1. Polio Communication Indicators Reflections from Polio Communication TAG/Review Process

2. History and Background 2005 Global Review panel Multiple national presentations Recommendations 2006 Regional Review panel Multiple presentations Recommendations 2007 National Review panel Field Trip National and sub- national presentations Recommendations. 2008 TAGS + Local Review panel Field Trip Sub-national focus and chair Recommendations. Communication representation on TAGs/ERC What follows flows from this process and is based on the reflections of several of the panelists. It focuses on the needs and conditions of polio communication programmes in the four endemic countries and specifically on communication for HRAs.

3. Present situation Polio eradication challenges: Need to maintain overall awareness. Need to respond to issues within specific groups or localities (fatigue, refusals, mis-information, gender relations, cross border coordination, nomads, security, access etc) Need to maintain morale and commitment among communities, teams, local and national leaders, global donors. Need to do all of this in the context of diminishing resources.

4. Present situation Routine Immunization and polio The eradication of polio has been a huge effort and there are lessons to be learned across many sectors of health including communication The ultimate success of PEI (global certification) depends on successful RI Successful RI will depend in part on strong communication both in terms of national awareness and in terms of building political commitment, accessing local and global resources, building demand and ownership amongst disparate communities Many of the indicators that make sense for Polio will make sense for RI

5. Key Questions 1 of 4 Are key programme messages being heard and are they resonating with caregivers, health professionals and community leaders across a range of cultural, religious, ethnic, urban and rural differences: Are messages being appropriately tailored to different groups? Are those groups confident in the safety of OPV? Do they understand and believe the need for multiple doses and rounds? Do they accept and want their newborns to receive OPV? What are the reasons for missed children and are conversion rates improving?

6. Key Questions 2 of 4 Is the programme building an environment of ownership and trust: Are communities and influencers participating in activities like flag-offs/inaugurations? Do community meetings on polio have good attendance and real participation and do they achieve the kinds of positive action or outcome they were held to engender? Is the media covering polio accurately, how receptive is it to epidemiological and campaign information and is the overall tone of media coverage positive, negative or neutral? Are religious, political and other leaders behind the campaign at all levels but especially in HRAs?

7. Key Questions 3 of 4 Does the programme have the people in place to do the work: Are the posts filled for all the roles the programme requires (these may vary from country to country but for example - national, regional and district polio coordinators, supervisors, vaccinators, underserved coordinators, independent monitors, CMCs, BMCs etc) Are they adequately trained and motivated to do the communication aspects of their jobs well? Are there enough of them and are they placed appropriately to cover the communication needs of especially though not exclusively prioritised HRAs and groups? Are they appropriate to the communities they are working with in terms of gender, religion, ethnicity etc.

8. Key Questions 4 of 4 Is the programme well planned and monitored: Is essential programme data being collected accurately and analysed from a communication perspective? Are there national, regional and local communication plans in place? Does each micro-plan have a strong communication component which is reviewed and updated after each round? Is media tonality being monitored and are there plans in place to work with media regularly? Is there an accepted cycle of monitoring the programme that incorporates data collection, analysis, strategic reflection and revision of communication plans between each round at all levels?

9. These questions led us to… A set of 14 example indicators we hoped would help to: Facilitate discussion within countries seeking to strengthen their own indicators Utilise data collected from campaigns, surveillance and programme research effectively from national to lowest administrative level. Guide planning, monitoring and resource allocation. Ensure a flexible approach focused on needs of high risk areas while maintaining high general awareness. Establish trend data related to strategies and activities. View communication as an internal tool for improving operations and maintaining morale etc as well as an external tool for building ownership, demand and immunisation seeking behaviour.

10. 5 example indicators 1 of 5 Use AFP surveillance, control room and PCM data to analyse case characteristics and data on zero, low dose and missed children to identify where the highest risk areas are among what populations with what characteristics. Communication Indicator 1: Percentage of high risk areas/population groups have been reached with communication strategies specifically designed to respond to problems in those areas (ie reaching underserved populations, increasing newborn vaccination or reducing low dose children). Target = 100%

11. 5 example indicators 2 of 5 Use PCM and independent monitoring data to analyse the number and location of areas with poor coverage by reason and the percentage of children and households converted between rounds. Communication Indicator 2: Percentage of areas with coverage <95% in previous round that have updated social maps to track conversions by reason in subsequent round. Target = 100%

12. 5 example indicators 3 of 5 Use KAPB and other studies along with PCM data to measure key PEI knowledge and information sources. Communication Indicator 3: Percentage of households that know about the round before by source of information. Target 80% Percentage of households that can recall at least 2 of 3 key messages. Target = 80%

13. 5 example indicators 4 of 5 Use staff performance reports to track between round revisiting. Communication Indicator 4: Percentage of non-converted refusal households in prior round visited by an influential person between rounds. Target = 80%

14. 5 example indicators 5 of 5 Use regular media monitoring reports to track international, national and local media coverage, respond to mis-information and develop media management/engagement strategies. Communication Indicator 5: Percentage of media stories by tonality. Target = 80% positive or neutral. Percentage of media stories with one or more error of polio fact. Target = Less than 5%.