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Deconstructing Social Resistance to the Polio Eradication Campaign in India: A Social Determinants FrameworkRajib Dasgupta...
Social Determinants of Program Implementation: The western Uttar Pradesh context<br /><ul><li> Robust coverage at district...
 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</li></li></ul><li><ul><li> Wild polio virus cases significantly clustered amo...
 Distinct social resistance among Muslim communities for polio vaccine during ‘pulse’ rounds
% of Muslim population: 4 times higher in endemic districts
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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

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

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