Draft: CHECK POLIO - Briefing note for OBRA support.
Briefing note: 20 check points to help undertake an effective OBRA.
2019 demonstrated that full polio eradication will require effective responses to vaccine derived polio outbreaks - VDPV. 17 countries in 2019 had 302 cases of VDPV. An OBRA (Outbreak Response Assessment) is a monitoring and strategic guidance component of the overall response to vaccine derived polio outbreaks. The response involves several steps and actions from risk assessment, to ensuring surveillance quality, to preparing and conducting campaigns which all happen before the OBRA is constituted. The OBRA team should be in place within 3 months of notification of VDPV and comes in after the first one or two immunisation rounds.
The Communication Initiative (The CI) has both been involved in OBRAs in countries (eg Laos and Madagascar), summarised and shared knowledge from the involvement of some other groups in OBRAs (eg Horn of Africa) and has reviewed and summarised the OBRA considerations of polio related bodies (eg the USAID related groups involved in polio eradication). See links below to relevant summaries and other documents.
As a contribution to the ongoing efforts for more effective and relevant OBRA initiatives, The CI was asked to review its past experiences and develop a briefing document on OBRAs from a communication for development perspective. That briefing note follows. It provides a complement to the SOPs by drawing on other evidence and reflection from direct field experience. Just a couple of points in advance of your review:
- The orientation of the briefing that follows is towards the people directly involved in an OBRA - the team, the government and other in-country people who are guiding, and the international organisations that are supporting.
- The purpose of the briefing below is to provide a set of 20 important checks that can be referred in order to help focus the OBRA process.
- Those 20 questions are entry points for an OBRA not a comprehensive outline of all possible IBRA related questions.
- The knowledge that informs the selection of these points are the collected OBRA related summaries on The CI platform.
- The structure and design of this briefing note is based on the principles of (a) immediate practical use (b) brevity to ensure ease of quick access and easy use and (c) links to the full documents for any items of particualr interest for each user.
- The briefing note is NOT meant to be the full and comprehensive guide to conducting an OBRA. That task is the responsibility of the overall OBRA managers of course.
- What follows IS meant to complement those core, comprehensive and detailed OBRA guidance notes with a briefing document that outlines 20 checks (like the check oil and tyre pressure checks in a car) that support improving the performance, outcome and relevance of an OBRA.
- These are all in the context of and seek to add specificity and detail from a communication for development perspective to the areas outlined in the SOP; for example, fully engaged national and subnational governments; rapid detection, notification, investigation and risk assessment; strong advocacy, communication and social mobilization; and, a robust immunization response.
CHECK POLIO
As part of the briefing for and conduct of OBRAs, from our experience, we recommend the following 20 checks be undertaken and considered:
1. Check that the review is independent with a focus on providing practical and strategic guidance
"The first is to provide independent oversight and guidance to the country in developing and implementing its response to the outbreak." (Overview)
From Maternal and Child Survival Program Polio Communication Program Summary [Expert Technical Advice]
2. Check that the national polio eradication strategy has broad support.
"Ensure that the national level polio communications strategy and guidelines are supported at the provincial level and implemented at the district, village and health service delivery site levels. Where necessary provide specific guidelines for local level use" (Laos)
From Polio Outbreak Response Assessment - Lao People's Democratic Republic
3. Check the present situation against the situation described and recommendations prescribed by any previous reviews or evaluations.
"... tasked, first, with assessing progress made to date vis-à-vis previous evaluation recommendations, including those of both the previous external evaluation team and T. Daniel Baker of the United States Agency for International Development (USAID)" (Madagascar)
From Madagascar Polio Program Evaluation Trip Report
4. Check the national and local plans against the global strategy
"This Global Polio Eradication Initiative (GPEI) guide is for national governments and public health decision-makers who coordinate responses to poliovirus events and outbreaks, and their global, regional, and country-level partners. The purpose of these standard operating procedures (SOPs) is to offer policy guidance and to provide performance standards on how to respond to any type of poliovirus outbreak or event in a timely and effective manner and, specifically, to stop an outbreak within 120 days."(Overall Guidance)
Standard Operating Procedures: Responding to a Poliovirus Event and Outbreak - Version 3
5. Check that in-country managers are traveling with the external OBRA review team.
"Busy medical, epidemiology, and immunization managers at district levels and above can easily get so caught up in managing logistics and reviewing data that they forget to make the time to go out and gather their own data by visiting static sites and observing field teams ... During recent assessment visits to two countries experiencing polio outbreaks, senior health decision-makers traveled with the OBRA team and saw for themselves, for the first time, the actual gaps in performances of campaign workers. In every instance, they were shocked, and then determined to make changes that would make a real difference on the ground." (Numerous countries)
From Seeing What We Don't See: An Experience of Supportive Supervision
6. Check that the information gathering process of the strategy and the review are tailored to local social dynamics
Example: "Because of the agricultural work that keeps many community members away from home/village during the day, the meetings were held in the evening, and teams often spent the night in the villages in order to meet with the communities for a second night to answer remaining questions." (Laos)
From Overcoming Barriers of Distrust to Improve Vaccination Coverage: Lessons from Lao and the Hmong Community
7. Check that there is a priority focus on supervision training.
"... supportive supervision training that can ensure both real-time information on gaps in performance and the opportunity to close the gaps" (Overview)
From Seeing What We Don't See: An Experience of Supportive Supervision - (Ellen Coates editorial)
8. Check that there are clear and understood accountability processes and systems for performance of the polio erdication actions required
"Integrate communications and social mobilization activities, and timelines into campaign plans and microplans, especially at local levels. Include specific actions to be taken, by whom, when and where." (Laos)
From Polio Outbreak Response Assessment - Lao People's Democratic Republic - (Ellen Coates trip report)
9. Check that there is evidence based planning
"Country teams should ensure use of data for evidence-based planning and corrective action, including zero dose social profiling, and disaggregate data for special and mobile populations at all levels." (Horn of Africa)
Technical Advisory Group on Polio Eradication for the Horn of Africa Countries: 18th Meeting Report
10. Check that there is high quality formative research
"Formative research would be a valuable investment toward improving the effectiveness of communications and social mobilization, informing efforts to identify and overcome both active and passive resistance, and supporting future establishment of robust community-based active surveillance." (Madagascar)
From Madagascar Polio Program Evaluation Trip Report
11. Check that social change, behaviour change, communication and community engagement indicators are part of the overall set of core indicators used to measure progress.
"Systematic reporting of identified social indicators, especially for missed children, refusals, and absences, as part of the overall national outbreak reporting mechanism" (Overview)
From Standard Operating Procedures: Responding to a Poliovirus Event and Outbreak - Parts 1 and 2 - Effective 01 November 2017 until 30 April 2018
12. Check the relationship to routine immunization
"Plans for strengthening basic immunisation services in the context of polio transition; and, Communication strategies focusing on building and sustaining demand for immunisation, particularly in high-risk groups." (Horn of Africa)
From Technical Advisory Group on Polio Eradication for the Horn of Africa Countries: 18th Meeting Report
13. Check the quality control mechanisms
"Improved quality of immunization services and polio vaccination campaigns, along with communications efforts that contributed to overcoming lack of awareness and distrust among the Hmong population, have strengthened immunization coverage through increased participation in polio vaccination campaigns." (Laos)
Overcoming Barriers of Distrust to Improve Vaccination Coverage: Lessons from Lao and the Hmong Community
14. Check the decision-making processes of marginalized groups
"There is also a need for research that places polio within a wider social context in order to better understand overall social dynamics without assuming that polio is, or should be, a major priority for caregivers. A research agenda should be developed that is flexible enough to respond to emerging issues and focused on areas of priority to the program." (Overview)
From Maternal and Child Survival Program Polio Communication Program Summary [Recommendations]
15. Check the nature of the content of the public engagement communications
"In recognition of the fact that risk or crisis communication preparation and management can avert costly problems, reflected by complacency, rumours, adverse events, and a lack of confidence in vaccines or health systems, the document offers guidelines such as "let the media and public know if you don't know." (Laos)
From Lao PDR Polio Communication Strategy and cVDPV Outbreak Response Action Plan 2015 - 16
16. Check that at least one new communication, social change, behaviour change and/or community engagement strategy has been implemented in the previous 2 years.
"Establish new communication approaches and materials for use in areas where security has compromised access, resulting in a range of new strategies and materials specifically designed for circumstances, such as those in which house-to-house campaigns are prohibited." (Overview)
From Maternal and Child Survival Program Polio Communication Program Summary [Expert Technical Advice]
17. Check that there are milestones in place
"The second is to set milestones to be used to determine whether the response is adequate and provide periodic assessments as to whether the outbreak has stopped." (Overview)
From Maternal and Child Survival Program Polio Communication Program Summary [Expert Technical Advice]
18. Check the nature and role of social media
"... the increasing influence of social media in the spread of misinformation and rumors that undermine vaccine acceptance" (Overview)
From Maternal and Child Survival Program Polio Communication Program Summary [Recommendations]
19. Check the relationship between the polio programme and marginalized communities
"reaching and engaging the most marginalized, population movement" (Overview)
From Maternal and Child Survival Program Polio Communication Program Summary [Recommendations]
20. Check the strategies in place to reach hard-to-reach communities and people
"This was a time-intensive approach, to be sure, requiring that members of the minority or otherwise underserved community who visit the villages be trained MOH staff with the stature to command both respect and some decision-making authority. The MOH also adjusted polio campaign approaches to better reach the plantations and rice fields where many Hmong (and other minority migrant workers) stay for extended periods. A poster showing a Hmong member of the Lao Parliament giving polio vaccine drops to an infant was also produced and widely distributed." (Laos)
From Overcoming Barriers of Distrust to Improve Vaccination Coverage: Lessons from Lao and the Hmong Community