GPEI External Evaluation - International Spread Team

This 26-page report details an independent, external evaluation of the Global Poliomyelitis Eradication Initiative (GPEI) that was carried out in response to a request from the Executive Board of the World Health Organization (WHO). The report is part of a package that consists of an Executive Summary and 5 full reports from 5 separate evaluation teams, focused on: Nigeria, India, Pakistan, Afghanistan, and the international spread of polio.

To evaluate polio's international spread, this team visited WHO Regional Office for Africa (AFRO) in Brazzaville (Republic of the Congo), Angola, and southern Sudan, as well as WHO Regional Office for the Eastern Mediterranean (EMRO) in Cairo, Egypt. The visits took place from August 17-31 2009.

First, the report lists overall conclusions on the spread, with specific lists for: GPEI-Geneva, Regional Offices (i.e. AFRO and EMRO), and countries with circulating viruses acquired through importation (Angola and South Sudan). Examples of findings from the latter category that are communication-centred include:

• "Persistent transmission following importation of viruses is clearly related to weak health systems, in particular...inadequate...workforce, services, technologies, information and governance."
• "The quality of recruitment, training and use of volunteer immunizers and social mobilizers is not optimal."

Next, recommendations are provided - some of which are relevant to communication for development:

• In general, evaluators stress that additional human resources, technical guidance, and financial resources should be devoted to social mobilisation in order to adequately tackle resistance, create demand, and involve communities. To facilitate this, they assert that coordination between the Expanded Programme on Immunisation (EPI)/polio team and the social mobilisation team must be strengthened at both central and decentralised levels. Also, coordination of WHO, the United Nations Children's Fund (UNICEF), national EPI programmes, and other GPEI partners needs to be improved at country level in some countries to ensure that both routine EPI and campaigns are conducted optimally. Finally, capacity in planning, management, and monitoring should be strengthened - with a particular emphasis on the district level.
• At the regional level, one recommendation is as follows: "...weekly contact and discussion between AFRO and EMRO would facilitate greater cooperation in identifying gaps and arriving at more efficient interventions for cross border transmission control."
• In Angola (where the most recent wild polio virus, type 1 (WPV1) importation persists, with 19 cases in 2009 to date), the key issue is to get political commitment to campaigns at every level of the government. [See the document for further details].
• In South Sudan (where, as reported by WHO, as of December 15 2009, there are 45 cases reported in 2009 to date, compared to 17 the previous year-to-date), "Social mobilisation for campaigns needs to use all possible modalities (including tribal chiefs, churches, among others) and should put more emphasis on oral messages given the high level of illiteracy in the population. This requires a significant increase in the equipment, particularly megaphones." [See the document for other recommendations].
  

Appendix 1 of the document includes detailed Office and Country reports. Some communication-related lessons are included.

• For example, with regard to surveillance in Angola, "There are WHO funded staff in all provinces who have developed a network of reporters. They have weekly contact with these posts by telephone. Each Province provides a weekly report to the central level - both to WHO and the national EPI office. This system has been strengthened in the last year with the provision of internet connections for all provinces and mobile phones to facilitate transport of samples. There is dedicated transport for this purpose. Further support is planned in terms of local training, logistic availability and an update of active surveillance sites." There are also findings offered about the state of social mobilisation (SM) for Supplementary Immunisation Activities (SIAs), which "relies mostly on the mass media which do not reach all population targets and a large network of unpaid Social Mobilizers of uneven quality who are poorly supervised. Fatigue and resistance to vaccination has built up and Social Mobilizers and Vaccinators are not equipped to address parents’ concerns. A comprehensive communication and Social mobilization strategy for polio and routine immunization has been developed....The challenge is to ensure that it be translated into quality micro-plans, which requires building the Health Promotion Department capacity to support municipalities (and below) in the planning and management of communication activities, including the building of a sustainable social mobilization network and more community involvement."
• With regard to SM in South Sudan: "SM mainly relies on radio broadcastings, print materials of unequal quality, launching ceremonies and public announcements of the campaigns by a too small number of SMs, as vaccinators are to communicate with mothers when they go house to house. SMs are to help them tackle resistances but have to cover long distance and stick to pay days. Supervision is weak. Fatigue is tangible because of the many campaigns that have taken place....There are however, some improvements. A new communication strategy for polio and RI [routine immunisation] is being developed to strengthen partnership with the media, schools, churches and NGOs [non-governmental organisations] and promoting community involvement. SM focal points from the Ministries of Information or Social Welfare have been identified all levels and most State SM focal points have been trained. The micro-plans are to be operationalized at sub-district level in collaboration with the Paramount chiefs and local leaders."
  

The final portions of the report include detailed figures and assessments from the EMRO region. One communication-related finding is that "During the brief on Somalia, the team was informed that the surveillance system is based on a community network and experienced national staff and is performing well....The team noted that in Somalia the programme is conducted almost solely by local staff because of difficulties with security for international personnel....In the context of international spread, and for the reasons alluded to, it may be necessary to keep a close watch on Somalia as the team was concerned that this situation could be ripe for importation and that only the relative isolation of the country from countries with circulating virus was preventing this."