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

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.