Communication for Polio High Risk Groups in Balochistan reaching the underserved

Presented by : Jawahir Habib C4D Officer

Balochistan Population Density

Balochistan is 45% of total land of the country and only 5.1% of the population the population density in the province is low and highly dispersed.

Status of Polio Cases in Balochistan

Confirmed Polio cases in Balochistan (2005-2012till date)
73

10

11 8

11

12

W12

2 2005 2006 2007 2008 2009 2010 2011 2012

Confirmed polio cases in Balochistan

2011 2012

Balochistan reported the highest number of polio cases in any province of Pakistan

The province reported 37% of the total cases in the country

73% of the total cases in province were reported from Quetta ,Pishin and Killa Abdullah

ARABIAN SEA

2011

2012

Wild polio virus type 1 =

Main epidemiological characteristics of polio cases in Balochistan

66 % of polio cases below 2 years of age 75% of polio cases are Pashto Speaking 73% of polio cases are reported from three districts of Balochistan Quetta, Pishin and Killa-Abdullah. 83% of polio cases belong to low social economic groups 59 % of polio cases belong to rural town/villages 77% cases living in Multiple Family Dwelling 42% of Polio cases are OPV refusals

Who are the polio high risk groups in Balochistan?

Who are the Polio High Risk Groups in Balochistan?- Pashtun speaking population
First Language of confirmed polio cases (2007-2012 till date)
Confirmed polio cases(percentage)

75%

12% 0%
Urdu

10% 1%

0%
Punjabi

1%
Siraiki

2%
Sindhi Balochi Bravi Pashto

Other

Source :Epidemiological characteristics of polio cases WHo

Balochistan : Districts with main languages

Vaccination Status (Routine+SIAs) of Non Polio AFP Cases age 6-35 months, (Balochistan) in 2011*
Pashto Non-Pashto

14%
23%

3%
30%

14% 69%
17% 30%

160 cases excluded due to no information

As per recall of parents *Source AFP.rec: Data as of 21st Feb 2012

0 dose

1 - 3 doses

4 - 6 doses

7 + doses

Tribal distribution of Polio Cases in Balochistan

Tribal Distribution of confirmed polio cases in the Quetta Block (2011)
Series1 17

12 11

2 1 1 1 1 1 1

Achakzai

Kakar

Syed

Noorzai

Tareen

Khilji

Mengal

Lehri

Marri

Meshwani

Hotak

Magsi

Social data among Pashtuns

Caregivers who reported refusing OPV (%)* Question: Have you ever refused OPV?
25 20 15 10.3 10 5 0 Punjabi 25 20 15 10 5 0 Punjabi Sindhi Pathan Baloch Afghan Afghan Refugees Sindhi Pathan Baloch Afghan Afghan Refugees 19.2

12.8

Once

More than once

Always

Source: 2012 KAP Study

Social data among Pashtuns

Caregivers who know polio is a disease (%)* Question: What is polio?
100 90 80 70 60 50 40 30 20 10 0

68

51

Punjabi

Sindhi

Pathan

Baloch

Afghan Refugees Afghan

Perception that polio can affect their children(%)*

60 50 40 30 20 10 0 Highly unlikely Unlikely Not sure Likely Very likely

Source: 2012 KAP Study

Pathan Afghan

Social data among Pashtuns

Beliefs about OPV Safety
Question: Do you think OPV is safe?
16
14 12 10

Not safe at all

6 4 2

Don't know

% Punjabi

% Sindhi

% Pathan

% Baloch

% Afghan

Afghan Refugees

Source: 2012 KAP Study

Who are the Polio High Risk Groups in Balochistan? Mobile and Migrant Population

38% of Polio Cases reported travel history by a family member or a visitor

15 % of Polio Cases reported from 2007-2012 were Nomads

There is a intense population movement with in the province , in between Balochistan and other provinces and cross borders : Approximately 2500 eligible children cross PakistanAfghanistan border each month at friendship gate Districts with
Polio Cases

Population on move in Balochistan

Nomadic Populations: Low socio-economic class depending largely on livestock on move usually
living in temporary structures like tents e.g. bakarwals, koochians, pawindas, baghrees, beggars etc.

Cross border Populations: Moving for trade, health and other services

Afghan Refugees : Residing in temporary or permanent settlements in different areas of Balochistan particularly the districts which share border with Afghanistan Seasonal migrants : include Agricultural workers ,construction and industrial Laborers (skilled and non-skilled) ,population frequently moving for social or religious festivals

Brick kiln workers: living within the brick kiln areas or small temporary settlements near work places

Internally Displaced Populations (IDPs) : Mainly population from FATA due to the conflict and Sindh due to floods

Highly Mobile Population Movement between South East & Southern Region Afghanistan & Balochistan

DI Khan

Tonsa

DG Khan

Panjgour Khuzdar Kambar Sukkur Khairpurr

Who are the Polio High Risk Groups in Balochistan? OPV Refusals
Refusal Confirmed Polio Cases in Balochistan(2011)
Non Refusals
60
50

Refusals

40
30 20 10 0 Killa-Abdullah Psihin Quetta

42% 58%

Source : PCM Data

Source : AFP Data

Communication activities to address the High Risk Groups in High Risk District of Balochistan

Communications for HRGs in light of Augmented NEAP

NEAP #3: Populations at highest risk for polio are aware of the importance of OPV vaccination and vaccinate their <5 year old children each time it's offered

High risk groups as Mobile populations and clusters of refusal families are mapped using social data Families on the move are mobilized for OPV Partners from the medical and religious community actively participate in social mobilization Families from High risk groups are mobilized for OPV. Enhanced Pakistan-Afghanistan cross border coordination

Target audiences for communications interventions

Pashtoon Speaking parliamentarians
Pashtoon Minsiters

Media

Religious communities/Institutions
Transporters Associations

Other Sectors As WASH Education

CBOs/ NGOs Political Leaders

Pashtoon Speaking /Mobile & Migrant /Refusal Parents

Tribal elders

Transport regulatory bodies

Teachers

Madrissa Schools Ministers From High Risk Landowners Districts Religious leaders

Health care providers Religious parliamentarians

Human Resource support for communications COMNet in High Risk Areas of Balochistan
New 3rd Party Management Structure to relieve burden on EDOs and strengthen monitoring and reporting of results
Social Mobilizers

DHCSO
Union Council Communication Officer

Union Council Communication Officer

Social Mobilizers

Human Resource support for communications COMNet in High Risk Areas of Balochistan
48

42

60

8 District Health Communication Support Officer, 31 Union Council Communication Support Officer and 192 Social Mobilizers are deployed in 5 High Risk Districts
20 22

56% of social mobilzers, 58% UCOs are Pastho speaking and 62% DHCSOs are Pashto speaking DHCSO
UCO Social Mobilizer

Only 20 % of the COMNet staff in Balochistan are female

Social Mapping and Micro-planning

Social profiles for 70 HRUCs in Balochistan were developed to support the micro-plans . Digital social maps with the help of google earth have been developed for Quetta and Pishin , with other districts to follow

Mosques in the Union Council Kharotabad, Quetta, Balochistan Mosque Name Alam Khan Masjid
Haji Muhammad Zai Masjid

Masjid thoothpull Jamia Haqqania Spin Masjid Masjid Haqsa Masjid Alam Khan Masjid Surankhail Jamia Masjid Kharotabad Masjid Mohhammadi Masjid barakhail Masjid paindkhail Tokhi Masjid Masjid shalabagh fakir Masjid Bandarkhail Masjid Bangul Passani

Address Mirza Khan Street Kharotabad Near Govt. primary Schol Kharotabad kharotabad Ghairabad Ghairabad Baboo Zehri kharotabad Surankhail Near Kharotabad Bridge Saleh Agha Street Near middle school khrotabad Rasheed Nasar street Ganda nala

Khateeb's/Imam's Name Molvi Yahyah Khan Molvi Ali Mohammad Molvi Abdul Salam Molvi Miarajuddin Molvi ezatullah Molvi Mohammad Hanif Molvi Saadullah Molvi Dost Mohammad Qari sultan Molvi Abdul Rasheed

Molvi Aminullah Molvi Mir qalam

Route of Traveling

Mapping and tracking of mobile population

Nomadic population of pirkani, lehri, langove, bagries, jatt, and Afghans dairkhani tribes

Entering point of nomads at nouttal

Nomadic population of pirkani, lehri, langove, bagries dairkhani tribes

Maps developed identifying entry and exit routs for the mobile population to support transit strategy

Nomadic population of Afghans tribes Nomadic population of brahvi tribes Nomadic population of Afghans tribes Nomadic population of brahvi tribes Nomadic population of brahvi tribes Nomads Crossed Naseerabad at toll Plaza Shahi chowki

Identification of the mobile population in Naseerabad/Jafferabad who will be travelling to Quetta block : Ensuring they are fully immunized and sharing the community links with Quetta team

Mobilizing Population on Move

Key contacts established within the nomadic population ,seasonal migrants ,refugee settlement areas and brick klin workers. Focusing on the elders ,TBAs and group leaders. Identification of informers for the communities here for connection to and information on arrivals and movement IPCs /Awareness sessions held for the population on move. Display of visibility material at transit points , highways and entry-exit points . Promotion of routine immunization through group meetings of nomadic population

Mobilization Population on move- Focusing on Hospitals and transit points

Polio information booth established at the Hospitals and transit points ad bus stations /railway station. Information booths are established to share information regarding polio with population travelling and visiting hospitals to seek health facilities- the only tertiary care hospitals in Balochistan are present in Quetta which receive patients from all over Balochistan and across the borders

Improved visiblity at transit points ,through branded buses transit booths ,banners , wall chalking etc

Partnership with Medical associations

Orientation sessions held for members of PMA particularly belonging to Quetta, Pishin and Killa-Abdullah. Public engagement through press briefings arranged by members of PMA in High Risk areas as Pishin and Killa Abdullah. Participation of doctors in community meetings and school sessions to dispel misconceptions Information sharing with local First Line Heath care providers regarding campaign dates , OPV safety and display of visibility material at their centers

Involving religious communities

Key religious leaders have been involved at provincial ,district and UC level through advocacy meetings and religious seminars. The religious groups provide support in addressing refusals , creating awareness regarding campaigns through inaugurations or announcements and inform of written endorsements

Involving religious communities

Key achievements include working together with JUI in field, working closely with Male and Female Madrissas and Iqra schools through awareness sessions

Involving religious communities

Mosque announcements in HRDs of Balochistan 2012
Number of mosque announcementsJanuary 2012 435 217 129 69 180 71 45 54 86

640

112

112

Focus of the activities is creating awareness regarding OPV safety and endorsing religious support through mosque announcements, Friday sermons and written FATWA

Engaging political parties for High Risk Groups

Political parties as PKMAP , JUI ,ANP and other pashtoon parties have been engaged at district and Union Council level these parties have exhibited their support inform of inaugurations, participating in community meetings, identification of polio teams and addressing refusals. Particular awareness sessions have been held for parliamentarians from the High risk districts

Engaging tribal elders for High Risk Groups

Meetings with tribal elders of Achakzai ,Kakar ,Syed and Tareen tribes have been conducted at district and union council level. Tribal elders have supported the polio program in provision of local team members, in providing safe access to polio teams and addressing refusals . COMNet team are also invited at the Jirgahs to share the current situation of outbreak in the district and to urge fellow tribes men to support Polio campaigns

Bringing all the religious, political and tribal stakeholders together

Stakeholders have been brought together at one platform in the form of polio walks, al parties conferences and grand jirghas in which hundreds of participants show their support to PEI by working together

Using traditional media

Traditional mediums as vehicle announcements and mega phone announcements are used to promote campaign dates and key messages in the High Risk Areas

Using traditional media

Interactive theaters/Speech and drawing competitons have been conducted in the schools of High Risk areas- particularly focusing on OPV refusals

Using traditional media

Polio awareness festivals for women conducted in Naseerabad ta and Jafferabad- to create awareness regarding polio vaccination amongst women from high risk groups

3000 2500 2000 1500 1000 500 0

Refusals Covered by COMNet staff in Quetta Block (August 2011 -March 2012)

August

September Quetta

October December Feb-12 Pishin Killa-Abdullah

Mar-12

Way forward..
Political support :Sustained partnership with PKMAP and JUI

Religious support : Partnership with National Research and Development Foundation for advocacy with religious leaders and capacity building of COMNet staff on working with religious groups Tribal support : Focus efforts on active involvement of Achakzai tribes.
Improved women involvement : Women to women communication through Traditional birth attendants by Balochistan Rural Support Program

Way forward..
Engaging local radio channels particularly Pashtoon transmissionto promote OPV safety and efficacy . Improved awareness through sports events in the High Risk areas Involving Football clubs across the border. Using ootball as an entry point to Pashto communities Visibility at transit points through branding for the new 3 months transit point strategy

Transit points in Balochistan..

Way forward
Communication planning for the new Short Interval Additional Dose Strategy A step closer to eradication

Thank you