Comprehensive Assessment of the CORE Group Polio Project (CGPP)

"...emphasized the CGPP's effectiveness at the community level - engaging community leaders, creating relationships with influencers, working with household caregivers and changing attitudes that yield normative and community change not just individual behavior change."

Over the past 20 years, the CORE Group Polio Project (CGPP) has worked in high-risk areas of 20 countries to conduct community-based activities designed to strengthen supplemental polio immunisation, routine polio immunisation, and surveillance of acute flaccid paralysis (AFP). This evaluation exercise was designed with the aim of providing a comprehensive assessment of the CGPP by: (i) documenting its accomplishments and key contributions to the Global Polio Eradication Initiative (GPEI), (ii) identifying pertinent programmatic innovations and strategies, (iii) highlighting challenges or difficulties, and (iv) preparing a report of the findings that includes key lessons learned and recommendations for transition, future programming, and potential adaptation of the CGPP Secretariat model. As such, it was designed to complement previous global and in-country evaluations that focused primarily on programme implementation results in terms of social and behaviour change (SBC), and therefore concentrates on the perceptions of those currently involved in the actual work of polio eradication.

Of the 8 countries in which the CGPP was working as of this writing, the evaluation team members (3 polio experts) visited 5 of them: Kenya (Horn of Africa - HOA), Nigeria, South Sudan, Ethiopia, and India. During in-country missions, they conducted in-depth, key informant interviews with CORE Group members, their GPEI partners, and government counterparts. In addition, they participated in field visits and/or meetings with community mobilisers to obtain their "on-the-ground" perspectives of the CGPP experience and its community engagement programming.

The report discusses findings in the 5 key areas listed below, by featuring both GPEI and CGPP reflections and evaluator comments/observations:

• Secretariat model [In brief, this strategy of non-governmental organisation (NGO) collaboration at the global and country level is based on principles such as transparency, broad participation, and shared human resources]
• Major contributions - success strategies
• Main deliverables and GPEI programme objectives
• Strengths/successes/accomplishments vs. weaknesses/challenges
• Opportunities (4-5 years transition)/specific lessons

Summary of findings and lessons learned:

1. Programming: The evaluation confirms that the CGPP has made and continues to make "major contributions" to the GPEI, especially by working in areas where the virus is silent and routine immunisation is minimal or non-existent. By building community capacity to be self-sufficient and using community mobilisers and/or community health volunteers, "the CGPP has been able to reach underserved and remote populations and strengthen house-to-house contact and information exchange. Through their intensive community contact and involvement of community members in polio planning processes, they have been able to develop trusting relationships, and demonstrate respect for cultural/social norms while offering change options in a non-threatening manner....At the same time, it has evolved into a social communication and community surveillance platform that has the potential to expand into other programming areas beyond health." Sample recommendation: As polio tasks wind down, NGO partners should explore other areas of potential engagement in other emergency and humanitarian programmes, drawing on CGPP's experience in working in remote and high-risk locations.
2. Secretariat: "In terms of operational characteristics, the concept of a unified NGO network seems to positively resonate across all interviewees. As such, the Secretariat model is a key foundation for the CGPP....The future of the CGPP Secretariat - formal recognition as registered organization vs. independent project - is not decided. Particularly, its status is posing a challenge for India..." Sample recommendation: Employing local human resources (or international workers with extensive in-country experience) through a simple, independent coordination mechanism, with supportive supervision, is a replicable model; involvement of more women in supervisory and management positions should be facilitated, where possible.
3. Partnerships: Several GPEI partners view the CGPP as an implementing partner of the GPEI and not a GPEI member, per se. "While accepting that the CGPP provides grounded information about community realities, they are also perceived by some of having a micro-perspective of what is occurring and not necessarily a big picture of what is needed....In comparison, among others, it is perceived that GPEI partners need to be more willing to give NGOs/CGPP a 'voice at the table'....[Accordingly,] there is consensus among CGPP members that they should be included in future planning and discussions with the government and receive partner support for their efforts. At the same they realize that as an NGO project, the CGPP has a 'behind [the] scenes' role in supporting the government in polio eradication so there is a fine balance to be maintained - i.e. being recognized for work accomplished but not upstaging." Sample recommendation: Build capacity by providing an opportunity for CGPP partners to attend and participate in GPEI partner-sponsored training workshops and, where possible, to join CGPP Secretariat staff at national fora, which would also provide exposure.
4. Documentation: There is a need for better documentation of the CGPP to provide a fuller picture of what is happening and why, specifically. "Given that the different CGPP operations have developed numerous tools and materials, they have untapped resources that could be shared more widely to improve community-based practice more widely, i.e. social and behavior change communication [SBCC] materials developed by CGPP-India or community-based surveillance protocols developed by CGPP-HOA." Expanded documentation (e.g., rapid assessments on threats/obstacles to behaviour change and results of behaviour monitoring) would require additional resources. Sample recommendations:
   • Ensure that CGPP reporting tracks and links behavioural data findings to the community surveillance results and the effect of community mobilisation and communication activities.
   • Expand documentation of CGPP experiences and processes (e.g, training, mobiliser motivation, materials development) and related lessons learned and good practices to facilitate information/knowledge transfer and influence the profession. This could take the shape of: (i) presentations at national and international conferences, such as the SBCC Summit and the World Conference of the International Union of Health Promotion and Education, as well as at global United Nations (UN) fora and think tanks; and (ii) continued dissemination in the grey literature and/or publication in professional peer-reviewed journals within public health and the wider field of SBC of lessons learned. Potential areas of focus could include, but are not limited to: a) exit strategies from CGPP in Nepal, Bangladesh, Angola, and India; b) entry processes and opportunities into Afghanistan that can provide new insights about community-based work, using an adapted Secretariat model; and c) absorption of social mobilisation networks into government and/or other systems, as experienced in Ethiopia and India, with an emphasis on highlighting the pros and cons of such efforts, what is required for successful fusion.