Polio Communication Review - India 2008: Bihar, Kosi River Report

This report details the findings of the consultant team sent to the Kosi River region of India to review community mobilisation activities related to polio eradication in 2008. The team was asked to do this review via:

• Analysis of block-level communication plans.
• Analysis of block-level supplemental immunisation activity (SIA) data from January to April 2008.
• Meetings with supervisors, mobilisers, and non-polio community health workers.
• Meetings with selected X (missed) families.
• Meeting with service providers.

The guidelines for the review provided for the team to cover at least 2 districts, visiting 5 to 7 villages, including at least 5 households per village. Plans were to visit Saharsa and Khagaria districts; however, flooding of the road to Saharsa made travel impossible and the field visits were reorganised to focus only on Khagaria. The revised plan focused on meeting community mobilisation coordinators (CMCs) in their villages within areas that included hard-to-access villages. Because of the logistics and travel times involved in getting to some of these villages, the team was only able to visit a total of 4 villages in 3 blocks. Household meetings focused on X households and were conducted with individual households or with clusters of households sharing a courtyard.

The team was asked to review a set of indicators and found the following:

Progress against Indicators:

• Involvement of local Panchayati Raj Institutions (PRI) members/influencers/supporters identified by CMCs. A total of 592 influencers were identified in the Khargaria district as of July 2008. Influencer movement data comparing CMC to non-CMC areas indicate that CMC areas have 187 influencers moving with them, as compared to 181 for non-CMC areas. The Parbatta block has 22 identified influencers but the CMC area does not have any moving with the teams. Overall, CMC influencer support, as measured by influencer movement with teams, can be favourably compared to non-CMC areas and has considerable room to grow in the coming months.
• Number and quality of meetings/information, education, and communication (IEC)/interpersonal communication (IPC) activities conducted by CMCs. Like the data on influencer movement, this has only just begun to be collected, so there are no trends to report at this point. Furthermore, tracking is only being done against numbers of meetings, and qualitative data is anecdotal at this time. Nevertheless, each CMC has an up-to-date communication plan listing meetings to be held on specific dates during each round cycle. These meetings are approved by the block mobilisation coordinator (BMC) and data is collected to track proposed vs. achieved meetings in both CMC and non-CMC areas. This will provide a useful quantitative tool over time, measuring the impact of the CMC intervention. However, there is no qualitative measure being recorded, monitored, or tracked at this point, which is an area that is brought up in the further recommendations within this report.
• Percentage of X families recalling CMC visit to their home. This is not information that is being collected by the programme, and the authors of the report were unable to provide any data other than the anecdotal reports from the people they met with in the villages they visited. Those reports indicate that the CMCs are well-known and respected and seen often.
• Percentage of family recall of meetings/information, education, and communication (IEC) activities held in their area. As above, this information is not available. However, all the direct discussions that were held with people in the villages indicate that these activities are happening and villagers are aware of them and/or attend. It is difficult to ascertain the quality of such meetings given the already mentioned lack of qualitative data. However, discussions with people in the villages indicated that while there is no resistance to polio immunisation, neither is there much understanding as to why multiple rounds are required or the importance of ensuring that all children continue to be immunised in each round. This may be an indication that monitoring and strengthening the quality of IEC activities would help improve overall knowledge of polio, and especially the reasons for multiple rounds. Improved understanding of this issue could lead to a reduction in Xv (child out of village) children and a reduction of fatigue overtime.

The team identified the following key issues:

They feel that the programme is well-run and that the staff, influencers, and supporters are very committed and hardworking. The CMCs have accomplished an enormous amount since starting only 5 months prior to the review:

• Influencers have been identified and involved;
• IEC activities are ongoing;
• Data on X households and P conversions (when a household has been converted from X or missed to having their children vaccinated) are very positive;
• Identification and immunisation of newborns has become a clear focus;
• There is high awareness of the programme; and
• The CMCs are respected and recognised for their work by the villages they serve.

This is an excellent base for continued success.

The team suggested the following adjustments be made in order to improve overall performance:

1. Improving the consistency of reporting and tracking qualitative indicators for influencers and IEC activities.
2. Improving understanding of the reasons for multiple rounds.
3. Ensuring that efforts to provide materials and/or outreach to illiterate community members are strengthened.
4. Improving the tracking of missed children by enumerating based on numbers of children 0-5 years old.

The team made several recommendations after consultation with district and state level polio staff and partners, which can be found in the report.

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