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Purple Pinkies
       Dr. Roma Solomon, Director
 Mr. Manojkumar Choudhury, M & E Officer
      CORE Group Polio Project India

       CORE Group Spring Meeting
         3 May , Wilmington, DE
Social Mobilisation for Hard to
          Reach Populations
• Brief introduction through narrative & slides
• Role Play
• How we reach the unreached
• Using LQAS for improving social mobilisation
  activities
• Short film – ‘A drop of dialogue’
Polio cases (thousands)




       0
                             100
                                                 200
                                                        300
                                                              400
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
                           the world in India
                          Last type 2 polio in



2001
2002
2003
2004
                                                 1988
                                                 2008




2005
2006
                        1&3
                      Monovalent




2007
2008
2009
2010
                        Bivalent




2011
2012
                                                                    Polio Eradication: Historical Context




           2012: 14
Progress in Polio Eradication
                         1988 – 2012



1988                                                                                          2009
                                             Type 1
        125 endemic countries                                           4 endemic countries
        1000 cases per day                  Type 3
                                                                (India, Nigeria, Pakistan, Afghanistan)
        350,000 cases per year                                            1604 cases/year




                              2010           2012
       1292 cases -20% reduction since       46 cases; 43 in endemic
       2009; 99% reduction since 1988        & 3 in non-endemic
                                             countries
                               Source: WHO 17 04 2012
Purple Pinkies_Solomon_5.3.12
THE
CORE GROUP POLIO
     PROJECT
      INDIA
    1999 - 2012
IMAGINE   THE

• 394 million people live in U.P., Bihar & W. Bengal
• 500,000 children are born every month in U.P and Bihar
• 2.3 million vaccinators used in one National Immunization Day
• 500,000+ vaccinators cover about 45 million children in each SNID
• 900 million doses of OPV were used in 2011
• 9,125 community mobilisers visit over 3 million families each
  month in the three states
• In 2011, the SM Net tracked 30,000 migrant families and helped
  vaccinate 1,814,266 children on the move in transit and border
  areas.
Field Operations
                 Small mop-up in India

           4,200,000 children under age 5
               280,000 vials of vaccine
                50,000 square miles
                 37,000 vaccinators
                  4,000 supervisors
                  2,500 mobilizers
                    2,000 vehicles
18,000 vaccine carriers/ice/markers/chalk/tally sheets

                       3 days
Two National Immunization Days
          (Booth-based)
 Much fanfare in a campaign mode
172 million children under 5
      immunized in every NID



                          But


More than 15% children continued to
    be missed in every Round…
1999
House to House
    strategy
  introduced
Stiff
 resistance
encountered
Community Resistance grew in W. Uttar Pradesh,
2001

 Hindu and Muslim mothers
 in Western U.P. felt strongly
                                           Muslim mothers
 that polio program targets a
                                              reported the
 specific community
                                            highest rates of
                                           hearing rumours/
                                            concerns about
                                                 OPV
Communities believed that…                   (Unicef KAP study)

o Polio immunization led to impotency
o It was a family planning program
o Different color of polio vaccines were
  used for different communities
Shift from extensive mass
 awareness approach to
    addressing specific
   conditions/needs of
      specific groups
Communication response initiated

CORE volunteers
from schools,
nursing schools &
NGOs in High
risk areas of Uttar
Pradesh tackled
resistance to OPV
                      Increase in female vaccinators
Community Mobilisation Coordinators
           (CMCs) were Born
                             • Selected from the
                               same communities
                             • To overcome
                               resistance and
                             • Sustain community
                               participation for polio
                               eradication and
                               routine immunization

Unicef & CORE set up the Social Mobilisation Network in
Uttar Pradesh, deploying hundreds of CMCs in High risk
               areas to tackle resistance
Each CMC covers 400-500 houses
Analysed ‘Resistance' to develop
    ‘Negotiation' strategies
Shift from instructive to negotiation approach

                               Focus on skill
                                building of
                              communicators
                                  (CMCs &
                                 Vaccinators)
Shift to localised mobilisation
               activities
• Government mobilization
  – Formation of district core groups on polio & RI
  – Involvement of other departments like education,
    women & child welfare, etc.
• Religious and opinion leaders’ mobilization
  – Regular and continuous meetings
  – Izthema meetings (Meetings of Muslim ladies)
• Targeted IPC & mother/influencer meetings
  with resistant families/pockets
Hard to Reach??
How Do We Reach?
Let me count the ways…………….
CMCs visit each pregnant woman and
give Congratulation Card after child
birth
CMCs track polio immunization status of children
                    under 5 years
By focused IPC for Communities


                      Mapping & Registers
                                            Providing Immunization
                                             status of each child to
                                               vaccination teams
Health Camps




  Children's
    Rallies
1. Greater involvement of religious leaders
2. Formation of state ulemas committee
3. Appeals from religious institutions and leaders
9 million people exposed to polio messages during religious
                   congregations in 2010
Billboards, posters, etc
for brick kilns, construction sites, & transit teams

                                          Wherever you
                                          go, make sure
                                            your child
                                          receives OPV
Flip book




             Flash Cards


                                                      Message booklet


            Flash Cards    Snakes and Ladder Game
                                                    Streamer
Leaflets on Diarrhea Management and Routine Immunization
• Booth day
 – Bulawwa toli – child mobilisers
 – Decorated polio booths inaugurated by local
   influencers
 – Visit to X houses
2009
Who was sustaining transmission?

Very young: Definitely

Migrants:   Yes

Older children: Maybe(?)
Status of Wild Poliovirus Cases – UP
             Year 2009*




                                         75% cases
                                          below 2
                                         yrs of age
                  * data as on 19th Jun 2009
Emphasis on Birth Dose
Migrants
 • Brick Kilns
 Children of parents working in brick kilns

 • Construction sites
 Children of parents working on construction sites

 6. Slums
 Migrants in urban/peri-urban slums

 4. Nomads
 Communities who travel from place to place for
     livelihood, setting up temporary homes on empty
     tracts of land near railway stations, market places,
     etc.
 Often work as blacksmiths, basket weavers, puppeteers,
     acrobats, fortune-tellers, singers and dancers.
CMCs conduct special IPC sessions with migrant families on
     the importance of polio & routine immunization




       More than
                               Soap strips distributed to
          4000                 promote hand washing behavior
       informers
        enrolled
                   Barbers, shopkeepers, etc. engaged
                   as informers on migrant groups
2010

80% polio cases contributed
 by only 2% (107) of India’s
          blocks
Revised Communication Package for Polio
             Developed
Revised Communication Package for the very
            High Risk Blocks




                     Get 2 drops of
                       OPV + polio
                     plus messages
% Resistant Houses (XR) in UP - CMC areas
               2007- 2011




                                Source:Tallysheet
Mapping for Monitoring
      Relevance and Use

•Lack of detailed maps in rural & urban areas
•Need to map growth momentum
•Desire of wider audience to view the location
and data concurrently
CORE Work Area Map of Ward 46, Howrah, W.Bengal
               Booth Locations
Web based Booth-specific Information
2011
    Rukhsar from
W. Bengal, the only case


                           25th Feb. 2012
                           India declared
                            Non-endemic
                               country
Each child
receiving polio
 drops gets the
   left pinky
 marked with
   purple
indelible ink

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Purple Pinkies_Solomon_5.3.12

  • 1. Purple Pinkies Dr. Roma Solomon, Director Mr. Manojkumar Choudhury, M & E Officer CORE Group Polio Project India CORE Group Spring Meeting 3 May , Wilmington, DE
  • 2. Social Mobilisation for Hard to Reach Populations • Brief introduction through narrative & slides • Role Play • How we reach the unreached • Using LQAS for improving social mobilisation activities • Short film – ‘A drop of dialogue’
  • 3. Polio cases (thousands) 0 100 200 300 400 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 the world in India Last type 2 polio in 2001 2002 2003 2004 1988 2008 2005 2006 1&3 Monovalent 2007 2008 2009 2010 Bivalent 2011 2012 Polio Eradication: Historical Context 2012: 14
  • 4. Progress in Polio Eradication 1988 – 2012 1988 2009 Type 1  125 endemic countries 4 endemic countries  1000 cases per day Type 3 (India, Nigeria, Pakistan, Afghanistan)  350,000 cases per year 1604 cases/year 2010 2012 1292 cases -20% reduction since 46 cases; 43 in endemic 2009; 99% reduction since 1988 & 3 in non-endemic countries Source: WHO 17 04 2012
  • 6. THE CORE GROUP POLIO PROJECT INDIA 1999 - 2012
  • 7. IMAGINE THE • 394 million people live in U.P., Bihar & W. Bengal • 500,000 children are born every month in U.P and Bihar • 2.3 million vaccinators used in one National Immunization Day • 500,000+ vaccinators cover about 45 million children in each SNID • 900 million doses of OPV were used in 2011 • 9,125 community mobilisers visit over 3 million families each month in the three states • In 2011, the SM Net tracked 30,000 migrant families and helped vaccinate 1,814,266 children on the move in transit and border areas.
  • 8. Field Operations Small mop-up in India 4,200,000 children under age 5 280,000 vials of vaccine 50,000 square miles 37,000 vaccinators 4,000 supervisors 2,500 mobilizers 2,000 vehicles 18,000 vaccine carriers/ice/markers/chalk/tally sheets 3 days
  • 9. Two National Immunization Days (Booth-based) Much fanfare in a campaign mode
  • 10. 172 million children under 5 immunized in every NID But More than 15% children continued to be missed in every Round…
  • 11. 1999 House to House strategy introduced
  • 13. Community Resistance grew in W. Uttar Pradesh, 2001 Hindu and Muslim mothers in Western U.P. felt strongly Muslim mothers that polio program targets a reported the specific community highest rates of hearing rumours/ concerns about OPV Communities believed that… (Unicef KAP study) o Polio immunization led to impotency o It was a family planning program o Different color of polio vaccines were used for different communities
  • 14. Shift from extensive mass awareness approach to addressing specific conditions/needs of specific groups
  • 15. Communication response initiated CORE volunteers from schools, nursing schools & NGOs in High risk areas of Uttar Pradesh tackled resistance to OPV Increase in female vaccinators
  • 16. Community Mobilisation Coordinators (CMCs) were Born • Selected from the same communities • To overcome resistance and • Sustain community participation for polio eradication and routine immunization Unicef & CORE set up the Social Mobilisation Network in Uttar Pradesh, deploying hundreds of CMCs in High risk areas to tackle resistance
  • 17. Each CMC covers 400-500 houses
  • 18. Analysed ‘Resistance' to develop ‘Negotiation' strategies Shift from instructive to negotiation approach Focus on skill building of communicators (CMCs & Vaccinators)
  • 19. Shift to localised mobilisation activities • Government mobilization – Formation of district core groups on polio & RI – Involvement of other departments like education, women & child welfare, etc. • Religious and opinion leaders’ mobilization – Regular and continuous meetings – Izthema meetings (Meetings of Muslim ladies) • Targeted IPC & mother/influencer meetings with resistant families/pockets
  • 21. How Do We Reach? Let me count the ways…………….
  • 22. CMCs visit each pregnant woman and give Congratulation Card after child birth
  • 23. CMCs track polio immunization status of children under 5 years By focused IPC for Communities Mapping & Registers Providing Immunization status of each child to vaccination teams
  • 24. Health Camps Children's Rallies
  • 25. 1. Greater involvement of religious leaders 2. Formation of state ulemas committee 3. Appeals from religious institutions and leaders
  • 26. 9 million people exposed to polio messages during religious congregations in 2010
  • 27. Billboards, posters, etc for brick kilns, construction sites, & transit teams Wherever you go, make sure your child receives OPV
  • 28. Flip book Flash Cards Message booklet Flash Cards Snakes and Ladder Game Streamer
  • 29. Leaflets on Diarrhea Management and Routine Immunization
  • 30. • Booth day – Bulawwa toli – child mobilisers – Decorated polio booths inaugurated by local influencers – Visit to X houses
  • 31. 2009 Who was sustaining transmission? Very young: Definitely Migrants: Yes Older children: Maybe(?)
  • 32. Status of Wild Poliovirus Cases – UP Year 2009* 75% cases below 2 yrs of age * data as on 19th Jun 2009
  • 34. Migrants • Brick Kilns Children of parents working in brick kilns • Construction sites Children of parents working on construction sites 6. Slums Migrants in urban/peri-urban slums 4. Nomads Communities who travel from place to place for livelihood, setting up temporary homes on empty tracts of land near railway stations, market places, etc. Often work as blacksmiths, basket weavers, puppeteers, acrobats, fortune-tellers, singers and dancers.
  • 35. CMCs conduct special IPC sessions with migrant families on the importance of polio & routine immunization More than Soap strips distributed to 4000 promote hand washing behavior informers enrolled Barbers, shopkeepers, etc. engaged as informers on migrant groups
  • 36. 2010 80% polio cases contributed by only 2% (107) of India’s blocks
  • 37. Revised Communication Package for Polio Developed
  • 38. Revised Communication Package for the very High Risk Blocks Get 2 drops of OPV + polio plus messages
  • 39. % Resistant Houses (XR) in UP - CMC areas 2007- 2011 Source:Tallysheet
  • 40. Mapping for Monitoring Relevance and Use •Lack of detailed maps in rural & urban areas •Need to map growth momentum •Desire of wider audience to view the location and data concurrently
  • 41. CORE Work Area Map of Ward 46, Howrah, W.Bengal Booth Locations
  • 43. 2011 Rukhsar from W. Bengal, the only case 25th Feb. 2012 India declared Non-endemic country
  • 44. Each child receiving polio drops gets the left pinky marked with purple indelible ink

Editor's Notes

  1. Hard to reach includes both social and geographic inaccessibility
  2. Incredible progress over the past 20 years, but the remaining places are very, very challenging. There has been a 99% reduction in cases and we’ve prevented over 6 million cases of childhood paralysis. © 2009 Bill & Melinda Gates Foundation
  3. Tremendous progress has been made in the Global Polio Eradication efforts. There has been a 99% reduction in cases globally since 1988. Nearly 6 million cases of childhood paralysis have been averted. In 1988 more than 1000 polio cases per day were reported in more than 125 countries. Today, only 4 countries are now considered polio-endemic. (India, Pakistan, Afghanistan, Nigeria). 10 countries have re-infections in circulation, down from 19 countries last year. Stopping virus transmission is a top global priority with a goal of certifying the world polio-free 3 years after the last case. The investment thus far has been $8 billion from a large coalition of UN, foundations, bilateral donors, civil society and host countries.
  4. Year of KAP Study????
  5. Rope picture to be added
  6. What year was child tracking introduced?
  7. Better Rally picture
  8. Add picture or coverage
  9. Core Group India has begun to map its operations using GIS based tools. The experimental initiatives have been taken for Ward 46 of Howrah Municipal Corporation, West Bengal. The mapping will continue through subsequent rounds of polio eradication program to track the progress.
  10. Guessed Right??