The Social Mobilisation Network (SMNet) was formed in 2001 as a direct intervention to reach out to families to immunise their children against polio. Today, this three-tiered structure is supported by UNICEF and The CORE Group and works exclusively for polio eradication in polio endemic and high risk areas in Uttar Pradesh, India. Community Mobilisation Coordinators (CMC) work at the grassroots visiting households and counselling families on a regular basis. In rural areas, each CMC is assigned the responsibility of maintaining contact with 500 families. In crowded urban areas, the CMC networks with 300 families in a given location.
Roles and Responsibilities of a CMC
As a frontline volunteer working with communities to influence health seeking behaviour, the CMC has four main goals: (a) to list all eligible children under the age of 5 years in the area allotted to her; (b) to mobilise all families with eligible children to vaccinate their children against polio at the booth; (c) to identify all likely non-acceptors and counsel and motivate families by addressing misconceptions and fears; and (d) to convert resistant families. Interpersonal counselling is the core of all CMC work. The SMNet relies solely on the continuous effort made by the CMC in influencing behaviour, building networks and partnerships at the local level and motivating people to ensure a huge turnout on booth day.
The chief task performed by CMCs is interpersonal communication (IPC) and counselling with families. Children vulnerable to polio belong to communities that are also susceptible to other communicable diseases. In the absence of informed opinion about polio, frontline workers or CMCs counsel communities on ways to prevent an outbreak of polio - through repeated vaccination.
The challenge is not to make information available and locally understood, but to combat prevailing notions about the Oral Polio Vaccine (OPV). Misconceptions about OPV arose chiefly because of lack of adequate knowledge among families and the frequency of polio rounds and the intense rigour with which vaccinators visited localities and immunised children.
CMCs are trained to quell these fears through facts and information about polio, how it spreads and its prevention. In addition to factual inputs on polio, they were also oriented to disseminate their knowledge to parents and caregivers. For this, they needed appropriate skills to counsel families. All CMCs are trained to conduct interpersonal counselling sessions with caregivers, mothers in particular to dispel misconceptions about the vaccine and to encourage them to immunise their children. Also, IPC training enables CMCs to pass on information without the possibility of it getting distorted along the way.
Building networks of support
A CMC needs allies to mobilise families effectively. The polio programme has hinged on building networks of support at the grassroots. Partnerships are thus forged with community leaders and religious leaders who command wide respect within the community and are considered to be sources of reliable information. These leaders or influencers assist CMCs to allay fears of families that reluctant to vaccinate children for various reasons: illness, age or the child being too young, fear of sickness and even general ignorance. Influencers and partners help to sustain the momentum built before the round. Though CMCs identify and contact influencers, their supervisors or BMCs sustain the contact by assigning them minor responsibilities. Religious leaders were also similarly included in the strategy of initiating partnerships at the community level. Their cooperation was especially useful in making announcements in mosques before a polio round.
Schoolteachers are a key contact for CMCs as they help to organise school rallies and bulawa tolis. While recruiting children to support the programme is an effective way to broaden the base of participation and support for the programme, it also serves the crucial role of creating awareness and a spirit of social service among impressionable children. Bulawa tolis are widely organised in most CMC areas.
In between two polio rounds, a CMC conducts meetings with different stakeholders to ensure their support to the polio eradication effort. These are: (a) A meeting with influencers (b) A meeting with expectant mothers (mata baithak) (c) Saas bahu baithaks (meeting with mothers-in-law and daughters-in-law) w (d) Meetings with members of the panchayat and other community leaders (e) Meetings with schoolteachers to recruit bulawa tolis or children s brigades that are deployed to fetch children to the booth (f) Ijtema or a meeting organised by Muslim men and women where religious topics are discussed with special emphasis on proverbs and the philosophy propounded by Islamic scholars based on their interpretation of the Koran and Hadis. CMCs are trained to introduce health topics during religious discourses
Mosque lans and announcements in Temples
An important communication challenge was notifying the community of the date of the polio campaign. While there was an intensive media campaign on air and IEC material had been developed to serve this purpose, the community needed constant reminders. Booth turnout would surely increase if announcements were made in mosques and other places of worship. Mosques also had microphones that could ensure that a large number of people heard the announcement. Although there was a provision for miking, there was nothing to guarantee that announcements made would be widely heard. Targeting a congregation was a surer way to ensure that the message delivered was heard. If this message was delivered at a place of worship, it had greater credibility. The CMC networked with imams at mosques and pundits in temples to organise announcements prior to booth day. Today, mosque announcements are universally made in all CMC areas. Mosques and temples often offer space to vaccinators to set up booths in their premises.