Building on the experience of the 2013-2014 wild poliovirus outbreak in the Horn of Africa, this study examines applied strategies that helped to engage pastoralists of the Somali cluster (Somalia, Somali Region of Ethiopia, and NorthEast Kenya) in supplementary immunization activities. Aimed at being applicable to other public health interventions, the study synthesizes knowledge about Somali pastoralism in the Horn of Africa and explains the approaches used for tracking nomadic groups and creating dialogue, as well as building trust to enable better vaccination opportunities for pastoralist children. Interventions across the three countries included creating a network of informants and influencers, engagement with clan leaders, mapping of water points and livestock markets, forming a partnership with an animal vaccination program, cross-border coordination, and establishment of permanent transit vaccination points. The proportion of children who had never been vaccinated against polio in the overall incidence of children reported with nonpolio acute flaccid paralysis in Somalia was used as an outcome measure before and after the interventions. Results demonstrate that the proportion of these zero-dose children was reduced from 44.6% to 19.5% between 2014 and 2015. Researchers discuss viability of pastoralist-focused approaches, as well as challenges associated with them, including the high-cost per child reached, lack of disaggregated epidemiological and social data for nomads, and a need to create special tools and strategies. This research provides practical recommendations to public health practitioners who are facing the challenge of reaching pastoralist populations with health services.
Background: Between 2013 and 2014, the Horn of Africa countries experienced a severe and prolonged outbreak of polio viruses. It started in one district in Somalia but quickly became a national and even international disaster, crossing international boundaries into Kenya and Ethiopia. This paper documents experiences in the establishment and contributions of the Polio Communication Network (PCN) to the polio outbreak response in the outbreak countries of Somalia, Kenya and Ethiopia from 2013 to 2015. Process: The establishment of the PCN network of partnerships and technical assistance was designed to implement a strategic communication response. Various strategies were used to establish the PCN. Some of these strategies included partnerships with faith-based organizations; involvement of local leaders in microplanning; social mobilization committees and research, monitoring, evaluation and documentation structures. Major Outcomes: PCN contributions through sustained high levels of community awareness of polio rounds were demonstrated. The contributions of the context-sensitive approaches included significant gains in reaching traditionally missed, hard-to-reach, pastoral communities with polio information, improved communication capacity, and successful closure of the outbreak within the expected timeline. This PCN experience provides important communication lessons relevant to polio eradication and other public health programmes. The focus on building capacity in areas such as monitoring, and data collection generated social data that led to the communication approaches making a significant impact. PCN contributed to a better understanding of the behavioral and environmental factors affecting the demand for, and uptake of, health services in the HoA which can be extended to most of the countries in the HoA with the same demographic and epidemiological realities. Conclusion: The use of the PCN helped bring the 2013-2014 polio outbreak under control and illustrates how the PCN can help drive progress towards the realization of the agenda of the universal health coverage and vision 2030 agenda in the African Region and elsewhere.
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