National Polio Communication Update [Pakistan]

This PowerPoint presentation was prepared for a September 2007 United Nations Children's Fund (UNICEF)-hosted meeting dedicated to examining polio communication efforts in Pakistan. In support of the final global push towards polio eradication, state-specific presentations were given by in-country communication and health practitioners working in Pakistan's polio-endemic states (Sindh, Balochistan, and the Northwest Frontier Province). 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 tthrough September 2007
2. Detailing activities on national and sub-national levels, specific to social mobilisation, community engagement, underserved areas, media, and political advocacy strategies
3. Suggesting communication strategy and programme refinements for the next 6- to 12-month period, designed to support Pakistan's polio eradication efforts

This presentation gives an overview of Pakistan's national polio communication strategy. It outlines the strong partnership between the National Steering Committee (consisting of the Government of Pakistan, the World Health Organization (WHO), UNICEF, Rotary International, and other Partners), the federal and provincial implementing partners, and district level implementers. The overarching communication platforms and objectives are discussed, as well as the effectiveness of their communication strategies over time. Detailed discussions are included on the media environment, locally appropriate activities, training of vaccinator teams, strategies for dealing with refusals, and religious advocacy. The main challenges facing the Polio Eradication Initiative (PEI) in Pakistan are outlined, as well as the proposed way forward through these obstacles.


The sustained communication activities for both the PEI and expanded programme on immunisation (EPI) in Pakistan are rooted in the following platforms:

1. Advocacy – Commitment at national, provincial, and district levels
2. Awareness – Building high awareness through media, branding, and interpersonal communication (IPC)
3. Community Partnerships – Expanding these whenever possible
4. High-risk Approach – Data-driven strategies focused on high-risk areas

The team outlined the following communications objectives for Pakistan's PEI programme by the close of 2007:

• 60% of parents will know the importance of having their child vaccinated 5 times before the age of 1
• 95% of parents will recognise the polio logo and associate it with immunisation services
• 80% of caregivers will understand that vaccination keeps children safe from the disease
• 85% of caregivers will understand the importance of administering oral polio vaccine (OPV) as many times as possible to children under 5 years
• Increased communication capacity in the 24 high-risk districts through deployment of 28 communications officers

In order to maintain visible commitment at the federal level, the national steering committee meets weekly for coordination. Daily polio updates are given to the Minister of Health, and the President and Prime Minister are briefed on PEI. This has resulted, among other things, in the inauguration of numerous vaccination campaigns by prominent government officials, and the allocation of domestic resources through the Ministry of Health to the PEI. At the provincial level, all Governors are routinely briefed on PEI/EPI, letters are sent to provincial officials highlighting these issues, and partners meetings and provincial steering committee meetings are conducted regularly. This has led to inaugurations of supplementary immunisation activities (SIAs) by provincial leaders and high levels of involvement of provincial government officials (i.e. Secretary of Health) on polio committees and taskforces.


According to a Household Polio Knowledge Baseline Sample Survey conducted in Pakistan, effectiveness of the communication strategies was demonstrated by the following:

• 80% of respondents were aware of/recognised the polio logo.
• Over 88% considered administration of polio drops "very essential".
• 55.5% indicated television was their main source of information about the polio campaign.
• 79.5% rated polio as a much more serious threat than other vaccine-preventable diseases.
• 93.1% felt OPV is safe.

Focus group research was also conducted to refine polio communication practices in Pakistan. The researchers believe that the findings reflect a need to portray polio victims through a variety of media, as well as a need to increase the emphasis on cable television. There also appears to be an increased need for engagement of health professionals and teachers in message dissemination and education.


According to the presenters, use of media for immunisation activities in Pakistan has become increasingly data-driven. Media engagement in recent years has resulted in a number of proactive media activities for immunisation, such as:

• Engagement of National media channels to support PEI/EPI
• Local programming in local languages using local influencers to support national programming
• Regular immunisation coverage secured on 12 national television channels, 4 local television channels, 12 local FM stations, and through local cable operators
• Media roundtable discussions
• Media capacity building
• Focus on routine EPI between campaigns

Social mobilisation strategies have focused on locally appropriate activities, such as holding Jirga meetings (gatherings attended by tribal elders); involvement of religious leaders and influencers; involvement of prominent paediatricians; and information dissemination through schools. Training of vaccination teams to focus on aspects of social mobilisation (such as social mapping, working with the media, and understanding the importance of data-driven approaches) is also seen as an important component in the overall communication strategy.


According to the national data, average immunisation refusal rates are highest in Balochistan. Activities initiated in order to resolve these refusals have included positive media pieces (such as Polio True Stories), engagement of local influencers, and social mapping. However, refusals are not seen as the major cause of low vaccination coverage. Child "not available" has accounted for over 50% of missed children during national immunisation days (NIDs) in 2007.


Ongoing national-level polio communication challenges in Pakistan include:

1. Maintaining commitment at all levels with the changing political climate
2. Increases in refusals in key high-risk areas
3. Competing priorities and negative reporting within media channels
4. Low awareness in some areas
5. Difficulty in securing trained communications personnel in high-risk areas

The team suggested that the way forward for Pakistan's PEI programme includes sustaining the focus on locally-appropriate activities, providing recognition to vaccinator teams for good performance, and development of an interpersonal communication (IPC) training and motivational video for vaccinators.


To summarise, the team noted that the continued focus on high-risk areas, as well as a strong need for cross-sectoral collaboration and leveraging of all community resources for PEI, is critical. They also point out that a high level of community awareness exists for the disease and the campaign throughout the country, and an increased engagement of local leadership and communities has been seen in recent years.


In conclusion, the following questions were asked of the TAG:

1. What should Pakistan be doing differently to increase awareness of immunisation?
2. What can be done differently to access children in security compromised areas?
3. What other indicators could we use to measure progress?

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