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Principle 1

Watch as Humayra Binte Anwar discusses #1: "Understand and leverage social perceptions, norms, beliefs related to polio & vaccination" (Step 4.6)
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HUMAYRA BINTE ANWAR: Principle 1, understand and leverage social perception norms and beliefs related to polio and polio vaccination. Step one is understanding social perception and norms. Before you try to change people’s ideas and norms, it is first extremely important to understand them. Let’s see an example from India. India’s suffered setbacks when the number of polio cases increased between 2002 and 2007. 80% of the cases were concentrated in Uttar Pradesh, where polio disproportionately affected the poorest, hardest to reach underserved community. Typically, Polio cases were among children aged less than two years, who lived in mostly poor Muslim communities. Poor Muslim population in the state of Uttar, Pradesh often felt threatened by the government.
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The fear led parents to hide their children or even attack the vaccinators. Misconception about OPV and suspicion about motivation behind the campaign emerged, especially in the light of other visible problems, like understaffed clinics, poor roads, other diseases. Misconception included OPV caused illness in children. It was ineffective, caused infertility and was part of the plan to curb the growth of Muslims and [INAUDIBLE]. Misconception resulted in residents to polio vaccination amongst a significant number of caregivers. [INAUDIBLE] and a massive polio outbreak that paralyzed 1,600 children focused the Indian government and the Global Polio Eradication Leadership into a crisis of confidence. This is a case of vaccine hesitancy.
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So it was rightly say that, “there is no vaccine against resistance or refusals that are rooted in cultural, religious, and political context. No supply chain can overcome issues or gender-based decision-making in households. Medical approaches alone cannot address surging community concerns. This challenges demand effective communication action.” Now I would like you to think about what are the root causes of vaccine hesitancy in Uttar, Pradesh? According to the root cause identification tool, they should find the causes of the problem and then keep digging farther for the root causes. Here the problem is vaccine hesitancy among the poorer Muslim communities in UP. If they ask why, the answer would be those felt threatened by the government.
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If we go further, then it will come out that they my thought OPV causes infertility and was part of the plan to cut growth of Muslims. So the root causes might be the misconception, lack of trust, et cetera. But how information should be collected to really understand what causes? Common approaches in public health to get more information include formal surveys, which is a great way to understand perception. Here the figure shows in the [INAUDIBLE] province of Pakistan, only 26% of caregiver trusted the health worker compared to 61% in the rest of the country. Also, in [INAUDIBLE] from districts of Afghanistan, only 40% of caregivers trusted health workers.
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We could get deeper understanding of some of these issues through conducting interviews and focus groups with parents and key stakeholders, but really a lot of the best understanding of social perception and norms come not only or even primarily from these formal methods. They come from the health workers and supervisors, who take the time to talk with and understand the perception and need of the people they serve. Step two, leveraging social perception and norms. Note that here it does not say changing. Sometimes you must try to change the perception, but this can be difficult. Often, working with existing norms and perception is the best way to forward.
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So I would like you to think about what were some of the strategies that were used in Pradesh. Did these strategies address any of the root causes you identified, and how? It was realized that polio could be curtailed by engaging with the communities in a more effective manner. UNICEF focused its communication intervention to counter the numerous myth and misconception about the resident communities. All communication was meant to change the opinion, attitude, and behavior of families from residents to acceptance. These interventions were clubbed under the umbrella term underserved strategy, that is USS. It was predicted that religious leader could be drawn in, since they are well-respected and accepted in their communities.
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They were a trusted source to whom people can turn to for other personal matters, including decision about health, education, and livelihoods. Religious leaders had well-established networks of volunteers and community groups. They had the potential to bring about positive changes in society. The ladies there [INAUDIBLE]. Regular meeting was done with them. and they were constantly involved in the planning and implementation of the program to build a sense of ownership. Through this initiative, trust was successfully created among the religious leader first. And the procession of the ladies were changed towards polio eradication. As a result, they themselves evolved innovative ways and used different religious functions as opportunities to disseminate the information. For an example, the time for [?
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namaz ?] or prayer became an opportunity to communicate the masses about polio. The result was [INAUDIBLE]. The resistant-household declined 86%

Humayra Binte Anwar, BDS, MPH, PhD James P. Grant School of Public Health, BRAC University, Bangladesh

Social perceptions, norms, and beliefs critically shape how each of us perceive disease threat, as well as our understanding and trust in a disease control program.

Based on the survey results displayed on Slide 6 (at minute 3:30 of the video), if you were in charge of developing communications for the polio program in Pakistan, what can you do with this information, and what other information might you need to act in this setting?

Post your responses in the discussion.

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