Report of the Second Independent Evaluation of the Response to the Polio Epidemic in Madagascar [Rapport de la deuxième Evaluation Indépendante de la riposte à l’épidémie de Polio à Madagascar]

This report in French provides an assessment of the polio situation in Madagascar, including the communication context and plan. As reported here, in October 2014, a case of acute flaccid paralysis (AFP) - circulating vaccine-derived poliovirus (cVDPV) type 1 (cVDPV1) was reported in a 3-year-old girl in the Analalava district, region of Sofia, northwest of Madagascar. This brings to 10 the total number of cVDPV in this country. The first evaluation of the response from July 9 to 20 concluded that Madagascar had not followed the guidelines of World Health Assembly (WHA) resolution WHA 59.1, and the country had failed to stop poliovirus transmission. Conducted by an evaluation team comprised of 8 international experts who visited 5 regions (Analamanga, Boeny, Menabe, Southwest, and Androy), this second evaluation finds, in short, that Madagascar continues to make progress in responding to the polio epidemic, with the country's authorities making the polio outbreak a national public health emergency and the Ministry of Health setting up an emergency committee and technical committees to better organise and track the response. Localised campaigns and 3 National Immunisation Days (NIDs) have been carried out since the beginning of the epidemic, one particularly designed to reach children under age 15. However, the AFP surveillance system has not been sufficiently strengthened, supplementary immunisation activity (SIA) quality is not optimal, and it is likely that the cPVDV continues to circulate in the country.

Strong points in the response to date are outlined, including communication-related findings such as the participation of the President of the Republic and the highest authorities of the country in the launch of the polio campaign, as well as evidence of a continuity of authorities' engagement in the SIAs. There has also been advocacy and adoption of 2 ministerial decrees (by the Ministry of Health and Ministry of Education) making vaccination against polio a national priority. Collaboration is cited as having been effective, as evidenced by the adoption of the multi-sectoral approach in the response through the involvement of sectors other than the Ministry of Health. There are some areas that need improvement as well, such as, in the case of AFP surveillance, the flow of non-standardised information resulting in a gap of data between different levels (district, regional, national). Also, regional and local partners are not involved in routine immunisation (RI) activities.

With regard to communication and social mobilisation in particular, as noted above, a national advocacy plan with participation at the highest level of the state has been developed and covered widely by television and radio media. There has been regional training for journalists and evidence of commitment on the part of radio programmes and national and subnational television. Social mobilisation guidelines for SIA campaigns are available nationwide, and the timely transfer of funds for communication activities has exceeded that of previous campaigns. However, national and international non-governmental organisations (NGOs) are not sufficiently engaged, and the roles and responsibilities of different actors in the areas of advocacy, communication, and social mobilisation are not sufficiently articulated with other operational components of the campaign. Furthermore, social mobilisation training does not include the components of implementation, supervision, and monitoring. According to the assessment team, the messages and images are inadequate (do not include the perceived risk, the safety of the vaccine, and the importance of repeated campaigns as long as the epidemic continues).

A number of recommendations are made, such as: organise formative research to clarify a number of social data (such as the reasons for absences, refusals, missed children, etc.) to ensure that communication activities are based on evidence; use community workers and social mobilisers before campaigns optimally with a focus on advocacy and community mobilisation; engage people with local influence, especially Fokontany leaders, members of Rotary International, Red Cross, and other partners such as NGOs; develop a crisis communication plan at the national level to address rumours, boycotts, etc.; and provide all vaccination and social mobilisation teams with aprons / tunics or tee-shirts with defined colours and images used nationally.

Click here the 18-page report (French language only) in PDF format. A 38-slide PowerPoint presented (in French) to the Ministry of Health (MOH) and partners in October 2015 is also available.