Achieving polio eradication a review of helth communication evidence and lessons learned in india and pakistan

624 Bull World Health Organ 2009;87:624–630 | doi:10.2471/BLT.08.060863
Public health reviews
Achieving polio eradication: a review of health communication
evidence and lessons learned in India and Pakistan
Rafael Obregón,a Ketan Chitnis,b Chris Morry,c Warren Feek,c Jeffrey Bates,d Michael Galway e & Ellyn Ogden f
Abstract Since 1988, the world has come very close to eradicating polio through the Global Polio Eradication Initiative, in which
communication interventions have played a consistently central role. Mass media and information dissemination approaches used
in immunization efforts worldwide have contributed to this success. However, reaching the hardest-to-reach, the poorest, the most
marginalized and those without access to health services has been challenging. In the last push to eradicate polio, Polio Eradication
Initiative communication strategies have become increasingly research-driven and innovative, particularly through the introduction of
sustained interpersonal communication and social mobilization approaches to reach unreached populations.
This review examines polio communication efforts in India and Pakistan between the years 2000 and 2007. It shows how
epidemiological, social and behavioural data guide communication strategies that have contributed to increased levels of polio immunity,
particularly among underserved and hard-to-reach populations. It illustrates how evidence-based and planned communication
strategies – such as sustained media campaigns, intensive community and social mobilization, interpersonal communication and political
and national advocacy combined – have contributed to reducing polio incidence in these countries. Findings show that communication
strategies have contributed on several levels by: mobilizing social networks and leaders; creating political will; increasing knowledge;
ensuring individual and community-level demand; overcoming gender barriers and resistance to vaccination; and reaching out to the
poorest and marginalized populations. The review concludes with observations about the added value of communication strategies in
polio eradication efforts and implications for global and local public health communication interventions.
Une traduction en français de ce résumé figure à la fin de l’article. Al final del artículo se facilita una traducción al español. . الترجمة العربية لهذه الخلاصة في نهاية النص الكامل لهذه المقالة
a School of Media Arts and Studies, Ohio University, Athens, OH, United States of America (USA).
b United Nations Children’s Fund, Bangkok, Thailand.
c The Communication Initiative, Vancouver, BC, Canada.
d Polio/EPI Program, United Nations Children’s Fund, New York, NY, USA.
e The Bill & Melinda Gates Foundation, Seattle, WA, USA.
f Worldwide Polio Eradication, United States Agency for International Development, Washington, DC, USA.
Correspondence to Rafael Obregón (e-mail: obregon@ohiou.edu).
(Submitted: 1 November 2008 – Revised version received: 1 February 2009 – Accepted: 6 February 2009 )
Introduction
Since 1988 the world has come very close to eradicating
polio through the Global Polio Eradication Initiative,1 a pro-gramme
in which communication interventions have played
a consistently central role. This large public health initiative
is organized by WHO, Rotary International, the US Centers
for Disease Control and Prevention (CDC) and the United
Nations Children’s Fund (UNICEF). Other leading partners
include the United States Agency for International Devel-opment
(USAID), the Bill & Melinda Gates Foundation,
governments of polio-affected countries, donor agencies,
non-governmental and private sector organizations. Primar-ily
through mass vaccination campaigns, the Initiative cut the
number of polio cases from about 350 000 in 1988 to 1643
by January 2009.1,2 Mass media and information dissemina-tion
approaches used in immunization efforts worldwide have
contributed to this success. However, polio is still endemic
in Afghanistan, India, Nigeria and Pakistan.3 Reaching the
hardest-to-reach, the poorest and most marginalized, and
those without access to health services remains a critical
challenge in all four countries that have pushed eradication
efforts to explore increasingly research-driven and innovative
communication strategies.
We examine polio communication efforts in India and
Pakistan between 2000 and 2007 and show how epidemio-logical,
social and behavioural data guided communication
strategies that have contributed to increased levels of polio
immunity, particularly among underserved and hard-to-reach
populations. As efforts to eradicate polio in these two
countries continue, the period covered in this paper saw the
emergence of innovative use of epidemiological data and
application of multiple known and new communication in-terventions.
We focus on India and Pakistan because: (i) they
have faced challenges in reaching often disparate hard-to-reach
populations that have required more sophisticated,
data-driven and targeted communication approaches; and
(ii) communication approaches have been evaluated against
surveillance and campaign data, and reviewed periodically
by independent bodies including the Technical Advisory
Group, the India Expert Advisory Group and technical
communication review groups. Monitoring and evaluation
of activities implemented in India and Pakistan have been
expanded since 2004.
Polio communication reviews at international, national
and sub-national levels have supported improvements in the
collection, analysis and use of data, contributed to a consen-sus
building process about communication interventions and

Bull World Health Organ 2009;87:624–630 | doi:10.2471/BLT.08.060863 625
Special theme – Public health communication
Rafael Obregón et al. Polio eradication in India and Pakistan
inclusion of communication expertise
in some of the polio technical advisory
groups. These reviews provide useful
spaces to step back periodically to re-view
the communication programmes
and develop recommendations to fur-ther
strengthen polio communication
work. We illustrate how evidence-based
and planned communication strategies
such as intensive interpersonal com-munication
and social mobilization,
media campaigns, and political and
national advocacy combined have con-tributed
to reducing polio incidences
in these countries. We conclude with
observations about the value that these
strategies bring to addressing the chal-lenges
faced in the final phases of polio
eradication and its implications for
public health communication. We
define public health communication
as the strategic design, application and
evaluation of communication interven-tions
(i.e. social mobilization, interper-sonal
communication, mass or local
media and advocacy) to achieve public
health objectives.4–6 Social mobilization
is defined as “a broad-scale movement
to engage people’s participation in
achieving a specific development goal
through self-reliant efforts”,7 which of-ten
demands the participation of differ-ent
social actors including community
organizations, national, local and state
governments, professional organizations
and media.8,9
Method
We conducted a review of primary and
secondary data sources that include
research, evaluation and technical
reports, as well as policy, theme and
working papers that document com-munication
efforts for polio eradication
in India and Pakistan. We examined
data from randomized before and
after reports of national and regional
surveys, exit interviews at vaccination
booths and other research and reviews
commissioned by the Technical Advi-sory
Group and India Expert Advisory
Group. Other sources of information
analysed include country data present-ed
at Technical Advisory Group and
India Expert Advisory Group meet-ings,
polio communication reviews and
other independent/academic research.
Some of these reports were peer-re-viewed
while others were not. However,
all of them provided additional context
about polio communication in both
countries. We also examined reports
on polio eradication efforts in other
countries that are available on data-bases
such as Medline. We support our
findings through references of selected
quantitative and qualitative data from
studies conducted throughout the years
covered in this review.
Challenges
Despite the monumental challenge of
coordinating logistics, health workers
and volunteers at fixed site polio booths
and during house-to-house visits, India
has made tremendous progress towards
reducing the polio disease burden since
1995. By 2005, India was immunizing
170 million children with oral polio-myelitis
vaccine (OPV) during National
Immunization Days at least twice a year
and approximately 100 million chil-dren
multiple times a year during Sub-
National Immunization Days.10 The
number of children in polio endemic
areas that received at least two doses of
OPV increased steadily from 85% in
1995–1996 to 96% in 2000–2001.11
Pakistan’s Polio Eradication Initiative
started in 1994 with implementation
of National Immunization Days. From
an estimated 2500–3000 cases per year,
this number was reduced to only 156
reported cases of wild polio in 1998.
Despite peaks in 1999 and 2003, there
has been a consistently downward trend
until 2007 (Fig. 1).
The use of mass immunization
campaigns in the Initiative’s early
years and the annual decline in polio
cases led many to the expectation that
polio eradication was imminent.12,13
However, India suffered setbacks when
the number of cases increased from
268 in 2001 to 1600 in 2002 (Fig. 2)
and from 66 in 2005 to 873 in 2007.
Eighty percent of the cases were con-centrated
in Uttar Pradesh, where polio
disproportionately affected the poorest,
hardest-to-reach underserved commu-nities.
Pakistan experienced increases
in 2003 and 2006 and a small number
of polio cases continued to be reported
in high-risk areas suggesting the need
to intensify activities to reach the most
underserved and marginalized popula-tions
to interrupt transmission.
Typically, polio cases in India were
among children aged less than two
years (75%) who lived in mostly poor
Muslim communities, lacked access
to basic sanitary services, were often
missed in OPV rounds, and thus were
more likely to receive fewer doses.11 The
question was why these children were
consistently missed. While most parents
were aware of the need for polio drops
to protect their children, many did not
understand the rationale for repeated
rounds.14 Misconceptions about OPV
and suspicions about motivations behind
the campaign emerged, especially in
the light of other visible problems (i.e.
understaffed clinics, poor roads, other
diseases). Misconceptions included:
OPV caused illness in children, was
ineffective, caused infertility and was
part of a plan to curb growth of Mus-lims
and scheduled Hindu castes.15,16
Misconceptions resulted in resistance
to polio vaccination among significant
numbers of caregivers. Pakistan faced
similar challenges and its limited reach
to children in underserved areas led to
resistance towards vaccinators who were
not members of some communities,
especially all-male vaccinator teams, as
well as barriers towards women’s in-volvement
in the Polio Eradication Ini-tiative.
Caregivers reported being tired
of repeated rounds and questioned the
OPV’s efficacy, a situation exacerbated
by news coverage accusing the Initiative
of using a substandard vaccine.17 Pas-sive
resistance emerged where families
did not actively resist OPV but did not
take action to immunize their children.
Note that resistance to polio vaccina-tion
is not unique to India and Pakistan.
In Nigeria, for instance, there has been
intense resistance to polio campaigns
for similar reasons.
One of the most difficult chal-lenges
for India and Pakistan has been
reaching underserved populations
where immunity is too low to stop
circulation of wild poliovirus, espe-cially
in environments conducive to its
spread. Reaching and engaging under-served
populations has become a turn-ing
point in the Initiative’s communica-tion
strategy as information alone is not
sufficient to encourage behaviour and
social change in these populations that
would lead to acceptance of OPV.11,18,19
Therefore, the twofold communication
challenge has been to: (i) engage and
convince caregivers in hard-to-reach
areas of the benefits of vaccinating their
children, and (ii) ensure that caregivers
whose children have received OPV are
motivated to continue vaccinating their
children.

Polio eradication in India and Pakistan Rafael Obregón et al.
Fig. 1. Wild polio cases in Pakistan, 1998–2007
Source: Global Polio Eradication Initiative.1
0
Number of cases
1998
350
300
250
200
150
100
50
156
1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
324
199
119
90
103
53
28
40
32
Fig. 2. Wild polio cases in India, 2000–2007
Source: Global Polio Eradication Initiative.1
0
Number of cases
2000
1800
265
Year
268
1600
225
134
66
676
873
1600
1400
1200
1000
800
600
400
200
2001 2002 2003 2004 2005 2006 2007
Social mobilization
While widespread mass media cam-paigns
continue to ensure national
visibility and public awareness of the
Initiative, augmentation of interper-sonal
communication and social mo-bilization
interventions have become
crucial to reach unreached populations.
In India, these strategies relying on
cadres of trained health workers and
communicators have been intensified
to address the context in which the
wild poliovirus thrives. In coordina-tion
with local health authorities, a
social mobilization network involved
coordinators working at different lev-els:
the sub-district, block (covering
about 100 villages) and community
(village) mobilization coordinators.
They teamed up with vaccination teams
for routine follow-up of families. Ac-tivities
included planned, intensive and
repeated interpersonal communication
in selected sites using house-to-house
visits as well as systematic and sustained
mobilization of community and reli-gious
leaders and influencers (e.g. local
doctors, Imams).11
Several evaluations and stud-ies
show how these activities have
contributed to the Initiative’s efforts.
Communities where social mobilization
activities are conducted are consistently
less likely to refuse OPV, more likely
to attend booths and more likely to
report positive attitudes towards OPV
and higher perception of polio risk,
compared with families in communi-ties
without these activities, hence
contributing to lower incidence. In
four high-risk districts of Uttar Pradesh
where social mobilization activities
were conducted, the number of wild
poliovirus cases dropped from 116 to
49 and there was a significant increase
in booth coverage between 50 and 57%,
compared with 19–35% at district
level.11 A one-year longitudinal study
in 13 districts of Uttar Pradesh dem-onstrated
that booth coverage was 8 to
12% higher in areas with a community
mobilization coordinator than in areas
without one. Other evaluations found
a statistically significant difference (P <
0.05) in families’ positive attitudes and
behaviours towards OPV.5,6 An evalu-ation
of the role of community mobi-lization
coordinators in Uttar Pradesh
pointed to a 20% increase among fami-lies
who reported that interaction with
community mobilization coordinators
influenced their intention to vaccinate
their children.20 Social mobilization
raised community perceptions of polio
risk for an unvaccinated child from 76
to 87.4%.10 Researchers at JN Medi-cal
College in Uttar Pradesh studied
the impact of follow-up interpersonal
communication and social mobiliza-tion
activities with resistant families in
five high-risk urban areas and found
that 49.76% of 1025 resistant families
accepted OPV after the first follow-up
visit. After a second follow-up visit, a
total of 79.32% of resistant families
had accepted OPV for their children.8
In Pakistan, attitudinal changes
were reported in districts with intensive
social mobilization, where 93% of re-spondents
agreed that polio is a serious
health problem compared with 83%
in districts without these activities. In
communities where this was intensi-fied,
95% of respondents believed that
OPV was safe for children, compared
with 88% in districts without.21 The
use of programme and research data
enabled Pakistan’s Polio Eradication
Initiative to revise its communication
strategy to focus on messages for specific
audiences and adapt behaviour-change
goals towards improving OPV accep-tance.
A 2005 evaluation22 found that
while mass media campaigns were ef-fective
in sustaining peoples’ interest in
polio (98% of respondents knew about
the campaign; 55% said they discussed
OPV with other community members),
findings underlined the need to target
women, often the primary decision-makers
on child health, through on-going
interpersonal communication by
trained female health workers. While
men remained important opinion
leaders and information gatekeepers,
female caregivers played a primary role
in the decision-making regarding im-munization
of their children in 55% of
households.22

The communication strategy re-focused
on reaching women through
interpersonal communication with an
emphasis on OPV safety and efficacy
and its benefits to children. Trained fe-male
health workers spearheaded inten-sified
efforts as communication support
persons. They communicated directly
with female caregivers or indirectly
through females in the community,
with support from male community
and religious leaders. The female teams
were effective in influencing caregivers
shown by reports of improvements in
attitudes towards OPV and percep-tions
of risk of polio in target areas.
A 2005 UNICEF study in high-risk
and four low-risk areas (categorized
by poor campaign indicators and/or
poor coverage; n = 2143 households)
showed that in districts with intensive
social mobilization (n = 808 house-holds),
78% of respondents reported
that OPV protected their children
from polio, compared with 71% in
areas without these activities (n = 1335
households) caregivers.22
Engaging influencers
The challenge of reaching underserved
and hard-to-reach populations in In-dia,
which included high proportions
of Muslim families, led to a focused
strategy aimed at “areas with families
at high-risk of wild poliovirus infection
and … poor access to health, sanitation,
and other basic services”.15 Influential
Muslim training institutions (such as
Aligarh Muslim University and Jamia
Milla Islamia) and religious and com-munity
leaders were engaged in build-ing
public confidence and credibility
in the Polio Eradication Initiative, im-proving
coverage in underserved com-munities,
providing support at district
and settlement levels and countering
resistance to polio vaccination in Uttar
Pradesh.
In 2004, Muslim religious (2697)
and community (1892) leaders were
asked to participate in the polio cam-paign,
resulting in 77% and 79%, re-spectively,
of these leaders supporting
the programme’s efforts to convince
resistant caregivers. They succeeded in
87% of cases in their coverage area,
reaching 100% in some districts. This
was a critical contribution to the re-duction
of the immunity gap among
Muslim and Hindu children in Uttar
Pradesh’s western region. The num-ber
of Muslim children who had not
received at least two polio drops was
reduced from 5% in 2002 to nearly
0% in 2004.15 Engagement of reli-gious
leaders to counter refusals due
to religious reasons or misperceptions
has yielded similar results in Pakistan’s
north-west frontier province. Data
from 2007 show that, after involving
religious leaders in polio eradication
activities, coverage of children in fami-lies
refusing due to religious reasons
increased from 13% in August to 17%
in October, and coverage of families re-fusing
due to misconceptions increased
from 37% to 50% in the same period.23
When properly engaged, religious and
community leaders become strong
community allies to eradicate polio.
Role of media and advocacy
Data support claims of the contri-bution
of mass and folk media and
advocacy to increased awareness and
booth attendance. In India, large-scale
mass media campaigns involving movie
and cricket stars and political figures
focused on dispelling rumours about
OPV and encouraging caregivers to
bring their children to vaccination
booths. A 2003 evaluation showed that
nearly 92% of 9370 respondents cited
television and radio spots as “very influ-ential”
or “influential” in their decision
to take children to vaccination booths,
while “9 out of 10 respondents … said
they had come to the booth largely due
to … the TV and radio spots”.12 Entry
and exit polls following exposure to
messages on local media among 2552
randomly selected respondents showed
a 60% increase in awareness of the next
National Immunization Day’s date
and a 20% increased intention to get
their children immunized at the booth.
Puppet/theatre shows, video vans and
other folk media activities held in more
than 3500 villages in Uttar Pradesh,
contributed to a 20% increase in booth
attendance.10,20 Data from 2004–2005
showed that 68% of respondents ex-posed
to polio radio and television spots
reported taking their children to the
booth for vaccination, compared with
only 44% among those not exposed to
the advertising (Fig. 3).10
Advocacy efforts have focused on
mobilizing professional associations
and enlisting their support for polio
eradication activities, particularly dur-ing
National Immunization Days.
Political endorsement and support of
professional associations include the
Indian Academy of Paediatricians,
whose members have encouraged care-givers
to vaccinate their children and
have used their own clinics as polio
booths during National Immunization
Days. In Uttar Pradesh, this led to the
“full-scale involvement of partners
and communities … who contributed
to an increase in the number of chil-dren
vaccinated from 30.48 million to
33.96 million and an increase in the
total number of children vaccinated at
booths from 8.77 million to 14.7 mil-lion
over the same period”.11
Fig. 3. Exposure to polio radio and television advertising and polio immunization
rates, Uttar Pradesh, India, 2004–2005
0
80
Percentage
Exposed to advertising
Immunized
at
booth
10
70
60
50
40
30
20
Not exposed to advertising
68
44
Immunized
at
home
27
47
Not
immunized
5
9

Value added to the initiative
Strategic and synergistic communica-tion
efforts that integrate social mo-bilization,
interpersonal communica-tion,
gender- and culturally-sensitive
interventions, mass/folk media and
political advocacy have contributed to
the Initiative’s progress and to access
unreached populations in challenging
socio-economic environments. Prin-ciples
underpinning communication
strategies in India and Pakistan include:
i) use of epidemiological, social and
behavioural data to assess social/indi-vidual
constraints, such as knowledge
gaps and resistance, to develop effec-tive
interventions to reach underserved
groups; (ii) development of innovative
and intensive interpersonal commu-nication/
social mobilization strategies;
and (iii) engagement of community
and religious leaders.18 Evidence of im-pact
of communication interventions,
including vaccine-related interventions,
has been discussed widely.4,5,24,25
Lessons from the added-value of
polio communication may contribute
to other public health communication
programmes, particularly those trying to
reach out to the marginalized and poor.
They include:
• implementation of communication
interventions based on routine mon-itoring
of epidemiological, social
and behavioural data on affected
populations;
• intensive use of interpersonal com-munication
and social mobilization
at different levels to maximize reach,
effectiveness and efficiency;
• mobilization of community leaders,
communication and relationship-building,
engaging families and care-givers
who question repeated polio
vaccination;
• involving religious leaders as spokes-persons
and using faith-based folk
media (i.e. mosque announcements)
to reach community members;
• working with trained communica-tion
outreach workers as part of a
house-to-house strategy to reach
children missed during National Im-munization
Days;
• advocacy with intensive grassroots
mobilization to reach and commu-nicate
with marginalized communi-ties;
and
• addressing social/gender norms to
improve interpersonal communica-tion
and increasing access to hard-to
reach groups.
Conclusion
Historically, communication for po-lio
eradication relied on information
dissemination about health services,
primarily through mass media, aimed
at increasing demand for vaccines,
especially in areas with a good health
infrastructure and high routine im-munization
rates (i.e. Latin America).
Polio eradication in India and Pakistan
has raised new challenges that demand
communication interventions that are
responsive to the evolving nature of the
epidemic and the social context of the
children they hope to immunize. Both
countries have implemented proven
strategies and developed innovative
approaches to reach and immunize
children in hard-to-reach areas. Epide-miological,
social and behavioural data
have informed multiple communica-tion
interventions and culturally-sen-sitive
approaches. These include setting
a national agenda for polio eradication,
creating demand for OPV, increasing
booth attendance during National Im-munization
Days, pushing for universal
coverage through mobilization of local
partnerships and networks, and over-coming
pockets of resistance to vacci-nation
among caregivers in unreached
and underserved areas.
Despite setbacks in their polio
eradication efforts, India26 and Paki-stan
have made remarkable progress
in lowering the burden of polio. Com-munication
strategies have contributed
to such progress on several levels by:
mobilizing social networks and lead-ers,
creating political will, increasing
knowledge and changing attitudes,
ensuring individual and community-level
demand, overcoming gender
barriers and resistance to vaccination,
and, above all, reaching out to the
poorest and the most marginalized.
They should continue to play a central
role in the final push to eradicate polio.
This review documents the value
and crucial contribution of carefully
planned and closely monitored com-munication
in building widespread
support and understanding, as well as
accessing unreached populations and
overcoming resistance. There is no vac-cine
against resistance or refusals that
are rooted in social-cultural, religious
and political contexts. No supply chain
can overcome issues of gender-based
decision-making in households. Medical
approaches alone cannot address certain
community concerns (i.e. why OPV is
brought to their door when many other
services are not available). These chal-lenges
demand effective communication
action. Lessons learned by the Global Po-lio
Eradication Initiative may contribute
to global public health efforts as we look
for innovations to address even more
challenging objectives outlined in the
United Nation’s Millennium Develop-ment
Goals. ■
Acknowledgements
We thank Christie Billingslie, pro-gramme
officer, JSI Research and Train-ing
Institute; Ellen Coates, director,
CORE Group Polio Project; Michael
Favin, senior programme officer, Im-munization
BASICS; Kiyuri Naicker,
polio coordinator, The Communica-tion
Initiative; Lora Shimp, polio pro-gramme
officer, John Snow Inc.; and
Prof. Silvio Waisbord, School of Media
and Public Affairs, George Washington
University for their comments to
earlier versions of this paper. We also
thank Ohio University graduate stu-dents
Rukhsana Ahmed and Giovanna
Monteverde for their support in the
preparation of the first draft of this
paper.
Rafael Obregón is also an affiliated
faculty member of the Department of
Social Communication, Universidad
del Norte, Colombia.
Funding: Rafael Obregón received
funding from The Communication
Initiative.
Competing interests: Jeffrey Bates, Ellyn
Ogden and Ketan Chitnis are affili-ated
with institutions that support the
Global Polio Eradication Initiative. At
the time of writing, Ketan Chitnis was
affiliated with a different institution.

Résumé
Eradication complète de la poliomyélite : revue des données de communication dans le domaine sanitaire et
leçons acquises en Inde et au Pakistan
Depuis 1988, le monde s’est beaucoup rapproché de l’éradication
de la polio grâce à l’Initiative mondiale pour l’éradication de
la poliomyélite, dans laquelle les interventions en matière de
communication jouent invariablement un rôle central. Les
approches utilisant les mass médias pour diffuser des informations
appliquées dans le cadre des efforts de vaccination partout dans
le monde ont participé à ce succès. Cependant, les personnes les
plus difficiles à atteindre, les plus pauvres, les plus marginalisées
et celles ne pouvant accéder aux services de santé ont posé de
grandes difficultés. Dans cette dernière offensive pour vaincre la
polio, les stratégies de communication de l’Initiative mondiale pour
l’éradication de la poliomyélite sont de plus en plus innovantes et
portées par la recherche, notamment avec l’introduction d’approches
de communication interpersonnelle durable et de mobilisation sociale
pour atteindre les populations encore non desservies.
La revue examine les efforts de communication concernant
la polio entrepris en Inde et au Pakistan entre 2000 et 2007.
Elle montre comment les données épidémiologiques, sociales
et comportementales guident les stratégies de communication
contribuant à accroître les niveaux d’immunité contre cette
maladie, en particulier parmi les populations non desservies et
difficiles à atteindre. Elle illustre la façon dont des stratégies
de communication étayées par des données factuelles et
planifiées - telles que les compagnes prolongées utilisant les
médias, la mobilisation communautaire et sociale intensive, la
communication interpersonnelle et la sensibilisation politique et
nationale - ont participé globalement à réduire l’incidence de la
polio dans ces pays. Les résultats montrent que les stratégies de
communication ont apporté une contribution à plusieurs niveaux
en mobilisant les réseaux et les leaders sociaux – en créant une
volonté politique, en élargissant les connaissances – en garantissant
une demande au niveau individuel et communautaire et en permettant
de surmonter les obstacles liés à l’appartenance sexuelle et la
résistance à la vaccination, ainsi que d’atteindre les populations
pauvres et marginalisées. La revue conclut avec des observations
sur la valeur ajoutée des stratégies de communication dans le
cadre des efforts d’éradication de la polio et sur leurs implications
pour les interventions mondiales et locales de communication en
santé publique.
Gracias a los esfuerzos desplegados desde 1988 a través de la
Iniciativa de Erradicación Mundial de la Poliomielitis, el mundo
está a punto de erradicar esta enfermedad. En esa empresa las
intervenciones de comunicación han sido siempre decisivas, y
las tácticas de recurso a los medios de difusión y divulgación
de información empleadas en las actividades de inmunización
en todo el mundo han contribuido a ese éxito. Sin embargo, ha
habido dificultades para llegar a las poblaciones más remotas,
más pobres y más marginadas y a las personas sin acceso
a los servicios de salud. En la última acometida para erradicar
la enfermedad, las estrategias de comunicación de la Iniciativa
de Erradicación de la Poliomielitis se han visto cada vez más
impulsadas por las investigaciones y han tenido un carácter
crecientemente innovador, gracias sobre todo a la introducción
de mecanismos sostenidos de comunicación interpersonal y
movilización social para llegar a las poblaciones que quedaban
fuera del alcance.
En esta revisión se analizan los esfuerzos de comunicación
contra la poliomielitis desplegados en la India y el Pakistán entre
2000 y 2007. Se explica cómo los datos epidemiológicos, sociales
Resumen
Erradicación de la poliomielitis: análisis de la evidencia sobre la comunicación sanitaria y enseñanzas
extraídas en la India y el Pakistán
y comportamentales orientan las estrategias de comunicación
que han contribuido a aumentar los niveles de inmunidad contra
esa enfermedad, sobre todo entre poblaciones subatendidas y de
difícil acceso, y se describe el proceso por el que unas estrategias
de comunicación basadas en la evidencia y planificadas en
consecuencia -como una combinación de campañas sostenidas
en los medios, una movilización comunitaria y social intensiva,
fórmulas de comunicación interpersonal, y medidas políticas
y de promoción a nivel nacional- han contribuido a reducir
la incidencia de poliomielitis en esos países. Los resultados
indican que las estrategias de comunicación han contribuido en
distintos niveles a: movilizar a las redes y los líderes sociales;
generar voluntad política; ampliar los conocimientos; garantizar la
demanda individual y comunitaria; superar las barreras de género
y la resistencia a la vacunación; y dar alcance a las poblaciones
más pobres y marginadas. El análisis concluye con diversas
observaciones sobre el valor añadido de las estrategias de
comunicación en las actividades de erradicación de la poliomielitis
y sus implicaciones para las intervenciones mundiales y locales
de comunicación en materia de salud pública.
ملخص
تحقيق استئصال شلل الأطفال: مراجعة للبينات حول التواصل الصحي وللدروس المستفادة من الهند وباكستان
منذ عام 1988 ، أصبح العالم قريباً جداً من استئصال شلل الأطفال من خلال
المبادرة العالمية لاستئصال شلل الأطفال؛ والتي أدّت فيها التدخلات التواصلية
دوراً محورياً على نحوٍ مستمر، وقد ساهمت في هذا النجاح وسائل الإعلام
وأساليب نشر المعلومات المستخدمة في الجهود التمنيعية في شتى أرجاء
العالم، إلا أن الصعوبات تمثلت في الناس الذين يصعب الوصول إليهم، والأشد
فقراً، والأكثر تهميشا، والذين لا تتاح لهم الخدمات الصحية. وفي سياق الدفعة
الأخيرة لتحقيق استئصال شلل الأطفال، أصبحت استراتيجيات التواصل في
المبادرة العالمية لاستئصال شلل الأطفال أكثر طواعية للبحوث وأكثر ابتكاراً،
ولاسيَّما من خلال إدخال التواصل المستمر بين الأشخاص وأساليب استنهاض
المجتمع للوصول إلى السكان الذين يتعذر الوصول إليهم. وتتفحص هذه

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المراجعة الجهود المبذولة في التواصل حول شلل الأطفال في الهند وفي
باكستان في المدة بين عامي 2000 و 2007 ، وتوضح كيف قادت المعطيات
السلوكية والاجتماعية والوبائية استراتيجيات التواصل التي ساهمت في ازدياد
مستويات المناعة ضد شلل الأطفال، ولاسيما بين السكان المحرومين من
الخدمات والذين يصعب الوصول إليهم.
كما توضح المراجعة كيف ساهمت الاستراتيجيات المسندة بالبيِّنات
والمخطَّط لها حول التواصل، مثل الحملات الإعلامية المستديمة، واستنهاض
المجتمعات العامة والمحلية، والتواصل بين الأشخاص، وضم حملات الدعوة
السياسية والوطنية معاً، في إنقاص معدلات وقوع شلل الأطفال في هذين
البلدين.
وتبين النتائج والموجودات أن استراتيجيات التواصل قد ساهمت على
مستويات مختلفة في: استنهاض الشبكات الاجتماعية والقيادات، وخلق
الإرادة السياسية، وزيادة المعارف، وضمان الطلب على المستوى المجتمعي
ولدى الأفراد، والتغلب على عوائق الجندر ومقاومة التلقيح الوصول إلى الناس
الأشد فقراً، وكذلك الوصول إلى السكان المهمشين. وتختـتم المراجعة بملاحظة
ما لاستراتيجيات التواصل من قيمة مضافة في الجهود المبذولة لاستئصال شلل
الأطفال وتأثيراتها على التدخلات الخاصة بالتواصل في الصحة العمومية على
المستوى العالمي والمحلي.

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