Cote d’Ivoire - Communication Consultant Report

Main epidemiological data:

• 15 cases of polio confirmed in the safe zones of Cote d’Ivoire
• Polio Vaccine coverage before the October round: 101% (75% to 114%)
• Polio Vaccine coverage after the October round : 98.2% (70% to 114%)
• Course of routine Expanded Programme for Immunisation (EPI): Measles : 57% in 1999 to 46% in 2003, OPV3: 58% in 1999 to 48% some 2003

Main sociological data:

• Country in war since September 19, 2002 and cut in two; "zone of the new strengths" to the north and "governmental zone" to the south, separated by a strip called "trustworthy zone" under control of the strengths of the UNO, of the CDEAO, of France.
• Administration and system of health destabilised
• 80% of health staff in the "zone of the new strengths" left the land for reason of war; their redeployment is not even sufficient in all health centres in zone under control of "new strengths"
• Suspension of the vaccination activities since 2002 in the "zone of the new strengths"
• Resumption of the vaccination activities in the whole territory in 2004
• There are IDP populations in the west part of the country
• There are refugees in the country part of which are in a camp, while others are integrated in the population, notably in the west south (region of the Low Sassandra)

Main negative behaviour problems related to the vaccination:

1. The distrust amongst certain parts of the population, probably linked to the situation of the conflict; for example, a part of the population would think that the vaccines belong to the power in place that would use them to kill their children.


2. A certain weariness of the populations; always taking the children for same "treatment" (5 to 6 rounds for the same vaccine) - polio burnout.


3. Doubts on the efficiency of the vaccination (the number of successive rounds has the tendency to discredit the idea of his/her/its inefficiency).


4. The feeling of insecurity with the technique of marking of the houses; some populations think that the technique of marking of the houses would be a way to indicate houses to be attacked.


5. Poor behaviour of some vaccinators, sometimes, they fill the documents without giving the drops of vaccine to the children.


6. The quality of the vaccination: the sanitary practices of the vaccinators and the cleanliness of carriers is doing little to reassure the elites and the expatriates (large Lebanese population) of the quality.


7. The disorganisation and the insufficiency of the communication activities in some sanitary districts because of the absence of the planning amongst teams in sanitary district.


8. The weak implication of the government, the civil society and the society in general in the activities of vaccination. For example, the National Immunisation Days (NIDs) often appear as the only the business of the Minister of State, Minister of Health and the population.


9. The participatory stakeholder approach is not always considered in the development and the assessment of the activities.

Communication Objectives:

To contribute to modifying the 9 behaviours of the actors / partners of the EPI in order to interrupt the circulation of the wild poliovirus in Cote d’ Ivoire by the quality vaccination of all children of 0 to 5 years.

Specific objectives

• To make the populations understand that the vaccines are bought offered free by the international partners who are friends of all populations of the Coast-D'Ivoire
• To bring the populations to understand that the OPV is of good quality
• To bring the populations to accept the technique of the marking of the houses as pledge of the quality of the NID
• To bring the populations to understand why there has been several rounds of the supplementary activities in addition to the routine EPI activities
• To bring the vaccinators and their supervisors to become aware of their responsibilities in the success and quality of the NID and the eradication of the polio
• To sensitise the partners of the EPI on the importance of the hygiene of the material and the presentation of the vaccinators in the quality of the NID
• To improve the conception, the scheduling, the setting
• To sensitise the government (Ministry of the Public health and sanitary authorities at the operational level) to appropriate activities and to operationalise multi-sectorality in the vaccination activities.

Retained strategies

1. Communication for the change of behaviours for the JNV / PEV

• To prepare microplans of communication / social mobilisation
• To develop activities of proximity communication in advanced strategy of door-to-door in door
• To form the mobilising of land to the techniques of proximity communication for the eradication of the poliomyelitis and for the routine vaccination and the supplementary vaccination

2. Advocacy

The Advocacy in favour of the eradication of the polio aims to cause and to get a lasting political and financial engagement to all levels of the society of the Ivory Coast. The actions of advocacy in favour of the country Polio and country polio/measles are going to be oriented:



At the NATIONAL LEVEL:

Toward the highest authorities

• Political (President of Republic, Prime Minister, President of the national assembly, President of the Economic and social Council)
• Governmental in related sectors (Agriculture, Struggle against the AIDS, Ministry of Finance, Business Social, Condition of the Woman, Environment and Forests, national Education, Youth and Sport, etc.).
• Advocacy to the decision-makers, to bring the political authorities to sustain the activities of vaccination
• To contribute to bring the administrative decision-makers (military and administrative authorities) to apply themselves in the PEV, notably to guarantee the mobility and the security of the teams and materials of vaccination.

The National Representatives of the main bilateral and multilateral partners of the Coast-D'Ivoire

• Red cross,
• Rotary International,
• WHO,
• UNICEF,
• European union
• Bilateral cooperation (GTZ, French, Japanese, American cooperation, etc.)

At the REGIONAL LEVEL:

To contribute to bring the customary and religious authorities and of the institutions to enter in general into the activities of the NID and the EPI

Toward the local officials

• Decentralised (Presidents of Councils Régionaux, Prefects of Regions)
• administrative
• policies
• elected
• economic operators
• the communal decision-makers
• leaders of opinion
• responsible of the related sectors
• NGOs, Red Cross, organised groups, associations of women.

3. Social mobilisation / communal Involvement

• To engage the communities in the marking of the houses, the cartography of the communities
• To contribute to convincing the parents (the mother and the father) to vaccinate against polio all children of 0 to 59 months residing or staying in Cote d’Ivoire by the time of the 3 round of the NID of October, November and December 2004.
• To sensitise the guardians of children that they are required to vaccinate the children
• To engage the communities in the vaccination activities.
• To engage the institutions, NGO, groups and associations in the actions in favour of the JNV polio through the whole Coast-D'Ivoire.

4. Clarity in communication for health agents and vaccinators

• To train the vaccinators in techniques of interpersonal communication (IPC) for the eradication of the poliomyelitis, the vaccination against the polio and for routine vaccination
• To train the supervisors for the vaccination activities
• To train the members of the district cadres in techniques of IPC and micro scheduling of the vaccination activities
• To train the health staff in the techniques of micro scheduling of the communication / social mobilisation.

5. Mobilization of resources

• To mobilise at the national, peripheral and operational level, human, material and financial capital necessary to implement the communication activities for the eradication of the polio and control of measles.

Results expected

• The participation of the highest political authorities (government) and administrative to the central level will have been renewed and intensified
• Greater engagement of the decision-makers of the provincial level in the NIDs
• Backing and renewal of the intersectoral alliances and the partnership with the different partners to the development (related sectors, NGOs, Red Cross, opinion leaders, women’s association and other groups organised)
• Financial resources and material sufficiently mobilized
• Plan of available multimedia communication
• The capacities of communication / social mobilisation will have been reinforced at all levels
• All communal relays (The NGO, women’s association and youngsters, the Red Cross, the professional associations, the religious confessions, the pupils, the corporative associations, the sport associations, the elites, the diplomatic and consular missions) will be conscious of the risk polio and will have taken an active part in the sensitisation of the various segments of the of the population in Cote d’Ivoire
• The parents of children of 0 to 5 years will have been convinced of the advantages of the vaccination against the Polio and will have made vaccinate all their children concerned including the children of the difficult populations and those of the zones of difficult access
• The identified special populations will have been reached
• All children "zero measures out" will have been identified and vaccinated against the Polio.

Local Communication Committees

Committees were struck at all district health levels.

Strengths

• Existence of a National Strategic Plan of Communication
• National Social mobilisation committee composed of 10 functional members (7 ministerial department representatives, 1 representative of the economic operators, representative of the international organisations, 1 representative of the NGO implementing the vaccination)
• Under-committees at decentralised, local levels : regional levels and health districts

Weaknesses

• Financing of the plan
• Operationalisation of the plan
• Lack of leadership
• Non-involvement of non-health sectors
• Under-committees (local) largely non-functional

Action Points

• Advocacy for the mobilisation of resources at the national level and to the internal level through UNICEF
• Energising the under-committees of the districts and areas of health for November and December

Area Communication



Strengths

• Some community mobilisers recruited in the villages worked under the supervision of the NGOs

Weaknesses

• Strategy limited to 4 sanitary districts
• Negotiations with NGOs has been neglected
• The NGOs are weak in the areas of scheduling and in strategic communications
• Implementations difficulties

Action Points

• Knowledge in CCC (?) given to be given some mobilisers, vaccinators and supervisors.

Media

Strengths

• Existence of numerous communal local radios in the northern (non-governmental) areas
• Good engagement of the communal radios in the vaccination
• Existence of many national media outfits

Weaknesses

• No formal partnership with the UNICEF and the other partners of the PEV
• Commercial interests prioritised over humanitarian ones

Action Points

• Support for the execution of the communication plans of the communal radios
• Publication of an info supplement (MEDIAVAC) in 12 dailies

Decentralisation



Strengths

• Realised in the 66 sanitary districts with data at the health area level

Weaknesses

• Poor identification and analysis of the communication problems / social mobilisation

Action Points

• Actualisation of the microplan (shutter communication / mob plowshare), before the second passage of the NID in 15 sanitary districts

Involvement of all partners



Strengths

• Supervision of the activity by the DR, the WHO, UNICEF, the DCPEV

Weaknesses

• Weak communal involvement in the micro scheduling
• Low capacities of scheduling of the operational level
• Difficulties of understanding of the tools by the health agents

Action Points

• Engagement of the communities in the microplanification of the activities of CCC
• Training at the operational level on the use of the tools of microplanning

Local Resource Usage



Strengths

• Utilisation of local radios, religious authorities, ASC, chiefs of villages, prefects and sub-prefect, associations, private corporations (financial, material, logistics, advocacy, personnel)

Weaknesses

• Not all potential contributions capitalised on

Action Points

• To valour and to post all contributions, to establish the amount of the effort of the national part,
• Engagement of the related sectors with community involvement

Financial Allocation to Microplanning Activities



Strengths

• Financial resources assured by the WHO and by the UNICEF (money, consulting, rolling stock, reproduction of the tools, DSA)

Weakness

• Financial resources setting up late

Action Points

• Financing for this activity deemed more important by UNICEF for the second passage

Internal Level (UNICEF)



Strengths

• Health Section heads, (Dr Siguifota and Dr Alfani) dedicated a lot of time for the communication / social mobilisation.

Weaknesses

• The consultants often meet alone and sometimes in positions where they are brought to hang some decisions in absence their supervisors.
• Absence of supervisors UNICEF on the ground

Action Points

• Institution of daily meetings of coordination of the activities of the JNV to the level of the UNICEF since October 14

External Level (Coordination between UNICEF national partners)



Strengths

• Existence of coordination mechanisms at the national level, in the setting of the coins committees of the national committee of organisation of the JNV, the CCIA, (under committees of social mobilisation, finances, logistics especially), the technical committee of support in the NID.

Weaknesses

• Weak representation of the BCI to the meetings of these processes of orientation of the decisions to take (only the person responsible of the PEV in the BCI to the works of all these committees, outside of the consultants who bring a support to the committee of social mobilisation)
• Irregular meetings of the committees, with the exception of the one on social mobilisation
• Weak leadership and weak visibility of the BCI in the coalition

Action Points

• Focal points designated among the staff members to follow the activities of the different committees
• Affirmation of the leadership of the BCI in social mobilisation

Coordination



Strengths

• Existence of a communication plan / social mobilisation
• Existence of fund for the communication / social mobilisation
• Engagement of the NGO

Weaknesses

• Erroneous perception of the social mobilisation
• Contradictory instructions on the ground
• Absence of a shared activities calendar by all
• Bad flow of information between the central level and the peripheral and operational level
• Bad flow of information between partners, between governmental part and partners
• Belated routing of the vaccines

Central Level Positioning of Inputs

Weaknesses

• Belated routing of the vaccines in the districts and areas of health (October 8 for some)
• Belated reproduction of the management support materials
• Belated routing of the management support toward the operational level
• Intermediate distribution of the vaccines delayed
• Excessive centralisation of management system (belated distribution of all management tools, DSA, operational costs and supports of communication)
• Non-justification of funds received the UNICEF and the WHO by the governmental part
• Belated routing of the chalk for the marking of the houses
• Non-routing of the products for the marking of the children
• Very approximate appreciation of the realities on the ground in the rainy season (accessibility problems)

Ground Level Activities

(Marking of children and houses, vaccinator recruitment, etc.)

Weaknesses

• No marking of the houses and children in some sanitary districts
• Cartography and sketch of the areas of deployment, itineraries and progression of the non available teams or non used everywhere
• Lack of local recruitment of the vaccinators in their respected communities, some vaccinators have been imported from Abidjan
• Ratio of supervisors / team of vaccinators below standard
• National norms of spreading of the vaccinators and the inappropriate supervisors to the realities of some DS and areas of health.
• Weak presence and very discreet mobilisation activities in 4 districts of health
• Insufficiency of funds granted to the vaccination (operational costs, social mobilisation)
• Setting up and belated freeing of available funds.
• Insufficiency or absence of the justifications of precedents funds advanced to the governmental part

Action Points

• Explanation of the importance of the cartography, of the itineraries, of the marking of the houses and children cowpoxes for NIDs of quality

Engagement of Community Leaders

(religious, administrative, celebrity)

Strengths

• Good to very good engagement of the religious and communal leaders by the departmental Directors
• Involvement of the prefectorial authorities

Weaknesses

• Absence of incentive for these communal relays (Caps, posters, T-shirts, transportation)
• Little interest and generosity demonstrated by the media, sport and music stars
• Weakness of the system of the NID in the organisation of special events

Message Diffusion Characteristics

Strengths

• 13 messages developed at the national level
• Initiative taken for the adaptation of the national messages to the local level

Weaknesses

• Numerous messages, but most not financed
• Belated consignment to the operational level of the messages elaborated at the central level
• Messages not pre-tested
• Lack of financing of the communal local radios
• Messages distribute three days before the NIDs

Action Points

• To produce some messages for the visibility of the BCI
• Pre-test the national messages before November 14
• Diffusion of the messages planned for November 14 for the second round

Mediums Used

• Written press (12 dailies of Abidjan have published of the articles and served of support of distribution of the "Mediavac" supplement)
• communal local radios
• griots
• megaphones
• mail
• posters
• Internet (Web site of PANAPRESSE)

• Management tool prepared
• Observation of the communication activities / social mobilisation by the two consultants UNICEF and the Regional Aviser of the BRAOC in 11 of 66 health districts
• Daily synthesis meeting with identification of problems and proposition of actions for the following day

Weaknesses

• On the ground teams not engaged with E&M
• No supervision for E&M because of recall of teams to Abidjan by BCI

Actions Points

• Preparation of a national report on the communication / social mobilisation by the UNICEF, leader of this component of the NID

Mechanisms of evaluation of the budgets

Strengths

• Budget estimated by the under-committees and validated by the CCIA
• Operational level forecasting of the costs of the vaccine, sensitisation material and the operational costs are made on the basis of the demographic data and the microplans of the sanitary districts

Weaknesses

• There is some confusion about which funds are allotted to each level
• The government's funding is not announced beforehand
• Resources have not been unblocked until this day to defray the NGO.

Total Budget

October Round

Announced: 861,101,215 FCFA

• Operational costs = 623,077,793 FCFA
• Vaccines = 238,023,422 FCFA

Mobilised: 781,782,717 FCFA

• Operational costs: 543,759,295 FCFA
• Communication / social mobilisation of proximity 42,772,800; articles and spotlights national medias: 80,000,000

Gap: 79,318,498 FCFA

November Round


Announced: 812,565,142 FCFA

• Operational costs: 57,454,1720 FCFA
• Communication / social mobilisation: 726,288,000 FCFA
• Vaccines = 238,023,422 FCFA

Mobilised:

• Operational costs: ?
• Communication / social mobilisation: 71,288,000 FCFA (= 134,000 $ UNICEF BCI)
• Vaccines: 238,023,422 FCFA

Gap: ?

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