187144 Towards Polio ‘Endgame': Need to Focus on Social Determinants

Wednesday, October 29, 2008

Rajib Dasgupta, Assistant Prof , Centre of Social Medicine and Community Health, School of Social Sciences, Jawaharlal Nehru University, New Delhi - 110067, India
Sanjay Chaturvedi, MD , Community Medicine, University College of Medical Sciences & GTB Hospital, New Delhi, India
Vivek Adhish, MD , Community Medicine, National Institute of Health & Family Welfare, New Delhi, New Delhi, India
Kalyan Ganguly, Scientist 'E' , Reproductive Health & Nutrition Division, Social Behavior Research Unit, Indian Council of Medical Research, Delhi, India
Sanjay K. Rai, Assistant Prof , Centre for Community Medicine, All India Institute of Medical Sciences, Delhi, India
Leena Sushant, Prog Consultant , International Clinical Epidemiology Network (INCLEN), New Delhi, India
Narendra K. Arora, MD, MPH , International Clinical Epidemiology Network (INCLEN), New Delhi, India
Sunil Kumar Agarwal, MBBS , Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC
Background: Till 2007, wild virus poliomyelitis continued to occur in India with varying annual incidence. The `endgame' strategies to hasten polio eradication did not seem to work to the desired extent. Objectives: To gain an understanding of perceptions and likely determinants that facilitate or act as barriers in implementing additional strategies (a) accelerated delivery of mOPV1 (b) use of IPV (c) provision of incentives. Design: Rapid Appraisal Procedures (RAP) was adopted to derive the reality by synthesizing multiple sources of information; search for opinions, motivations, behaviors and attitudes of key stakeholders within their organizational and socio-cultural matrix. Setting: Two districts of Uttar Pradesh – Moradabad and J P Nagar. Subjects: Total 156 interactions were conducted; 33 interviews and 4 FGDs conducted with providers; 33 mothers (of <5 years) and 10 leaders were also interviewed; 8 FGDs of mothers were conducted. Informal interactions conducted with village pradhans, religious leaders, parents, businessmen, journalist (Hindi and Urdu media), mobilizers, vaccinators and supervisors. Results: Providers expressed reservation regarding accelerated rounds of OPV; scientific rationale of accelerated rounds not clear to parents and leaders. Although technical advantages of introducing IPV exist, issues of logistical difficulties and injection safety emerged strongly. Providers and communities indicated a clear ‘no' to the cash incentives but argued for developmental issues. Resistance to the programme has declined over time but still the program is perceived as the “government's need, not ours”. Conclusion: The polio eradication program is critically poised, an opportunity to intensify efforts for reducing inequities in health services and improve access of all children to the PHC services. Ongoing dialogue with local communities and strong political commitment would be essential to translate the technological innovations into a sustainable program.

Learning Objectives:
1. Identify the role of qualitative research methods in evaluation of newer strategies incorporated into an existing public health program. 2. Recognize that the last lap of polio eradication initiative in endemic countries is going to be challenging and shall require innovative endgame strategies. 3. Develop an understanding that such strategies can be effective only when they are in consonance with the socio-cultural sensitivities of local communities and realities of the existing health systems, particularly in developing and transition societies.

Keywords: Immunizations, Ethnic Minorities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked in the area of policy for infectious diseases control in India. I am aware of work done in this abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.