Launched: December 2014
Polio is a highly infectious viral disease that can be symptomless, lead to paralysis in a matter of hours, or cause death. Although anyone can contract polio, children under the age of 5 are the most-at-risk population. There is no cure for polio, but it is preventable through multiple, appropriately timed doses of the polio vaccine.
In 2014, 85% of the world’s polio cases occurred in Pakistan, one of three countries where polio is still endemic. Until vaccination coverage is boosted to levels necessary to stop transmission, children in all countries remain at risk to contract polio.
Reaching all children
With renewed energy and focus, UNICEF, partner organisations, and governments are working together to vaccinate each child, stop transmission, and eradicate polio. Polio eradication is campaign-based. During monthly Government-coordinated campaigns, frontline health workers go door-to-door vaccinating children. But reaching Pakistan’s 35 million children under five is a significant logistical challenge. In the most difficult operating environments in Pakistan, frontline staff must negotiate access to communities, identify unvaccinated children, address caregiver’s concerns about vaccination, and educate parents who refuse to vaccinate their children because of misconceptions surrounding polio and polio vaccination. These difficult tasks are compounded by isolation, long travel distances, limited training and supervision, and threats to personal security.
The eradication of polio will only happen if vaccinators are able to reach each and every child multiple times; therefore, every doorstep interaction between frontline staff and caregivers must be accompanied by trust, respect, empathy, and accurate information.
PolioTrac facilitates real time communication between UNICEF and its social mobilisation network, COMNet. Simple mobile phones are used to collect structured data for rapid analysis and open ended conversations to address individual needs.
- Training is a key aspect in advancing the fight against polio and protecting the lives of frontline workers. In trainings to strengthen interpersonal communication skills, frontline workers use role play to model the process of visiting with a caregiver, learn how to talk to reluctant parents about the importance of vaccination, and de-escalate difficult situations like an encounter with an aggressive parent. Parents typically have many questions and if a social mobiliser fails to answer even one, children are more likely to remain unvaccinated. PolioTrac is used to monitor the rollout of training sessions, assess knowledge, gauge participant satisfaction, and reinforce these crucial messages and skills.
- Within campaign and programme quality, PolioTrac provides a pulse on reach and quality of communication tools, like radio spots; and provides an opportunity for frontline staff to give open ended feedback in real time.
- PolioTrac sends motivational messages through voice and SMS to thank frontline workers for their important contribution to the polio eradication effort.
- PolioTrac sends reminders to frontline staff of their roles and responsibilities.
- PolioTrac supports supply and logistics through the monitoring of campaign and programme material distribution; payment for frontline workers; performance of third party field monitors and other partners working in the field on behalf of the Polio Eradication Initiative.
PolioTrac also intends to implement the following activities in the near future:
- Support community engagement through SMS messaging to community influencers, and health-related information to frontline staff and caregivers.
- Record motivational messages from recognisable and influential individuals encouraging and commending frontline worker efforts
- Provide incentives like public recognition, badges, and airtime with public SMS and voice messages
- Enrol frontline workers in group chat applications to connect and support one another over SMS.
- Send reminders to polio programme partners (medical associations and religious influencers) of upcoming campaigns.
- Remind caregivers of upcoming campaigns; check with caregivers that a vaccinator visited the house; and monitor programme indicators before, during, and after campaigns to support campaign and programme quality.
- Monitor deployment of field security teams and the information, education, and communication materials distributed during supplementary immunisation activities to support supply and logistics.
- Launch a mechanism for rapid reporting and notification of security incidents to promote security.
From a programmatic perspective, information collected in RapidPro has contributed to many actionable findings:
- In a flow to assess interpersonal communication skills, mobilisers received a phone call where they listened to two scenarios they might encounter when speaking with caregivers. They were prompted to answer a question about each situation, received immediate feedback on their responses, and were provided with additional information on the topic. Mobilisers were also asked to give open ended feedback, where they expressed appreciation and even the intention to review training materials. Although 90% of 1021 respondents replied with the correct responses, UNICEF also learned through SMS that over 100 people were interested in additional training in the area of interpersonal communications. This flow is now part of a series of questions that will be used to reinforce interpersonal communications skills learned through training.
- UNICEF is using a RapidPro campaign to support Union Council Medical Officers in planning and logistics for vaccination campaigns. At the district level, UCMOs are responsible for 30 to 50 tasks to prepare for each campaign. Training vaccinators, distributing communication materials, collecting data and reporting are a few of the tasks that complicate the organisation of vaccination campaigns. In a pilot, UCMOs began to receive SMS reminders containing the details of their daily tasks two weeks before the launch of a vaccination campaign. UCMOs were asked to respond to each message when they completed each task. This approach was employed in Sindh province with 20 participants receiving 25 reminders. Participants are currently being interviewed to determine the value of the reminders and next steps for the programme.
- COMNet staff stationed at transit points (bus stations, border crossings, etc.) were asked over SMS to report the number of children vaccinated at the transit point during their shift, and the number of those children who were “zero-dose” or had never been vaccinated. These data were compiled to create a one-day snapshot of “zero-dose” children at transit points. UNICEF found that of 17,040 children reached at transit points, 251 “zero-dose” children (1.47%) received their first dose of oral polio vaccine. This finding was used to validate a longer, three month assessment examining the effectiveness of vaccination at transit points. In addition, vaccine stock outs at transit points were also reported through this channel, and the relevant focal points were notified accordingly.
Policy and advocacy
In addition to supporting programmes, information collected through PolioTrac has been used for advocacy and to influence policy. To identify gaps in the programme and show support for COMNet, UNICEF deployed a voice flow asking four questions about training, supervision, community relevance, and payment. First, the results showed that only 61% of COMNet mobilisers in Islamabad had received training. Those who had not been trained were sent to training immediately. Second, results showed that timely payment was a problem across all provinces, but it was particularly low in northwest Pakistan. The consulting firm managing COMNet was notified of the inconsistencies and asked to resolve them.
Two months after the December survey, a follow-up was conducted to confirm payment and assess progress in compensation. Overall, 92% of respondents received compensation on time in February, but 4% of respondents had not received payment for January or February. Compared to data collected for December, payment rates improved in all but one province, and one province experienced disproportionately low rates of on-time payment. These data were used to maintain pressure on the responsible consulting firm, thereby advocating for COMNet.
While there have been some improvements in compensation, payment of frontline workers has moved to the centre stage as a priority. Timely payment is now the number one policy issue in Pakistan’s Polio Eradication Emergency Action Plan. The information collected using PolioTrac played a central role in that shift and engendered conversations to continue supporting mobilisers and vaccinators. These data have been instrumental in recognising issues as they arise so that UNICEF can engage, support, and advocate for frontline workers in their efforts to reach every child and realise the goal of Pakistan free of polio.