Abstract
The Social Mobilization Network (SMNet) has been lauded as one of the most successsful community engagement strategies in public health for its role in polio elimination in India. The UNICEF-managed SMNet was created as a strategy to eradicate polio by engaging >7000 frontline social mobilizers to advocate for vaccination in some of the most underserved, marginalized, and at-risk communities in India. This network focused initially on generating demand for polio vaccination but later expanded its messaging to promote routine immunization and other health and sanitation interventions related to maternal and children’s health. As an impact of the network’s interventions, in collaboration with other eradication efforts, these high-risk pockets witnessed an increase in full routine immunization coverage. The experience of the SMNet offers lessons for health-system strengthening for social mobilization and promoting positive health behaviors for other priority health programs like the Universal Immunization Program.
Highlights
Polio eradication efforts in India and globally have demonstrated that, in many locations, the critical path to success lies in complementing a focus on biological issues with a comprehensive address of the sociocultural challenges [1]
A culture was developed where the identification of areas of programmatic weakness and capacity/knowledge gaps was considered good practice and rewarded. These trainings contributed toward capacity building and skill development of frontline workers such as Accredited Social Health Activists, Anganwadi Workers, and Auxiliary Nurse Midwives, in Bihar, where these cohorts were systematically engaged ahead of all campaigns. (Details are given in Table 1.) In Social Mobilization Network (SMNet) states in 2015 alone, 62 307 auxiliary nurse midwives, 135 411 accredited social health activists, and 68 395 Anganwadi workers were trained by the polio program to improve interpersonal communication skills related to the Universal Immunization Program
A large proportion of inequities in routine immunization coverage and health delivery can be attributed to inequalities in social determinants [21]
Summary
Legacy of Polio—Use of India’s Social Mobilization Network for Strengthening of the Universal Immunization Program in India. Experience has shown that the most tenacious pockets of wild poliovirus circulation are entrenched in either hard-to-reach or underserved communities with deep-rooted sociocultural resistance to immunization Polio eradication in these contexts in India became possible because of the support of a social mobilization and behavior change communication strategy, which encompassed a range of equity-focused community engagement efforts to overcome these challenges in the most at-risk communities [2,3,4,5,6,7]. As part of the 107 Block Plan, the network introduced convergent messaging promoting routine immunization, diarrhea prevention and management, handwashing with soap, and exclusive breastfeeding practices as a means to both tackle underlying causes for ongoing polio transmission and alleviate resistance by holistically addressing concerns of underserved populations.(Full routine immunization coverage is the percentage of 1-year-old children in SMNet areas who received 1 dose of BCG vaccine, 3 doses of diphtheriapertussis-tetanus vaccine, 3 doses of oral polio vaccine, and 1 dose of measles vaccine. These strategies are significant for the transition of the network into supporting broader health services and can be considered for other programs which depend on community orientation for better uptake of services
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