1. Mid-Term Evaluation of the Core Group Polio Project: Conclusions and Recommendations Henry Perry Department of International Health Johns Hopkins Bloomberg School of Public Health Core Group Spring Meeting, 11 May 2011

2. Conclusions

3. General Conclusions Investments by USAID and the Gates Foundation in the CORE Group Polio Project (CGPP) are being well-spent and are increasingly necessary for polio eradication to be achieved Increasing investments in “social mobilization” (and in the CGPP) will be required in order to achieve polio eradication

4. (cont.) CGPP interventions are effectively reaching high-risk areas CGPP effectiveness in high-risk catchment areas and in training and technical support for community-based programming is increasingly becoming recognized and valued by other Polio Eradication Initiative (PEI) stakeholders in Angola, Ethiopia and Uttar Pradesh, India (MOH, UNICEF, WHO, Rotary, CDC, Gates)

5. (cont.) The skills, resources and capacities that the CGPP brings to polio eradication (for building community partnerships and effective community-based programming) are becoming recognized as increasingly important for this final “do or die” stage of PEI programming

6. Value of Census-based Programming Identifying all households, registering eligible children, and tracking defaulters is a key strategy for the success of the work of the CGPP

7. Immunization Coverage Levels of OPV coverage and coverage of routine immunizations are similar in the CGPP catchment areas to levels of coverage in lower-risk areas, and this is a major achievement considering that these areas contain the hardest-to-reach/hardly reached populations (because of their geographic isolation, mobility, or social resistance to polio immunization) These levels have remained the same or increased modestly since baseline There are still “hard core” pockets 5-10% of unreached children not participating in polio Supplemental Immunization Activities (SIAs)

10. Monitoring and Evaluation Quality of M&E activities and of in-country external evaluations need strengthening, especially in Angola and Ethiopia There is an inability to identify who and where are those being missed by SIAs, especially in Angola and Ethiopia

11. “Campaign Fatigue” “Campaign fatigue” – both in the CGPP project staff/volunteers and in the communities themselves – is a reality that must be recognized and dealt with (in Uttar Pradesh, for example, SIAs are conducted almost monthly) Expanding the focus beyond polio to epidemiological and community health priorities offers the most promising approach to responding to “campaign fatigue”

12. Need for Expanded Support for Non-Polio Eradication Activities in Hard-Core Resistant Areas Programs for addressing epidemiological priorities and for addressing community-perceived priorities will garner support for PEI activities These programs can also serve to facilitate post-PEI transitioning once polio is eradicated

13. Weak Organizational Platform In all three countries, Secretariats are “loose” and almost “free-standing” entities without a strong organizational connection In the US, the CGPP is almost a “free-standing” entity without a strong organizational connection to the CORE Group itself or to the NGO (World Vision) within which it is housed

14. Recommendations

15. General Recommendations Investments by USAID, the Gates Foundation, and possibly other donors needs to continue and increase to strengthen current activities and to expand the scope of work to epidemiological and community health priorities for “hard core” populations (in collaboration with local governments and local health programs)

16. Monitoring and Evaluation More financial resources and stronger technical support needed for M&E For strengthening ongoing monitoring of its work For identifying and focusing greater attention on the 5-10% of the population in high-risk areas that are escaping participation in PEI activities

17. Organizational Structure CGPP needs a stronger organizational platform in the US and in Angola, Ethiopia and India if it is going to continue to play an effective role and be able to expand its role in eliminating poliovirus transmission in high-risk, resistant areas

18. Narrower Geographic Focus Made Possible with Stronger Surveillance Need to identify who and where the hard-core resistant population is in the CGPP catchment areas (made possible through stronger monitoring capabilities) and give increasing attention to this sub-group and less attention to the entire CGPP catchment areas

19. Expand Scope of Surveillance Consider including other diseases/events of greater epidemiologic importance of greater community concern – e.g., maternal deaths, under-5 deaths, measles cases, neonatal tetanus cases, etc. Use this information to define local epidemiological priorities

20. Expansion of Scope of Work Need additional funding to respond to epidemiological and community-perceived priorities in hard-core resistant areas

21. Conclusion The CGPP now has 13 years of program experience in social mobilization, local-level programming, and technical support for polio eradication in hard-core resistant areas This experience is becoming increasingly important for the final elimination of wild poliovirus transmission

22. (cont.) Expansion of scope of work into epidemiological and community health priorities provides the CORE Group with opportunities for longer-term engagement in some of the highest-mortality areas of the world post-polio eradication where community-based programming will be critical to achieve the health-related MDGs

23. (cont.) Need to advocate for strengthening of health services for hard-to-reach/hardly reached populations