By Sergiy Prokhorov

Anam wraps a shawl around her shoulder and covers her face as she tells me about her day-to-day work as a Communication Network (COMNet) social mobiliser. She works in Pakistani communities which are most at risk for the polio virus in the Punjab province. Anam helps vaccinators to address parents’ concerns about vaccination, identifies children who have not been vaccinated, and oversees the effectiveness of Pakistan’s polio vaccination campaigns.

Pakistan was responsible for more than 85% of the world’s polio cases in 2014, and is now one of the last remaining global polio endemics. In the first three months of 2015, Pakistan and Afghanistan are the only two countries in the world with recorded cases of polio.

COMNet job

COMNet SM conducts a polio awareness session with the nomads in rural Pakistan. UNICEF/PAK/2013/Zaidi
COMNet SM conducts a polio awareness session with the nomads in rural Pakistan. UNICEF/PAK/2013/Zaidi

Being a frontline health worker is a tough job. Frontline health workers are the backbone of the polio eradication initiative who work tirelessly to reach children across Pakistan during every campaign. Like many frontline health workers, Anam has to educate parents who refuse to vaccinate their children because of certain misinformation and preconceptions about polio. Reaching Pakistan’s 35 million children under five is a significant logistical challenge. Polio eradication is campaign-based, which means that during Government coordinated campaigns front line health workers go door-to-door once a month vaccinating kids. COMNet is tasked with making sure every child is identified and vaccinated. The success of the polio eradication programme lies in ensuring that no child below the age of 5 is missed during the immunization campaigns.

The busiest time for Anam is around campaigns. She gets up early and usually returns home late. Polio frontline workers in Pakistan often face security threats and Polio workers, like Anam, have to be extremely cautious working every day to end polio.

Training

Anam emphasizes the importance of training and being properly prepared for her job. Parents usually have many questions and if she cannot answer even one, the chances that they refuse to vaccinate their children increases. To ensure that COMNet social mobilisers know how to talk to parents about the importance of vaccination (as well as how to successfully respond to the many tough situations they may encounter), COMNet staff regularly attend UNICEF training sessions on polio and interpersonal communication skills. At the training they learn through role play how to behave in situations they may encounter visiting caregivers. Together with the trainer they go thorough each step a frontline worker should do when visiting a caregiver. Anam notes that knowing what to say to a reluctant parent and how to say it, and what to do if a parent gets aggressive is crucial. It advances the fight against polio and protects the lives of a frontline worker.

Innovations at work

And that’s where technology comes in; reaching out to frontline staff through mobile phones has proven to be a fast and cost-effective way to get actionable information and deliver messages; a real real-time feedback loop. In order to help COMNet to refresh their knowledge on interpersonal communication skills, UNICEF Pakistan has designed a series of “quizzes.” For our survey medium, interactive voice response (IVR), also known as the robocall, was used. The phone quiz consisted of two questions about real situations frontline staff often encounter similar to those when a caregiver may get angry or aggressive, reluctant or unwilling to cooperate. After answering each question, each respondent was told if they got the question correct or not, followed by additional details on why the chosen answer was the correct one. Respondents were also given the option of send in a text message with questions or comments about IPC skills. (UNICEF received many comments, including over 100 requests for additional training in interpersonal communications.)

COMNet social mobiliser visits a household in the Punjab province in Pakistan. UNICEF/PAK/2014/S.Prokhorov
COMNet social mobiliser visits a household in the Punjab province in Pakistan. UNICEF/PAK/2014/S.Prokhorov

When Anam’s supervisor informed her that she will get an automated call with two questions she thought that UNICEF just needs some information from COMNet. However, after taking the quiz she understood that the call actually was about helping her. Thanks to the phone quiz Anam refreshed important knowledge on how to behave in tough situations talking to parents about polio. She originally learned this approach a couple of month ago at a UNICEF training, but it is easy to forget this information in daily routine. After the call Anam even decided to go through training materials as realized that there may be some issues she needed to refresh.

It took 5 hours to ensure more than one thousand of COMNet social mobilisers completed the phone quiz. Anam notes that she liked the option of the call back the most. “I was right in the middle of the visit to a household, talking to a parent. Parents appreciate the attention and like being listened. It was very comfortable for me to select call back in one hour option”, – tells Anam.

UNICEF innovative technologies help Pakistan to fight polio and finally make the country polio free. Frontline workers are the first who can see how innovations help do the job better.

For the sake of security we have not disclosed Anam’s real name as well as her real work location.

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