Partnering with the Government: Collaborating to End Polio

"[T]he virus brought us all together with one single purpose - to work together to protect our children from it. We were forced to look at the disease from a human angle...and from the parents' point of view." - Dr. Roma Solomon, Director of CGPP India

To address the misconceptions and resistance that flared up in 2002 with the introduction of house-to-house visits by vaccinators and more intensive immunisation campaigns, the Government of India (GoI) needed to regain trust by promoting people's participation in and ownership of the polio immunisation programme. This chapter from the document Influencing Change (see Related Summaries, below) explores how the GoI looked towards partnerships with non-governmental organisations (NGOs) - in particular, the CORE Group Polio Project (CGPP) - to undertake rigorous social mobilisation at the community level.

As detailed here, after consultations with the Ministry of Health and Family Welfare (MoHFW), the World Health Organization (WHO), and the United States Agency for International Development (USAID), CGPP developed a plan to work with a range of partners at the community and household level. As part of this plan, various civil society organisations came together for a common purpose - that of polio eradication.

The intervention activities began with research to understand community needs and concerns, with a focus on the state of Uttar Pradesh (UP), which was home to the majority of polio cases in the country. CGPP engaged in: household surveys; discussions and interviews with community members; feedback from knowledgeable informants such as local NGOs, health officials, and community leaders; findings from government reports and academic research studies; information from the India Expert Advisory Group (IEAG) for polio eradication; and systematic enumeration and tracking of children under 5 years old in high-risk areas (utilising MoHFW lists and forms) to discover the reasons why children were not being vaccinated.

In order to minimise overlap and capitalise on their strengths and capacities, CGPP and the United Nations Children's Fund (UNICEF), along with Rotary International, collaborated to establish a multi-agency Social Mobilisation Network (SMNet). This cadre of mobilisers reached out to resistant or left out families to ensure polio immunisation. It consisted of 4 tiers at the community, block, district, and state levels, details about which are provided in the chapter. As political ownership was a key determinant of the success of polio eradication efforts, the government formed core groups and task forces at every administrative level. Specifically:

• At the national level, under the leadership of the MoHFW, the CGPP was set up to share experiences and address challenges faced by the partners in the field. Initially, the CGPP met every week, and helped polio partners come together and work proactively to respond to programme needs in a timely manner. CGPP was also invited by the MoHFW to all monitoring and evaluation processes relating to the Polio Eradication Initiative (PEI) and the Expanded Programme on Immunisation (EPI). Furthermore, CGPP was invited to participate in IEAG meetings, in a national-level Social Mobilisation Working Group that was set up by UNICEF, and in the Routine Immunization Working Group (consisting of MoHFW, UNICEF, WHO, and other international and national NGOs).
• At the state level, CGPP was a key member of the Polio Partners Meetings, which included representatives from the state government, usually the State Immunisation Officer or the Manager-Routine Immunisation. In addition, there were partners from USAID, WHO-National Polio Surveillance Project (NPSP), UNICEF, Rotary International, World Bank, and other stakeholders.
• District Task Force (DTF) Meetings, Tehsil Task Force (TTF) Meetings, and Block Task Force (BTF) Meetings were held on a regular basis. These meetings involved all partners and focused on the larger picture in terms of coverage and gaps. During these meetings, programme progress was discussed, preparations were made for the next campaign, and the roles and responsibilities of each partner were delineated to ensure the programme runs smoothly. In addition, evening "feedback meetings" were organised during polio campaigns to review the coverage, gaps, and problems faced during the day. These meetings were attended by representatives of WHO, UNICEF, Rotary International, and CGPP. They also discussed and planned the schedule for the next day's activities.
• At the community level, CGPP's support to the programme ranged from micro-planning to community mapping, community mobilisation, logistics, monitoring, and the provision of information, education, and communication (IEC) materials. CGPP trained volunteers in interpersonal communication (IPC) and on how to develop social maps and tackle the most "difficult" areas - both in urban slums and villages. CGPP also networked with various government functionaries representing different ministries and departments to seek their support for day-to-day activities. Village-level meetings, also called interface meetings, were held regularly.

The chapter details how SMNet integrated activities with the local health system, such as by referring caregivers to local health posts for other life-saving child health interventions and reinforcing health workers' messages about hand washing, sanitation, and oral rehydration therapy.

SMNet achievements/impact, according to CGPP, included:

• Participation and collaboration between different ministries, as well as international and national organisations, helped transform the polio programme into a people's programme. By building community trust in the government programme, the NGO partners were able to ensure that household doors were opened for the campaign every 6 weeks. The GoI started viewing NGOs as equal partners who had something valuable to contribute.
• Cooperation of SMNet with GoI vaccination teams led to significant increase in the uptake of oral polio vaccine (OPV) and routine immunisation (RI). Over the years of this partnership, the polio cases started to drop consistently.
• The various meetings with government agencies led to better relationships, as many operational problems could be solved by working together. CGPP's participation in these meetings helped improve networking and coordination with all partners, which led to support for improving service delivery to the community.
• The gaps that were reported during the various meetings were addressed swiftly, especially when they were backed by data and reports from CGPP field staff.
• Coordination between partners led to more effective use of human resources, as well as coordination around the development of communication materials to ensure that messaging was consistent.

In reflecting on establishing and maintaining a good relationship with the GoI, the Director of CGPP India, Dr. Roma Solomon, said it was important to "not refuse the government anything they asked for...and we never questioned their leadership." This ensured that the working relationship was one of respect and trust. At the same time, it was very important that a secretariat that was coordinating the efforts of international NGOs, central and state government officials, and multinational organisations have a distinct legal status and identity. Dr. Solomon feels very strongly that "unless we involve people for whom this programme is intended, it will not work. It is a people's programme". She stated that CGPP was able to help achieve this, as it acted as the “bridge between the government and civil society."

Editor's note: This is Chapter 2 in the document Influencing Change: Documentation of CORE Group's Engagement in India's Polio Eradication Programme, which is a collaborative effort of the CGPP and The Communication Initiative. Please see Related Summaries, below, to access it in its entirety.