Reaching missed children Lessons learned from polio S usan MacKay, Maya van den Ent , UNICEF
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Reaching missed childrenLessons learned from polioSusan MacKay, Maya van den Ent , UNICEF P
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When it comes to missing children measles can learn a great deal from polio …
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Routine and campaigns – we’re missing the same children
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BURUNDINAMIBIA
MALI
BENIN
LESOTHO
SENEGAL
GUINEA
S. LEONE
S. LEONE
NIGERBENINB-FASO
G-BISSAU
COTE D'IV
GAMBIA
TOGO
NIGER
COTE D'IV
BENIN
NAMIBIA
GHANA
0
20
40
60
80
100
Non-clients (no health card)RI Clients
• (Very) Low participation among non RI clients
• In some SIAs, > 80% coverage overall, but <40% among non-RI users
Polio SIAs and prior use of Routine
Hellinger et all (2012) Bulletin WHO
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Where do we miss the most children?
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Polio Sanctuaries
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2.7 million children have not received a single dose. Many more are under-immunized.
Missed children disproportionately belong to minority groups.
Not all are in the sanctuaries. But if a data-driven, missed-children-focused approach can be honed in the sanctuaries, it can be applied elsewhere.
Every Missed Child, Report from the Independent Monitoring Board, June 2012
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Polio SanctuariesVaccination status non-polio AFP cases
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Who do we miss?
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Risk profiling in Nigeria
Location: Rural 52%; Urban slums :28%Literacy: Mothers (98%) , fathers (83%) illiterateOccupation: 45% of cases are farmers; Trader 21%Nomads: 8% with 49% living close to nomadic communities
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We’re rapidly expanding our use of risk profiling and special investigations to better understand exactly who is most at risk
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Why do we miss them?
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www.polioinfo.org
Reasons for missed children – both social & operational
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DR Congo, Nigeria and Quetta Block (Pakistan) present the biggest challenges.
Share of refusals among all missed children in priority countries and select sanctuaries March 2012 Source: Independent Monitoring DataOvert refusals are
not the main reason for missing children in any country
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Bauc
hi
Born
o
Jigaw
a
Kano
Katsi
na
Kebb
i
Niger
Soko
to
Zam
fara
Tota
l
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1% 3% 4% 5% 11% 6% 8% 10% 5% 6%
76% 78% 80%61%
66%89% 89%
55%
84%72%
23% 20% 16%34%
23%6% 3%
35%
11%22%
Hse Not Visited Child Absent Non-Compliance
NIGERIA: Reasons for Missed Children by State,High Risk States, July 2012
Inside Household Monitoring
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Can we increase demand from parents so that they make sure their children are immunized?
In Nigeria 22% are at the family farm, 28% at social events and 28% are playing nearby the house P
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Personal selling(Volunteer Community Mobilization Network)
Can we innovate to bring the vaccines to where the children are?
Transit sites, border crossings, markets and other social gathering places give us valuable opportunities for both polio, measles and routineP
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Importance of social data – answering the ‘what’
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September 2011
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www.polioinfo.org
Data driven approach to communications and social mobilization
Indicators
Sources: - Surveillance reports (non –
polio AFP cases)- Independent monitoring;- LQAs - UNICEF monitoring;
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Importance of social research – answering the ‘why’
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Rapid social research using FGDs and other qualitative techniques is proving vital for revising communication – and operational - strategies
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How to improve communication and social mobilization
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Campaign awareness globally
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Awareness & Knowledge of Polio - Pakistan
• Recent KAP study in high risk populations
• Only 6% heard of polio but don’t exactly know what it is
• Only 55% named polio vaccination as a way to protect from polio disease
• 20% still don’t know how to prevent polio
Example from Pakistan
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Mass Media Campaign reaches over 110 million caregivers each month with at least 3 contacts – through TV, radio, print materials
How Far Would You Go to Eradicate Polio?
Vaccination is important. It’s everyone’s responsibility. Going the extra mile to
vaccinate your child/every child is heroic
Profiling Polio Hero’s: Mothers, Vaccinators, Athletes, Civil Society
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National Punjab Sindh KP FATA Balochistan0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
63%
72%
Jan
July
Polio campaign awareness nationwide has increased almost 10% after 3 campaignsSource: PCM Data
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Khyber Pakhtunwa
Sindh
Punjab
Federal Administrative Tribal Area
Balochistan
Karachi Central
Pishin
Quetta
Killa Abdullah
Refusal to accept OPV 2.0 - 8.08.1 - 10.010.1 - 51.0Missing Value
Delivery: Many parents who refuse the vaccine don’t trust child vaccinators. Male vaccinators also have trouble reaching women.
Trust: Some see polio vaccination as a Western strategy to target Muslims. Minority groups do not trust vaccinators who are not from the area.
Religion: Religious opposition is often linked to political positions that are at odds with the central government or “western” influences. Religious groups are linked strongly to political parties in Pakistan.
Overt refusals in Pakistan are limited to small pockets
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What does COMNet do?
25,347
6,140
4,5814,963
Community Meetings
Schools and Madrassa’s support polio campaigns
Mosques announce polio campaigns
Influencers identified in microplans
EVERY MONTH:
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January March April June July0
10000
20000
30000
40000
50000
60000
70000
0
10
20
30
40
50
60
70
80
58742
43041
25293 27272
41219
18614 16944 12612 14597 27934
32
39
5054
68
Refusals Reported & Converted in Pakistanduring Jan-Jul 2012*
Reported (#) Converted (#) Converted (%)* Source = PRIME Data
Ref
usa
l R
epo
rted
(#)
Ref
usa
l C
on
vert
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(%)
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What are the take home lessons for measles?
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• Regular data collection (RCAs, IM, surveys) to identify awareness, motivation for vaccination, source of information and reasons for missed vaccinations
• Development of evidence based communication plans
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• Systematically finding, understanding and addressing missed children requires considerable investment in collecting, analyzing and using social data
• An integrated approach to communications and social mobilization is required to ensure behavioral impact
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Political advocacy, mobilizing decision makers and opinion formers
Branding, advertising & ‘edu-tainment’ with national, provincial and community
mass media
Community engagement and mobilization (meetings, forums, film showings and events)
Personal selling(Volunteer Social Mobilization Networks)
Point of service promotion (Vaccinator IPC)
integrated communicati
on action
COMBI Star adapted for polio eradication
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What Measles can Learn from Polio
• Communication plans– Based on evidence
• Social data for action– Surveillance data– Independent Monitoring / Surveys– Focus Group Discussion – In depth Interview
• Measles to capitalize on polio investments
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Anne Ray Charitable Trust
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