach untargeted audience as well, and some economically and socially marginalized clusters from the majority community also get influenced
However in this case, seldom translate into a significant and lasting resistance to SIAs
Chaturvedi et al (2009)
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Interpreting Social Resistance
Social resistance to be interpreted in the light of deprivation and disparity
Minority communities suspicious of highly visible, quasi-vertical and repetitive pulse polio program
Contents and concerns of rumors: ‘cultural wisdom’ of a ‘community under siege’
Religion a ‘confounding’ of sorts; a bargaining point among other communities and better-off states too
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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
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
Policy terrain can itself be exclusionary by using labels such as ‘hard to reach’
Hard to reach, or hardly reached?
Nature and characters of citizenship and legality in rural and urban societies
Structural inequities of urban health systems
Complex intersections with poverty, gender and culture
Assimilative nature of campaigns can be a core process of alienation
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Issues of Social Exclusion and Inclusion

‘Under-served strategy’ from 2003: Decreased resistance and increased seropositivity
Reaching newborns
Reliable and responsive primary healthcare services
Community dialogue; complementary to social mobilization
Services in slums and peri-urban areas
Community fatigue and implementation fatigue
Engaging with ‘otherness’
Making micro-planning meaningful
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Key Last-Mile Challenges . . . .

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

by CORE Group on Jun 30, 2011

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