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The Social Mobilization Network in Uttar Pradesh and Bihar, India

In this lecture, Piyusha Majumdar highlights the role of the Social Mobilization Network in eliminating polio from India. (Step 5.7)
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PIYUSHA MAJUMDAR: In this section, I will give you a brief introduction of social mobilization network used as one of the powerful community engagement tools during the last phase of polio eradication activities in India and how this network actually addressed the major challenges with respect to vaccine acceptance and changed the entire paradigm by turning the resistant population into vaccine acceptor and also helped in making India a polio-free country. As it was found that the underserved community lacking trust is the main cause of resistance to OPV and UP in Bihar, a social mobilization network from the community was felt need to compliment all those activities.
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Although it was very important to reach out to the mother, but there were certain conservative social norms that made it even more difficult for male vaccinator to enter home or even communicate with women. So potential women candidates were selected and recruited as community mobilizers and vaccinators. Also, religious leaders were approached, convinced, and they influenced the community for OPV as they were considered as a person of trust and honor in the community. In coordination with local health authorities, a social mobilization network known as SMNet which is managed by UNICEF and core group was built based on the conventional principle of community mobilization.
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So the team utilized an accelerated framework that involved person of trust from the community who could open closed doors and were accepted locally. This slide is showing a pyramid-shaped diagram to basically epitomized Social Mobilization Network, or SMNet. SMNet was an intervention started by UNICEF for engaging community members to generate community support for polio eradication activity. As you can see, it’s a combined three-tiered diet structure comprising of State Mobilization Coordinators, followed by District Mobilization Coordinators, and then Block Mobilization Coordinators. And at the bottom of pyramid are CMC, or Community Mobilization Coordinators.
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Talking more about how this social mobilization network works, there was one District Mobilization Coordinator recruited for every 10 to 15 Block Mobilization Coordinators and one Block Mobilization Coordinator recruited for every eight Community Mobilization Coordinators in high-risk areas and one Block Mobilization Coordinator for every 12 Community Mobilization Coordinators in known high-risk areas. So talking more about the community mobilization coordinators who were the backbone of SMNet, they were assigned 500 families in the rural areas and 300 in the urban areas. The main work is to do the listing of all children under five in families assigned to her. They mobilized the family with eligible children to vaccinate and ask them to come at booth.
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The work also involved identification of all those people who were likely non-acceptors and finally motivate them to become the acceptors of the OPV vaccine. So these CMCs work very closely with the leaders and community influencers. Between polio rounds, CMCs, or Committee Mobilization Coordinators, they often meet with community influencers, expectant mothers, community leaders, school teachers, Muslim community members who were used to build trust among the community.
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And the strong network of community, cultural, and religious leaders, it acted as a credible communication channel to help gain community support by responding effectively to the fears and misconceptions attached with the OPV The Social Mobilization Network having developed various engagement tools and communication materials to mobilize community members, individual, and community-level behavioral change approaches using creative and innovative communication activities. So these activities were done and innovative materials were prepared that reduce the resistance and promoted vaccination awareness and safety. As you can see in the slide, there is a butterfly diagram shown here were developed, and it was disseminated across a wide range of community spaces. That includes barber shop, school, et cetera.
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So this butterfly is basically a booklet which was distributed to community influencers to remind them of the importance of disseminating the polio pulse message. There were some other community engagement tools which was used by Social Mobilization Network. First one is partnering with governmental leader, and this partnership has actually created an enabling environment to ensure people’s participation in the program and ownership of the polio immunization program. They’ve also developed a lot of communication materials for CMCs, developed materials for the group meeting among community members, materials for the community influencers, and for the children studying in school.
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To ensure CMCs have the knowledge and skill for conducting quality community-based activities, they have also planned and conducted annual trainings for building CMC’s capacity to dispel misconceptions and fear around immunization within the community. They’ve also organized classes and rallies for children. One of the most innovative engagement tools is the program which was conducted in the community focused on harnessing the power of children as motivators. And these rallies of children is also known as [INAUDIBLE].. They have also designed various strategies like mapping, tracking, identification, and coverage of mobile population or nomadic population. So, in this slide, we’re going to talk more about what happened in UP and Bihar after the SMNet social mobilization network intervention.
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It is an important strategy used in India for community engagement. So just look at these two graphs shown in the slide that clearly explained what happened in UP and Bihar after the SMNet intervention. The Social Mobilization Network was a huge success for interruption of polio transmission and the polio endemic state of Uttar Pradesh and Bihar. An independent assessment of SMNet carried out in 2013 that showed that increasing the total number of children immunized against polio and ensuring that those most at risk are protected.
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As it is visible in the graph, in Bihar, 86% of the cases NP-AFP among children zero to two years of age in the intervention area received more than seven doses of OPV as compared to 18% in 2002. The number of cases of zero to two years old with NP-AFP who have received zero doses of OPV declined from 4% to 0% in intervention areas between 2002 and 2012. Similarly, when you see the graph of UP, there is 76% of the cases of NP-AFP among children zero to two years of age and intervention area who have received more than seven doses of APV as compared to 20% in 2002.
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The number of cases of zero to two years old with NP-AFP who received zero doses of OPV declined from 8% to 2% in intervention areas between 2002 and 2012. Since the intervention areas are highly– generally high-risk, poorly served and vulnerable areas, the increase in uptake of OPV in this area was even more difficult than the better-off areas. So this increase in the uptake of OPV can totally be attributed to the SMNet intervention and the other field activity of the CMCs to a certain extent. In this slide, it’s basically the continuation of the earlier slide that shows the example of UP and Bihar.
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As you can see, there are two graphs in the slide that are depicting the households registered to give OPV drop to their children in Uttar Pradesh and Bihar from the year 2007 to 2015 in India. Since Social Mobilization Network initiated in Uttar Pradesh early in 2007, so the data was taken from that time. Whereas, in Bihar, SMNet initiated lately, so the data related to resistant households was collected from 2011 to 2015. An independent assessment of a SMNet in 2013 concluded that it has been effective and efficient at achieving its goal of increasing the total number of children immunized against polio, and it ensured that most at-risk are protected.
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Between 2007 and 2015, the resistant households declined from 77% in Bihar and 86% in UP where, now, less than 0.5% of households resist vaccination. Now, in this slide, I want you to deliberate on what kind of practical strategies utilized in the state of UP and Bihar of India. Now, take a moment to start thinking about all those practical and innovative strategies that we have discussed in this presentation. You can also think about different contextual considerations, like gender norms, power dynamics, ways to reach hard-to-reach populations. You can also ponder over the cycle of community engagement process prior to taking action during implementation and during evaluation or reflection or dissemination, but all were used.
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There’s some example of strategies that were identified and utilized in Uttar Pradesh and Bihar. So the strategies are overall social mobilization and awareness-raising, creating a network of people who are known to the community. Then comes trust-building with an influencer. Third one is reaching the special population like migrants, hard-to-reach, subculturally appropriate approaches. And then comes combating the security issue. And an important one is by improving technology or using innovative measures for tracking children and [INAUDIBLE].. So these are some of this strategies which was used for community engagement, used to eradicate polio. What other strategy can you think of?

Piyusha Majumdar, Ph.D, M.Sc (Anthropology) Indian Institute of Health Management Research University, India

The Social Mobilization Network became critical to India’s success in eradicating polio, by addressing hesitancy and refusals that were growing among communities in India.

Please review the reading Successful polio eradication in Uttar Pradesh, India.

Now, deliberate on strategies utilized in the state of UP and Bihar of India. Think about the innovative strategies that were discussed in the lecture. Keep in mind different contextual considerations (gender norms, power dynamics, ways to reach hard-to-reach populations), as well as think about the cycle of community engagement processes (prior to taking action during implementation and during evaluation or reflection or dissemination).

What other strategies can you think of that could be used?

Post your thoughts in the discussion.

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