Successful Strategies for Stopping Polio in India

"The polio program became a national movement."

This brief from the United Nations Children's Fund (UNICEF), one of the Global Polio Eradication Initiative (GPEI) partners, shares key approaches implemented by the polio programme in India to "triump over polio". Here is an overview of the key strategies underlying India's achievement of polio-free certification:

• Leadership and partnerships: Commitment at the national, state, and local government levels with role clarity among core polio partners helped prevent duplication and maximise synergies. Strong partnerships built on trust with local religious leaders, community influencers, non-governmental organisations (NGOs), and the media made it a people's programme.
• Planning and strategising: The backbone of the polio programme was intricate planning based on monitoring and analytics: constantly tracking and responding in real time. The information was used to adapt strategies for reaching missed children and groups such as migrant groups/high-risk groups, children on the move, children in areas that continually flooded during the monsoon season (the Kosi River strategy), and children living in 107 blocks of Uttar Pradesh and Bihar - including these children in micro-plans and communication plans, ultimately reaching every child.
• Mobilisation: "The 7,300 SMNet mobilizers worked tirelessly in the face of resistance, to ensure that every last child was reached." Specific strategies to address concerns, build trust, and motivate families to vaccinate children included: mobilisation focused on high-risk areas (HRAs), the strategic engagement of influencers (e.g., religious leaders, local medicine men, housewives) and "informers", involvement ofchildren as agents of change, mothers' meetings, and targeted capacity development of both SMNet mobilisers and over 100,000 government health and nutrition workers (Anganwadi and accredited social health activists, or ASHAs) in social mobilisation and interpersonal communication (IPC).
• Monitoring accountability and supportive supervision: This has entailed using data for action, continually adapting strategies based on evidence gathered through intensive monitoring, and ensuring high performance by making corrections on the spot and overall through supportive supervision and implementing a robust accountability framework. (The document outlines India's integrated accountability structure for mentoring community mobilisers and frontline workers, which feeds into task force meetings to resolve operations and communications issues.)
• Multi-pronged mass media strategy: A multi-pronged media approach got consistent messages to communities at all levels, including the hardest to reach, underserved, and illiterate. Simple messaging created an emotional connect with caregivers in information, education, and communication (IEC) materials featuring 'do-boond zindagi ki' (2 drops of life). The polio programme engaged high-visibility celebrities (movie stars such as UNICEF ambassador Amitabh Bachchan and cricketers) as persuaders and role models for polio through public service advertising. Their messages were designed to hit home and built trust. Entertainment-education was also a tool; polio and other health messages were woven into soap opera storylines and episodes for subliminal messaging. Media workshops and field visits were conducted to educate the media about polio and the programme; as a result, positive reporting increased from 27% in 2008 to 91% in 2014. Religious leaders were trained on how to talk with the media in relation to refusal (in Gaya district in Bihar).

Beyond certification, SMNet has been building systems and demand for and raising awareness about health, hygiene, sanitation, and nutrition practices in high-risk areas. Every month in non-polio rounds, 6,700 mothers meetings are held reaching some 81,000 mothers to discuss routine immunisation (RI), exclusive breast feeding, diarrhoea management, and more. "The SMNet has been agents of change for the communities on one hand in the behavior change and well-being of the community and on the other as an advocate for underserved to help improve health and sanitation services." The polio programme's legacy in action can be seen most notably in RI through Mission Indradhanush (MI), which builds on the polio lessons to boost full RI rates to 90% by 2020 by focusing on the lowest-vaccinated areas. According to UNICEF, this equity approach - using polio tools such as micro-planning and communication planning, capacity development, monitoring, supportive supervision, and immediate feedback for corrective action - is already showing dramatic results and increasing full RI rates by 1.3% per MI campaign.