National Emergency Action Plan for Polio Eradication, Afghanistan, July 2013 - June 2014

"...Polio program in Afghanistan has identified 6 key intervention areas that will be essential to assure the implementation of strategies [including]:...Communication directed to increased community demand and ownership..."

This document outlines the strategies developed by the Afghanistan Polio Eradication Initiative (PEI) programme as part of its revision of the National Emergency Action Plan (NEAP). Afghanistan PEI notes that the first half of 2013 was a turning point in that there were only 3 cases; moreover, there were no cases from the traditionally infected region of the South, where all of the Low Performing Districts (LPDs) are located. However, having seen the same trends in the past, Afghanistan PEI "is taking a very cautious stand in order to avoid any setbacks, which the [polio eradication] program cannot afford anymore."

Several elements of Afghanistan PEI's revision of the NEAP strategically prioritise areas of interventions and plans for activities that centre around communication. For example, in an effort to increase community demand for the oral polio vaccine (OPV), prior to this publication, actions have included:

• "The new polio communication campaign with a motto 'Ending Polio is MY RESPONSIBILITY' has been launched with over 8 times increase in the airtime use on both radio and television for PSAs [public service announcements]; over 25 radio and 12 television channels broadcast. Polio messages in SNIDS [sub-national immunisation days] and over 50 radio and 19 television challenges do so in NIDs, expansion of use to include all varieties of programs and active involvement of media personnel.
• Polio/ Immunization Communication Network restructuring to increase linkages between operations and communication workers has been completed. By end 2012, the social mobilization network covered 80% of the low performing clusters in Southern Region. Provincial Polio Communication Teams comprised of representatives of departments of education, religious affairs, women affairs, youth/ sports have been constituted in Kandahar and Helmand and are working on active involvement of these departments in awareness raising, community involvement and monitoring of communication activities.
• The Inter Personal Communication (IPC) training module for Polio campaigns was revised and training of all vaccinators, social mobilizers and cluster supervisors in the Low Performing Districts has been completed.
• Community Sensitization sessions with mullah imams, ulema-i-shura and other community elders organized in LPDs of Southern Region.
• Sporting events including football tournaments were organized to promote the cause of Polio eradication in Southern region.
• According to a KAP [knowledge, attitudes, and practices] survey conducted in 2012, in the 13 high risk districts of Southern region 73% of caregivers had heard of polio campaigns while 83% of caregivers were aware that OPV can prevent polio."

Going forward, the NEAP includes these focus points:

1. LPDs - here, immunisation communication network (ICN) engagement will go beyond campaign activities to include house-to-house interpersonal communication (IPC) with parents/caregivers between campaigns, focusing on missed children, refusals, identification of newborns, messaging on routine immunisation (RI), handwashing, and breastfeeding. Other communication activities suggested in the NEAP are engagement with key community leaders, local religious leaders, schools/teachers, and community-based organisations (CBOs) in meetings and events to promote social and behaviour change in an effort to further increase awareness levels, knowledge, and commitment to immunisation and related services. Mass media, engaging regional and local media, will integrate relevant messages about importance of immunisation, handwashing, and exclusive breastfeeding. Also suggested: development of polio campaign visibility materials and actions to build the capacity of media professionals and journalists on a quarterly basis, especially at the regional level, to highlight the importance of immunisation and promote healthy behaviour.
2. Missed children - sample strategy: "In line with global indicators, Afghanistan PEI has re-categorized the refusals to include the hidden ones and within that thinking to develop strategies for action including re-visit strategy and re-tailor communication activities." This will include: strengthening IPC skills of frontline workers; 1-day IPC training for vaccinators, supervisors, health workers, and community influencers; 2-day trainings for the ICN social mobilisers, with refreshers every quarter; and provision of information, education, and communication (IEC) materials for vaccinators and mobilisers. In addition, focused messages on vaccinating newborns will be disseminated through engagement of religious leaders and community health workers and skilled birth attendants' networks. At the community level, ICNs' interventions will include: pre-campaign house-to-house visits for IPC and dot marking (new and updated records); recording of newborns that will feed into microplans; accompaniment of social mobiliser (SM) within the vaccination team as part of the revisit strategy; and a list of missed children and refusals compiled by the vaccination team in their assigned area at the end of the campaign, to be shared with Cluster supervisors (ICN) and followed up for actual vaccination of the child through RI.
3. Communication for increased community demand and ownership: "ICN will continue to create awareness at community level and expand their activities beyond the campaign period in all 30 LPDs" by, for example, including house-to-house IPC with parents/caregivers between campaigns focusing on missed children, refusals, identification of newborn[s], and messaging on RI and hand-washing. Other activities include, for instance, using mobile technology to broadcast polio-related messages before and during OPV campaigns through SMS (text message)/outbound calls/interactive voice response (IVR).
4. Management and accountability - sample strategy: a training on IPC was scheduled to be conducted in the South-Eastern Region in August 2013.
5. Strengthening surveillance
6. Routine Expanded Programme on Immunization (EPI)

Supporting activities outlined include actions such as: efforts to secure political commitment through face-to-face meetings; use of mobile technologies to collect real-time data on timely availability of vaccine and IEC materials, timely payments, and spot checks for missed areas and children; advocacy and social mobilisation; and cross-border coordination with Pakistan, including building IPC skills of cross-border, transit, and transport hub teams.