new delhi 10 august 2004 aefi communication: bangladesh experience 1 for every child health,...

New Delhi10 August 2004

AEFI Communication:Bangladesh Experience

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For every childHealth, Education, Equality, ProtectionADVANCE HUMANITY

Naseem-Ur-RehmanChief, Communication & Information


UNICEF BANGLADESH



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Bangladesh’s Poliomyelitis Eradication Progress

• 1988, Bangladesh set the goal of polio eradication by 2000

• Four strategies:– 1). 1) three doses of oral poliovirus vaccine

(OPV3) among infants under one year; – 2) National Immunization Days (NIDs) – 3) surveillance of polio cases – 4) "mopping-up" campaigns to eliminate the

wild virus



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Bangladesh’s immunization picture• Remarkable success in increasing

immunization coverage from 2% in the mid-1980s to 95% by 2004

• No clinically confirmed polio case since 2001

• No case with isolation of wild poliovirus since 2001



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Brief on EPI• EPI initiated in 1979 • First NIDs in 1995 • 12 NIDs till date• Massive social mobilization efforts• More than 22 million children under five in each

NID• More than 50,000 health and family planning

workers and 600,000 volunteers• Multiple partners: UNICEF, Government of

Japan, WHO, CDC Atlanta, USAID, IOCH, DFID, Rotary, Royal Government of Netherlands



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EPI Communication in Bangladesh

• Message: ‘give your child vaccination’• Message: ‘ we look for every child’ • Vitamin A drop during National Immunization

Days. • EPI coverage has been stable 87%-98%• Independent surveys indicate that actual

OPV3 coverage ranged from 60%-74% since 1991.



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Examples of campaigns

Dhaka City Mayor’s call



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NID campaign modalities• Curtain-raiser

• Radio and TV count downs

• Newspapers stories/supplements/features

• Health minister briefs the media

• Media splash and high visibility

• Special PSAs, motivational messages

• Little reference to possible adverse reactions



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• AEFI not restricted to far-away, remote or inaccessible places

• Almost a national representative sample• 2004 Four cases so far• Three suspected polio cases. In Rangpur

(Rajshahi division) , Khulna (Khulna division) and Bandarban (Chittagong division) districts)

• One death of boy aged six in Khulna (Khulna Division) – One boy dies after administration of Vitamin-A

capsule in Munshiganj (Dhaka division) during NID

Overview of AEFI cases in Bangladesh



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Overview continued…

• 2003

• 3 deaths in Jamalpur (Dhaka division) after measles vaccination

• Six more fell ill, later recovered

• All deceased were 10-month old

• Two girls, one boy



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Actors’ responses: factual, mitigation, damage control

Agency

1. GOB

2. UNICEF

3. WHO

SEARO Team

National

Health Ministry

Line Director

Representative

Chief, H&N

Chief, C&I

Prog.Off. H&N

National Professional Officer, EPI Surveillance

District

Civil Surgeon

Divisional Chief

Sub-district

Upazila Health Officer

UPC



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• Report from the field• Joint GOB-WHO-UNICEF team leaves for field• Collection of samples (autopsy report, viscera)• Tests at government's central laboratory/

Geneva• Formation of probe body• Submission of report• Departmental action in case of negligence by

officials/ front-line functionaries• Withdrawal of vaccine if it is old and replace with

new supply

GOB response mechanisms



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• Exchange notes with team/field staff

• Alert MOH, Partners

• Joint fact finding mission

• Joint assessment with GOB and WHO

• Technical advise to GOB

• Monitor situation

• Procure new vaccine, if required.

UNICEF response



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• Subtle investigative media work• Comprehend media’s reaction/treatment• Counter negative press• Closely follow-up, scan/monitor media reports• Establish system of reply to media queries• Press clippings/summaries shared with field

colleagues• Translation of local language editorials/reports• Personalized briefings with key reporters• Identify trends in media reporting• Prepared Q & A for possible media queries• Media management

UNICEF communication response



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• Factual/ scientific position

• Position on efficacy, storage, distribution,/administration of vaccines

• Appraise GOB on situation

• Joint field investigation

• Technical advise on testing samples

• Monitor situation

Role of WHO



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Community’s perception and reaction

• When programme designed to save lives ends in death:

• Grief, anger, panic, pessimism pervades• Knowledge, attitude, perception clash• Fixing responsibilities/accepting reality• Some withdrawal tendency• Return to normalcy after some time• Lack of ability to handle complications• Programme opponents ( quacks, hakims,

conservatives) grab the opportunity• Rumour, negative message resurface• Issues of quality, handling and training emerges



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Media and AEFI: excerpts from Bangladesh press



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Impact on routine immunization

• Word of mouth spreads fast

• Huge damages to programme acceleration

• Lack of follow-up in different areas

• Poor strategy to neutralize negative messages

• No planning for rebuilding the confidence, winning back community support



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What worked well• Coordinated response by all actors• Proactive role of all

What could have been done better

• If report of the investigation was made public• Test report made available from Geneva• Actions taken as per recommendations of the

report • Strengthen communication to allay fear, if any.• Media training on AFP/AEFI and other

complications



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Thank You

new delhi 10 august 2004 aefi communication: bangladesh experience 1 for every child health,...

Documents

epi communication

boyaefi communication

wild virusaefi communication

nidoverview of aefi

khulna khulna division

jamalpur dhaka division

munshiganj dhaka division

surveillance of polio