Afghanistan Polio Communication, Southern Region

This PowerPoint presentation was prepared for a September 2007 United Nations Children's Fund (UNICEF)-hosted meeting dedicated to examining polio communication efforts in Afghanistan. In support of the final global push towards polio eradication, regional presentations were given by in-country communication and health practitioners working in Afghanistan's polio endemic regions. These were assessed by an external panel of experts in the fields of development communication, mass media, epidemiology, and anthropology, who provided communication programme recommendations based on data presented by the country teams, as well as data gathered on field visits to the endemic states. Communication strategies presented at this meeting were primarily focused on:

1. Analysing the results of programmes implemented through September 2007
2. Detailing activities on national and sub-national levels, with a focus on transient populations, security concerns, and social mobilisation, media, and political advocacy strategies
3. Suggesting communication strategy and programme refinements for the next 6- to 12-month period, designed to support Afghanistan's polio eradication efforts

This presentation gives an overview of the geographic and demographic distribution of wild poliovirus (WPV) cases in Afghanistan's Southern region. It discusses human resource availability for polio immunisation activities in 2007, vaccination coverage rates for the first half of 2007, and post-campaign monitoring activities. The framework for the region's social mobilisation network is illustrated, and areas of intensified social mobilisation activities are discussed. Finally, problems at all levels of the polio communication programme are detailed, as well as suggested responses to these issues.



Afghanistan's Southern region has an estimated population of 6.5 million people distributed over 50 districts. Approximately 1.3 million children under 5 years of age are targeted for polio vaccination in the region. To date in 2007, seven reported cases of WPV have been documented, four in Hilmand province and three in Kandahar. Six of these cases are male, with only one affected female; two cases occurred in children under 6 months of age, two in children 6 to 23 months of age, and 3 in children 23 to 59 months.



The region's polio immunisation network consists of 3,831 vaccination teams, 76 district coordinators, and 98 monitors. Coverage rates for the first half of 2007 indicate average coverage for each month reaching at least 90% with the exception of an 82% average in February. The estimated target nomadic population in the region is over 190,000 individuals, 27,000 of which were vaccinated in August 2007. Three cross-border immunisation points in the provinces of Zabul, Kandahar (with neighbouring Pakistan), and Nimroz (with neighbouring Iran) are illustrated.



According to post-immunisation campaign monitoring activities, major reasons for missed children in June and August of 2007 include child not being present (>50%) or newborns asleep or sick (>25%).



Major achievements in polio immunisation activities in the Southern region were outlined by the team, and include:

• Establishiment of a social mobilisation network
• Arrangement of advocacy meetings at the provincial and district levels
• Decentralisation of volunteer training to the village level
• Appointment of four access negotiators in security-compromised areas in order to open access for immunisation teams

The social mobilisation network structure was detailed in this presentation from the provincial to the household levels. Training is structured to trickle down from one social mobilisation team leader at the provincial level to impact 903 community influencers, through a few intermediary positions. Social mobilisation activities in August 2007 saw 10,575 students, 26,636 heads of families, and 16,519 family members exposed to polio communication messages. In addition, goodwill ambassador Martin Bell visited the high-risk Spinboldak district and attended a village Shura meeting to advocate for polio vaccination. Other social mobilisation activities included:

• A rickshaw parade
• A football match for polio
• Meetings of village elders and identification of volunteers in villages by elders
• Inauguration of National Immunisation Days (NIDs) by religious and political leaders
• Meetings on polio held within mosques
• A quiz competition for youth on polio trivia held in Kandahar

The media's role in polio communication in the Southern region was seen to be strengthened by briefing of media groups regarding polio matters and having experts answering media questions related to vaccination. Local television and radio announcements were also reported to occur one week in advance of NIDs to increase public awareness.



Current plans to refine social mobilisation activities in the future include: expansion of the network to Helmand; increased synchronisation of social mobilisation activities with an operational plan; and micro-planning to reach difficult populations. According to the presenters, major remaining challenges include:

1. Poor security – The team recommends encouraging Days of Tranquility for NIDs.
2. Missed areas – Increased involvement of access negotiators and local influencers is seen as potentially beneficial.
3. Population movement – Increased planning for NIDs should take these individuals into account.
4. Selection of service providers – The team suggests this process should include involvement of the elders and imams, and full responsibility should be given to the non-governmental organisations (NGOs) at the district level.
5. Poor training – Support and guidance for weak participants is seen as an important step, as is monitoring of training sessions.
6. Weak action for implementation at the district level - The team suggests that follow-up on all decisions should be done by the provincial team.
7. Poor management – Increased responsiveness to mismanagement and timely submission of data are seen as areas for future improvement.
8. Poor planning and monitoring for social mobilisation and communication activities – A range of measures are seen as important to these processes, including improved micro-planning, and coordination between social mobilisers and vaccination teams.
9. Poor supervision – The team suggested that emphasis should be placed on supervision during training of coordinators and volunteers, as well as strengthening of daily review meetings.

For the full PowerPoint presentation, please contact Kiyuri Naicker at knaicker@comminit.com