Political Commitment and Ownership for PEI/EPI - Punjab 2008

This PowerPoint was one of the communication presentations made at a technical consultation on polio eradication in Afghanistan and Pakistan, held in Egypt from February 3-4, 2008. The objectives of the meeting included:

1. Reviewing progress towards polio eradication in the two countries, with a focus on 2007.
2. Discussing planned activities for 2008.
3. Making recommendations to enable the programme to address constraints facing the two national programmes.

The two-day meeting consisted of a programme of presentations and discussion looking at the epidemiological situation and programme activities in both countries, with a strong emphasis on programme communication.

The presentation opens with an overview of the demographic background and political setup of Punjab. The main focus is on retaining the commitment of political leaders to ensure they are directly involved and use their power and influence to keep the Polio Eradication Initiative (PEI)/Expanded Programme on Immunisation (EPI) as a top priority. Communication with these leaders is focused on keeping them informed and involved and guarding against overconfidence. Communication is also focused on keeping a high level of interest and motivation to sustain high vaccination coverage and rigourous acute flaccid paralysis (AFP) surveillance even when polio is less visible as a public issue. The presentation discusses the importance of understanding and communicating with both formal and informal influential leaders and recognising that there can be multiple centres of influence which are sometimes competing with each other. It concludes that maintaining political commitment is a continuous and cumulative process that is essential to polio eradication and routine EPI. It warns that weakening of this commitment may undermine eradication efforts as well as efforts to improve routine EPI and deal with polio virus importation.

The following groups were identified as important to involve:

1. Provincial leadership and civil administration:
   
   • Governor, Chief Minister, Health Minister, Chief Secretary, Secretary Health, Director General for Health, EPI manager
2. District decision makers/opinion leaders/others:
   
   • Political and civil administration
   • Opinion leaders (religious, political, media, line departments)
   • Traditional healers, private practitioners
   • Community and community leaders
   • Non-governmental organisations (NGOs)/Unions
   • Field staff (better monitoring, supervision, and support)

The presentation noted that building commitment requires paying attention to the following:

• Building trust and mutual respect.
• Maintaining high quality implementation through capacity building, monitoring, supervision, and maximum use of social mobilisation
• Avoiding contradictory messages.
• Being careful not to bypass immediate officials.
• Avoiding the creation of parallel systems.
• Re-enforcing ownership continuously.
• Maintaining constant low profile constant communication about polio\EPI.
• Using appropriate local channels of communication.
• Maximising utilisation of all communication channels.
• Ensuring the appropriate approach for specific issues.

Meetings were described as the "most important tool," but these had to be supported by regular feedback, a combination of regular and high profile meetings with district-level political leaders, recognition events such polio-free flags and certificates and telephone calls from programme leaders to high district politicians in special circumstances.

The presentation also looked at special advocacy interventions designed to overcome specific challenges such as outbreaks, security issues, refusals, rumours, competing programmes, staff morale, and changes in leader attitudes.

Political commitment needs to be continuously monitored; Punjab has developed quantifiable, subjective, and composite indicators to track progress and identify issues, some of which are listed below:

1. Quantifiable indicators:
   
   • Statements made by leaders
   • Participation of district decision makers in the provincial review/preparatory meetings
   • Leading polio walks and inaugurations
   • District Polio Eradication Committee meetings
   • Mosque announcements
2. Subjective indicators:
   
   • Accessibility to decision makers
   • Leaders' knowledge about polio
   • Response of leaders to rumours
   • Response of leaders to the recommendations
3. Composite indicator:
   
   • Use the judgment of the field staff to assess leaders' commitment.

In concluding, it was noted that Punjab has maintained a high level of programme ownership but there are some emerging concerns including fatigue, competing priorities, anti-vaccine propaganda, resistance among the medical community, polio being seen as less of a public health problem, and loss of interest amongst some key decision makers.

Click here to download the full PowerPoint presentation.