Community Innovations for Polio Eradication: An Operational Research Project for Pakistan
Sector: Public Health
Date Range: December 2011 to December 2012
Type: New Program
With support from the World Health Organization and the Global Polio Eradication Initiative (WHO/GPEI), the Positive Deviance Initiative (PDI) at Tufts University is implementing a project to identify and address barriers to polio eradication in selected areas of Karachi, Pakistan with persistent transmission of polio. Positive Deviance (PD) is an innovative approach designed for entrenched, complex problems that have proven difficult to solve. By engaging stakeholders in a process of data collection, dialogue and discovery, PD enables communities to leverage behavioral and technical innovations that already exist. The proposed project will bring together an experienced PD team comprised of PDI staff and local partners to rapidly identify existing successful behaviors and strategies and to set the stage for disseminating the discovered solutions.
In December 2011 the PDI team traveled to Pakistan to provide an overview of the project purpose to WHO/GPEI Spearheading Partners (WHO, UNICEF, Rotary International, CDC, and the Gates Foundation). In addition to the overview, the PDI team met with representatives from the Ministry of Health, Aga Khan University, and NGOs including HANDS and the Rural Support Programmes Network to define organizational roles and responsibilities for the project. Site visits were conducted in various neighborhoods of Karachi to support the selection of the project site. During the visits, vaccination campaign activities were observed, informal interviews were conducted, and community demographics and social conditions were assessed. Gadap Town, located in northwestern Karachi, and with a population of nearly 300,000, was selected because: the area is considered to be at high risk for polio transmission; Spearheading Partners, MOH, and NGOs have a visible presence and have expressed clear support for the work; NGO partners have a history of trusted collaboration with community leaders and members; Early evidence suggests that positive deviant behaviors exist; and complex social conditions (lack of infrastructure related to water, sanitation and housing) are at the root of the problem and will allow for the proper framing of the problem.
The second site visit during March and April 2012 had significant outcomes, including the development of solid partnerships with Aga Khan University and HANDs and the 5 day training of 44 vaccinators, HANDS staff, supervisors and community leaders. During the PD training, trainees transformed from passive listeners to active participants and gained skills resulting in increased trust when interviewing potential PD's. Eight trainees (4 for UC4; 4 for UC8) were selected to conduct PD inquiries in May/June 2012.
Observation of the key players in the eradication of polio in Karachi has led the PDI team to focus the positive deviance inquiry on three main audiences/actors: 1) vaccinators, 2) vaccination supervisors, and 3) community leaders/members. This will allow for the identification of successful behaviors related to both the demand for and supply of quality, effective polio eradication activities.
Project implementation will continue through December 2012. The next stages of the project will involve working through the five steps of the PD process in collaboration with a local PD team, and will include: 1) Defining the problem, 2) Determining the presence of PD individuals or groups, 3) Discovering uncommon but successful behaviors and strategies through inquiry and observation, 4) Designing activities to allow community members to practice the discovered behaviors, and 5) Monitoring and evaluating the resulting project or initiative.
- Presentation: Project Update - Community Innovations for Polio Eradication (CIPE)
- Project Summary: Community Innovations for Polio Eradication
- Project Report: Capacity Building Workshop for Conducting Positive Deviance Inquiries
Community Innovations for Polio Eradication in Pakistan (April 2012): View the gallery
From 2003 – 2008, USAID funded five international NGOs, (CARE, Catholic Relief Services (CRS), Mercy Corps (MC), Save the Children US (SC), and World Vision International (WVI)), to implement Positive Deviance in Indonesia as part of food security programs. Together, the five NGOs reached 9,997 children across the country. Of this number, 59.6% gained 200g between admission into the program (Day 1) and graduation from the program (Day 10). Of 4,847 participants who were weighed again at the end of the month, 45% had gained the recommended 400g. Results differed slightly (but not significantly) between implementers; however, they differed dramatically between different communities.
For the full report, click here.