Drop by Drop: The NGO Contribution to the Polio Eradication Initiative in Angola

"Since 1988, the Global Polio Eradication Initiative (PEI) has worked to eliminate polio – a highly infectious viral disease that can lead to paralysis, muscular atrophy, or death – from all endemic countries. By increasing the coverage of routine immunisation, organising National Immunisation Days, and developing surveillance for acute flaccid paralysis (AFP), the PEI has reduced the world’s incident cases by more than 99%. However, the disease remains endemic in parts of Africa, the Indian subcontinent, and the Eastern
Mediterranean.

Angola faces a unique set of barriers in its fight against polio: the still-fresh legacy of a 26-year civil war has made it difficult to develop systematic immunisation and surveillance programs. The number of health centers and vaccination posts remain insufficient to meet the needs of this population. Maintaining vigilance against polio in this kind of post-conflict environment is critical to the global eradication effort, and is especially critical for children under age three who make up the majority of polio cases in Angola..." According to the report, as Angola rebuilds and extends its public health system, forging strong collaborations with civil society will play an increasingly vital role.

This document is the result of a 10-day qualitative methods and 'case story' writing workshop carried out by The Child Survival Collaborations and Resources (CORE) Group's Angola partners in March 2004. CORE is a membership association of more than 35 U.S. non-governmental organisations (NGOs) working together to improve the health and well being of children and women in developing countries through collaborative NGO action and learning. The report particularly focuses on the experience of Save The Children in Kwanza Sul province.

The most significant obstacles facing polio eradication and the intensification of routine immunisation in Kwanza Sul province are: 1) a limited number of health facilities offering vaccination services; 2) inaccessibility of many communities; 3) a shortage
of trained and committed personnel; 4) poor roads, communication and transportation options; and 5) difficulty in mobilising communities exhausted by decades of war and poverty.

According to the report, remarkable successes have been achieved in Angola with polio eradication through partnerships and widespread involvement of various stakeholders. In Angola, WHO and UNICEF provided technical assistance, scientific
guidance, and support while the Ministry of Health forged national policy and mobilised administrative will for its implementation. CORE Group partner NGOs, along with Rotary International and the Red Cross/Angola, contributed capacity building, logistics, and social mobilisation. This heterogeneous collection of NGOs, government agencies, and bilateral and multilateral organisations worked closely together to determine coverage rates, and then build infrastructure for the intensification of immunisation and disease surveillance. According to the report, a highly effective partnership resulted - one that laid the groundwork for future collaborative public health initiatives in Angola and one that represents an effective approach that can be replicated in other countries.

One dilemma that NGOs face is how to mobilise communities to participate in polio eradication when residents face other problems. CORE Group partners have trained 6,000 community volunteers, many of whom were recruited from existing partner programmes in agriculture, nutrition, and child survival. The volunteers educate parents about the symptoms and signs of major childhood diseases, often by organising dramas, which have been particularly effective. "When the drumming begins, everyone and his brother comes,” one volunteer said. “This way we can let people know about polio, measles, and tetanus in a way that they enjoy."

CORE's polio eradication initiative is not a stand-alone programme; member NGOs have integrated their polio work with other types of development programmes under way throughout Angola. In Bie province, for example, Africare supported community-based agriculture. “Africare trained villagers to be outreach workers,” explained Dr. António Dias. “They taught people in their communities how to cultivate new crop varieties, effectively use fertilizers, and rehabilitate the land. So when we began to participate in polio eradication, we asked these volunteers to help us. Now, when they talk to the community about pest control or irrigation they also pass on information about polio.”

Another strategy was for local village leaders to choose health volunteers from many different fields (farmers, teachers, religious leaders, traditional healers, and birth attendants) and all levels of formal education. Traditional healers, birth attendants, and religious leaders have proved excellent health volunteers in Angola. Even when they can’t spare the time to become full participants, their status and roles in the community often make them desirable collaborators. In the village of Salinas, for example, the traditional birth attendant helps the clinic nurse bring women in for their tetanus vaccinations. She also reports cases of vaccine-preventable diseases she encounters in her practice.