Abstract
This article explores the Polio Communication Network’s (PCN) contribution to the polio outbreak response in the Somali Region of Ethiopia from 2013 to 2015. The PCN strategies and innovations include the establishment of a communication network of experts, development of partnerships with locally trusted and influential groups, and capacity building of local structures. Results show PCN contribution through sustained high levels of community awareness of polio rounds and low rates of noncompliance with polio vaccination in line with the national indicator (< 1%). We argue that the context-sensitive approaches made significant gains in reaching traditionally missed, hard-to-reach, pastoral communities with polio information, improved communication capacity, and expertise, and contributed to the successful outbreak closure. The PCN experience in the Somali Region, one of Ethiopia’s lowest-performing regions for health indicators, provides important communication lessons for the long term relevant to polio eradication and other public health programs. Due to the focus on building capacity in areas such as monitoring and data collection, generated social data demonstrated impact of communication approaches and has contributed to a better understanding of the behavioral and environmental factors affecting the demand for, and uptake of, health services in Ethiopia’s Somali Region.
Acknowledgments
The authors thank the following persons for their review of this article: Dr. Belete Tafesse, Dr. Macoura Oulare, Tesfaye Simireta, Tariku Berhanu, Dr. Tersit Assefa, Almaz Merdekios, Angela Baschieri, Dr. Muse Soyan, Asli Hassan, and Mohammed Adem. They are grateful to Abdinasir Mohamed, Yejimmawork Ayalew, and Naseem Khan for their support with the data analysis and tables. In addition, they acknowledge STOP Team consultants Ahmad Shahvez, Hope Roobol, Abhishek Gupta for their contributions. Appreciation goes to the Somali Regional and Zonal Health Bureaus, the regional and zonal communication coordinators, the Islamic Affairs Supreme Council, other communication network contributors, and UNICEF and WHO field teams. Special appreciation goes to the community members, families, and parents who shared their time, energy, and knowledge. Many thanks to Rustam Haydarov and the polio teams in the UNICEF Eastern and Southern Africa Regional Office (ESARO) and the World Health Organization Regional Office for Africa (AFRO). We extend our appreciation to the members of the Horn of Africa Technical Advisory Group (HOA TAG). The authors thank the donors who have made significant contribution to the communication and social mobilization support of the polio outbreak response: Rotary International, the Bill and Melinda Gates Foundation, Crown Prince Court, Abu Dhabi, UAE, and others. Many thanks to the Communication Initiative and the United States Agency for International Development (USAID) Maternal and Child Survival Program for their generous support. Many thanks to the team at Global Health Communication. The authors acknowledge the leadership of the Ethiopia Federal Ministry of Health and EPI Taskforce throughout the polio outbreak response. We remember those individuals affected by polio in Ethiopia and around the world. This work is dedicated to Shamala Raj Rozario, whose love and support made everything possible.
Funding
The publication of this article was made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of the Cooperative Agreement AID-OAA-A-14-00028. The contents are the responsibility of the Maternal and Child Survival Program and do not necessarily reflect the views of USAID or the United States Government.
Notes
1. Diphtheria, Haemophilus influenzae type b (Hib), hepatitis B, measles, pertussis, pneumococcal, polio, rotavirus, tetanus, tuberculosis.
2. In this article, SIA refers to polio vaccination campaigns using oral polio vaccine.
3. In this article, SIAs referenced are primarily from rounds 8 to 14 (May 2014–April 2015), which provides a 1-year snapshot during the outbreak response () and reflects the time period in which a full range of activities described were implemented.
4. The STOP Program (Stop Transmission of Polio) is a global effort that trains public health professionals from around the world and sends them to the places with the greatest need (http://www.cdc.gov/globalhealth/immunization/stop/index.htm).
5. The method of partnership was a Programme Cooperation Agreement signed between IASC and UNICEF Ethiopia.
6. The “Polio Communication Survey: Kebele Checklist” initiated by UNICEF and the FMOH Communication EPI Working Group in 2012/2013 provides communication information relevant to the polio and EPI programs. The checklist is implemented by communication teams or SIA supervisors along with the RCS. For each woreda visited, 3 kebeles and are assessed. Twelve questions gather information on polio SIA awareness and notification, SIA visibility, SMC activity, routine immunization services, and health mobilization through religious institutions and leaders.
7. Children who had never received a single dose of the oral polio vaccine.
8. Round 11 reported the greatest percentage of religious leaders as a source of information, although in previous and subsequent rounds engagement was also reported, but not as significantly as in round 11.
9. The identified reasons for noncompliance by the PCN are in line with RCS results, which show that the main reasons for noncompliance were “too many rounds” followed by “child sick” between rounds 8 and 14 in the Somali Region; 55% and 24% of reasons were attributed to these factors, respectively, across the rounds.
10. Birka, shallow well, pond, or dam.
11. Event defined as act of revitalization or reestablishment of SMCs. The event might have occurred in one kebele more than once over the specified period of time.
12. SIA rounds 6 through 8 were conducted between January and May 2014.
13. SIA Rounds 16 through 18 were conducted between August and December 2015.