Transcript of A Social Norm Strategy for Polio Eradication in Pakistan Susan Roe, UNICEF ROSA / Kathmandu, Nepal.
- Slide 1
- A Social Norm Strategy for Polio Eradication in Pakistan Susan
Roe, UNICEF ROSA / Kathmandu, Nepal
- Slide 2
- Now A Much More Localized Problem
- Slide 3
- Global Efforts = Continued Progress GPEI Goals: By end 2011:
Cessation of transmission in at least 2 out of 4 endemic countries;
and, By end 2012: Cessation of all WPV transmission!
- Slide 4
- Pakistan Epidemiology - Challenges From 2011 cases / data: 71%
cases below 2 years of age 77% Cases Pashto Speaking (89% of
Karachi cases) 23% of the polio cases from 'refusal' families 88%
cases living in Multiple Family Dwelling Vaccination status (based
on recall): 31% no OPV dose 73% no routine OPV dose
- Slide 5
- An Innovative Approach Needed for Engagement with HRGs From WPV
Cases 2009 - 2012 Pashto speakers: 73% Have lower knowledge and
risk perception regarding disease (factual beliefs / personal
normative beliefs e.g. attitudes - individual); Yet concerns / lack
of knowledge about OPV safety are largest among Pashtuns (with
rumors of infertility / sterility also highest in this group); Are
more likely to chronically refuse than other groups; and, Among all
2011 refusal cases (47) or 89% were Pashto-speakers mostly
clustered in / around Balochistan. *KAP 2012
- Slide 6
- Refusal A Social Norm? Consider Social Dimensions What do other
community members do or say? (Empirical Expectations) My neighbors
dont accept and told me that this vaccine is brought from America
and contains family planning medicine. What do people in the
community expect from me or others? (Normative Expectations) My
mother-in-law does not allow taking of the drops. She says that her
children remained safe without them, so yours will be fine. Are
there consequences for not complying? (Normative Expectations)
These drops are not accepted by our household (e.g. husbands) and
if we raise the issue we could be kicked out of our home if we dare
say something. Or perhaps - What do I do based on actions of others
(but not caring what they think)? A Descriptive Norm?! Need for
further research and investigation!!!
- Slide 7
- Challenges Associated with Existing Polio Structure Top down
multi-level structure; Perceived as externally / internationally
driven; Focus: individual behavior (acceptance), coverage and
prevalence numbers; Delivered door-to-door - isolates / privatizes
action - casts community as receivers; Messaging primarily one-way
announcing campaign dates and promoting readiness to receive; Fails
to address other issues (intensive focused on eradication but some
linkage to RI - convergence); and, Credibility, motivation and
geo-political dimensions highly contentious (Western conspiracy,
drone attacks vs. immunization, fake campaigns to locate Bin
Laden).
- Slide 8
- Existing Communication / Social Mobilization Strategies Message
development - demand creation, addressing incorrect factual beliefs
and shifting attitudes (Individual); Enlistment of multiple
relevant network members / influentials as part of process and to
enhance credibility and trust (Social) ; Introduction of new
relevant network - Com Net (in HRDs) to forge linkages with
communities for engagement and interaction (Social); Recruitment of
HR group members / women as part of network and build capacity
(Social);
- Slide 9
- Existing Communication / Social Mobilization Strategies
Specific HRG strategies reach out to marginalized populations
(festivals and religious gatherings information provision
(Individual); New mass media campaign (How Far Would You Go?) to
activate stakeholders across levels & increase visibility
(Individual); Enlistment of celebrity and culturally relevant
advocates to promote polio for the wider population (localized
ownership - Individual); Continued work with media to promote
relevance, benefits and success at local level (visibility, local
ownership / support - Individual).
- Slide 10
- Further Considerations Data related to factual beliefs and
personal normative beliefs (attitudes) available through past
research initiatives; Resistance to the vaccine may be affected /
influenced / motivated by social expectations; Will require more
investigation / research into Empirical and Normative expectations;
In addition to survey tools use of in-depth interviews and focus
group discussions can also be applied.
- Slide 11
- Sample Empirical Questions: Do your neighbors accept polio
drops every time they are offered? Why or why not? Do your leaders
encourage you to immunize your child and that polio drops are safe
and cause no harm? Does your family members (husbands / mother in
laws) welcome polio vaccinators when they come to your door? Does
your community encourage one another to support social mobilization
around OPV and to accept drops when they are offered each and every
time? Sample Normative Questions: Do you feel that your neighbors
think that you ought to accept polio drops every time they are
offered? What happens to a member of the Pashtun community who
accepts polio drops when others feel that he / she shouldnt? Do you
think that your neighbors believe you and others in the community
should accept OPV because it is beneficial for the whole community?
What would your community do or say about someone who accepted
polio drops when others disagree or feel they should be
refused?
- Slide 12
- Desired Outcomes Polio acceptance / demand creation at
care-giver and household level (PB - Individual); Positive
attitudes around vaccine acceptance and service seeking behavior
(PNB - Individual); Demand and acceptance for polio drops
demonstrated and promoted by others (EE - S); Create expectation
that community / relevant network expects others to demand and
accept OPV each and every time it is offered (NE - S). To do this
in addition to existing strategies - need to introduce new social
norm around polio acceptance within the HRG (e.g. Pashtun)
community.
- Slide 13
- Review data / conduct additional research related to further
learning and next steps addressing social expectations; Revisit
existing messages and strengthen interdependent dimensions / social
normative perspectives; Use collective meetings (facilitated by Com
Net and relevant network members or leaders) for values
deliberation and unpacking scripts related to good parenting, child
health and social identity; Use triggering to explore issue of
social dilemma and for addressing incorrect factual beliefs /
rumors; Restructure existing networks through blending of Com Net
and traditional leaders in support of organized diffusion; Use
traditional gatherings or religious festivals as a mechanism for
bringing polio discourse more out into the open while building
credibility and trust; Proposed Way Forward
- Slide 14
- Use of pledges or public affirmation of commitment to new polio
acceptance norm (building visibility, confidence and trust);
Consider use of symbolic, collective immunization events to signal
shift to new norm, build confidence and solidify internal
motivation (also ensure acceptance when H2H rounds commence);
Sustain and prevent slippage through continued engagement with
local Com Net workers and social mobilizers / vaccinators from
local community; Continue / build on existing polio social
mobilization activities in support of organized diffusion to
sustain and reinforce (other partners and media to expand reach and
spread); Promote harmonization of social and moral norms around
immunization and gather evidence to negotiate with officials
regarding timing / severity of proposed legislation; Explore
possibility for replication especially along migration routes,
cross border or at end point destinations; and, Celebrate win win
situation with community, leaders, GoP, PEI partners as related to
implications for county, regional and global eradication.
- Slide 15
- Potential Risks /Additional Challenges Time / effort required
for additional research / analysis for new data related to
expectations; Community dialogue / discussion needs skilled
facilitation capacity?; Sensitivity of specific group being
targeted / singled out; Visibility of collection immunization could
also be mis- understood or perceived as sensitive (and backfire
with other groups / media); Limited time (GPEI goals) for
implementation / process!
- Slide 16
- Many Thanks for Kind Attention!