Report of the Communications Review

Pakistan Polio Eradication Programme

April-May 2012

This report presents the findings of the Communication Review panel, conducted for UNICEF Pakistan on behalf of the national polio eradication programme. The panel worked in four teams to cover four critical areas of communication and social mobilization:

·  Mass media (Rod Curtis, Amber Rana)

·  Interpersonal communication and community engagement (Jeff Bates, Susan Roe)

·  High-risk groups (Chris Morry, Hans Frey)

·  Monitoring and evaluation (Sue Goldstein, Seb Taylor)

This report primarily refers to the UNICEF polio communication programme. However, it is expected that, given the critical importance of partnership in the polio programme as a whole between UNICEF and WHO, donors and local counterparts, under the guidance of the Government of Pakistan, the report will provide useful information to all relevant actors.

The panel worked in-country between 27 April and 8 May. The panel received full briefing on programme and epidemiological status as at April 2012, before deploying to conduct brief province and sub-province level field consultations (Peshawar (High-risk Groups Team), Sindh (Mass Media & IPC/Community Engagement Teams), and Punjab (M&E Team).[1]

Pakistan Polio Communications Review Teams Members

Team Member / Background
Rod Curtis / UNICEF polio communications, India
Amber Rana / Creative Director, Go TV, Pakistan
Jeff Bates / UNICEF polio communications, New York
Susan Roe / UNICEF C4D, Kathmandu
Chris Morry / Programme Director, The Communication Initiative
Hans Frey / Senior Professor, Area Study Centre, Quaid-i-Azam University Islamabad
Sue Goldstein / Public Health and Communications, Soul City
Seb Taylor / Polio programme consultant

Contents

Report of the Communications Review 1

Pakistan Polio Eradication Programme 1

Executive Summary 3

Acknowledgements 3

Findings 3

Summary of Findings and Recommendations 5

Findings 5

Recommendations 7

Team Reports 9

Team 1: Mass media 9

Team 2: IPC and Community Engagement 18

Recommendations 19

Team 3: High-Risk Groups 27

Recommendations 30

Team 4: Monitoring & Evaluation 32

Recommendations 37

Annexes: 38

Mass Media Team 38

Media Summary Areas and Recommendations 39

IPC Team 43

HRG Team 44

M&E Team 44

Executive Summary

Acknowledgements

The review team would like to thank the many people who took the time to speak to us about their work with honesty and candor. We would especially like to thank the polio communication teams in Islamabad, Khyber Pakhtunkhwa, Balochistan, Sindh and Punjab for their assistance in making this review possible and for their work building this programme in very difficult circumstances. What follows below is not a criticism of that work but an acknowledgement of the very large strides that have been taken in 2011 and an attempt to help build on that progress. Much has been done but much, of course, remains, and continuing to improve the programme’s communication capacities over the coming months are critical to the ultimate success of the eradication effort in Pakistan and the world.

Findings

In general terms the review found that the significant increase in polio communication capacity over the past several months and the momentum this is creating within the programme are positive and provide the strongest and most comprehensive communication platform the programme has ever had. Foundations have been built for: focused community mobilization through COMNet; a mass media campaign capable of reaching high risk populations; training to strengthen inter-personal communication (IPC) skills for frontline workers; strategy to identify and reach high risk and mobile populations more effectively; a significant new capacity to collect and analyse social data to pinpoint contextual factors at the local level obstructing or supporting better programme performance; & a stronger emphasis on monitoring and evaluation communications and social mobilization initiatives with regard to their contribution to the programme as a whole. However, much of this capacity remains new and it is too early to see the impact of many of the strategies and initiatives that are guiding implementation. Equally, there is still considerable room for improvement, some critical gaps and areas where urgent action is required. The following are key summary observations found to be common across all or the majority of the review teams’ experiences:

·  Central to improving performance in the partnership is improvement in coordination and close collaborative working of key programme partners (primarily WHO and UNICEF) under the aegis and leadership of the Government of Pakistan (GoP), and with the backing of global donors. There remains room for improvement in this – a situation widely acknowledged to be remediable with some simple measures including, for example, more regular, systematic and frequent meetings at federal and provincial levels (mirroring close operational relations in Districts and Union Councils); particularly important is joint participation in, and strategy development from, surveillance review meetings.

·  On the mass media front, UNICEF now has the resources to fulfill its mandate as lead for programme communication but will not be able to fully step into that role without further development of media relations and a greater emphasis on coordinating the programme’s communication response.

·  In relation to front-line teams (including both vaccinators and local COMNet social mobilisers), there is an urgent need to strengthen interpersonal communication (IPC) skills yet the training and related materials are yet to be rolled out.

·  A high risk group strategy is in place and is beginning to demonstrate early signs of impact but it has yet to reach full capacity in the critical province of Khyber Pakhtunkhwa. Further, transit points need to be placed more strategically. IDPs that do not stay in camps pose a major challenge and there is still no specific strategy for FATA.

·  There is a very good new system (PRIME) being developed for gathering and analyzing social data. However, the system should be focused on answering one core programme question – why are children being missed. Further, this analysis should be produced and fed back into operational planning (critically through District and Union Council campaign planning, microplanning and mapping). And social data should be combined with operational and epidemiological data to produce a single shared analytical picture of programme performance by District and UC, owned jointly by core operational partners.

As we finalise this report, we are also struck by flood warnings and the potential for significant disruption of the programme and large scale displacement of people in the coming 2-3 months. We did not specifically focus on disaster preparation or readiness but hope that as the recommendations below are reviewed consideration also be given to prioritizing those elements of media, mobilization, training and reaching high risk and mobile populations that will be useful should floods lead to large scale disaster and all that that will entail.

Below you will find summary findings and recommendations though we hope that you will be able to find to read through each teams full report where further dimensions of analysis and insight can be found.

Summary of Findings and Recommendations

Given the substantial overlap in the four programming streams, overall findings and recommendations are presented in matrix format to maximize coherence between and among identified programme priorities, as well as national, provincial, District, Union Council and community levels of action.

Findings

Mass media / Interpersonal Communication / High-Risk Groups / Monitoring &Evaluation
Top-line / All teams reported significant operational strength – and highly positive up-scaling of engagement and investment – in polio eradication by UNICEF in the review period
Overview / Increased capacity now enables UNICEF to fulfill its mandate for polio communication but there remains considerable opportunity to develop media relations and coordinate communication response. / The Pakistan polio communication programme has regained momentum and now has an infrastructure capable of large scale social mobilisation interventions in key high risk districts. However, improving IPC skills and tools remains a critical and urgent need. / High-Risk Group strategy and activities are developed but need to be fully implemented; the programme needs to respond to fast-moving changes, e.g. conflict/natural disaster disruption. / UNICEF are building an excellent system for gathering social data for polio; all research, monitoring and evaluation should be focused on one issue: understanding and addressing ‘missed children’
Capacity / Need to engage media through workshops and meet and greets to build trust in the programme and capacity for polio reporting / There is a need to build IPC training and materials for front-line workers (social mobilisers and vaccinator teams) based on standard social engagement activities. / Need to improve specialised IPC training for vaccinator and transit point teams.
Community engagement / Mass media has achieved high levels of national reach but more work is needed to engage media at provincial and local level to reach HRGs and to increase threat perception. / There is evidence of high levels of community commitment to the programme; there is no sign of embedded resistance to OPV in most districts. / Need to define in more detail ‘High-Risk Groups’, to understand communication needs of specific tribal, religious, nomadic and mobile populations / Data do not support a continuing primary emphasis on ‘refusals’ – and on ‘conversion’/‘influencer’ communication/social mobilisation activities
COMNet / COMNet offers a platform for engaging hardest-to-reach communities/areas but needs more materials designed for frontline use and the roles of influencers need to be more structured and expanded beyond addressing refusals. / COMNet shows signs of potential impact (i.e. Balochistan) but is not yet fully operational in KP. / Focus COMNet on core programme challenges e.g.: supporting vaccinator delivery (including enabling vaccinator access in insecure areas and engaging mobile & displaced populations)
Data / External review is required for impact of mass media at national and community-specific awareness / Data (resolution, reliability and availability at local level) remain a challenge and should be better used for performance analysis and operational strategy at the micro-strategy level. / The lack of reliable data on reasons for missed children in high risk districts and amongst high risk groups remains an urgent issue. / Social research and data-gathering instruments (e.g. KAP) should be rapidly disseminated at operational levels in combination with technical/epidemiological data to support microplanning
Operations / There is no media crisis plan and a lack of coordination regarding spokespersons. / UNICEF has strong presence at District, UC and community levels, with parallel WHO structures but more coordination is needed to be able to adequately deal with the scope of issues in high risk communities. / A streamlined HRG strategy (currently over 50 activities) has been developed but not yet implemented and these is still no strategic communication plan for FATA. / Data analysis should be fed into operational review and planning each round; the Performance Cards are useful ‘dashboard’ for fast-turnaround programme review and planning
Coordination / All partner activities in polio mass communication activities should be streamlined into ‘one voice’ / There is evidence of collaboration between MoH, UNICEF WHO and community within UCs, though roles of key actors at UC need to be modified. / Recent joint meetings between UNICEF and WHO to develop a coordinated HRG strategy, improve data collection and strengthen working relations at the frontline worker level are promising but much still needs to be done to translate these discussions into a more effective programme. / UNICEF and WHO should be sharing data and programme analysis more regularly and actively (e.g. at national surveillance meetings and District/UC microplanning level)

Recommendations

Mass media / Interpersonal Communication / High-Risk Groups / Monitoring & Evaluation
Top-line / Strengthen coordination (national, provincial, district, UC and operational) between UNICEF and WHO, under GoP leadership, with specific reference to regular, systematic meeting to share data on PEI performance, analysis of barriers, and joint strategy to reduce missed children
National / Focus on building media relationships, and strengthening journalist PEI knowledge & reporting capacity through media workshops, take away media packs and more pre-round media events.
Develop a media crisis plan with supporting materials.
Ensure government is the leading voice on polio.
Improve coordination between partners through editorial meetings, aligning media and communication plans and improving staff training on EPI and communication to improve partner relations. / Standardise community engagement strategy and supporting materials, with intensified approaches for HRGs / Complete and operationalise Islamabad-based HRG team (GoP, UNICEF, WHO, partners) to coordinate implementation of HRG strategy / Maintain and develop core PEI social data instruments (KAP etc).
Focus all PRIME research, data-gathering and analysis functions on the core programme question – why are missed children missed, and what are the operational solutions to the problem?
Province / Prioritize ongoing relationships with key media houses, conduct regular briefings with local media houses, identify high profile local voices for media events and work with local medical associations to promote the programme. / Regular provincial COMNet review meetings to assess activities impact, and support KP strategy design and roll-out
Develop and implement a FATA communications strategy, emphasizing enabling access to insecure areas through local intermediaries. / Refine evidence of mass media impact, especially on identified HRGs
District / Increase media spend on terrestrial channels and radio and reduce spend on print while maintaining a rolling evaluation of media habits of HRGs. / Review and rationalize key operational roles for front-line PEI workforce, with particular emphasis on District and UC-level ‘teams’. / Develop high quality IPC materials and activities for social mobilisers and vaccinator teams, with specialized training for transit teams / Modify ‘Performance Card’ to focus on: missed children; causes of missed children; localized comms/operational solutions to missed children
Union Council/Community / Strengthen training for core communication and social mobilization personnel (data analysis, IPC, vaccinator support). / Ensure detailed mapping of disaggregated HRGs at UC level, feeding into microplanning for each round / Focus COMNet activities on core causes of missed children (e.g. vaccinator IPC support, insecure areas and access to high-risk and mobile/displaced groups)

Team Reports

The following sections provide in more detail the areas of investigation, analysis, findings and recommendations from each of the four review teams.

Team 1: Mass media (Rod Curtis, UNICEF India; Amber Rana, Go TV, Pakistan)