The Polio Communication Network Contribution to the Polio Outbreak Response in Ethiopia’s Somali Region, 2013–2015

Abstract

This article explores the Polio Communication Network's (PCN) contribution to the polio outbreak response in the Somali Region of Ethiopia from 2013 to 2015. The PCN strategies and innovations include the establishment of a communication network of experts, development of partnerships with locally trusted and influential groups, and capacity building of local structures. Results show PCN contribution through sustained high levels of community awareness of polio rounds and low rates of noncompliance with polio vaccination in line with the national indicator (< 1%). We argue that the context-sensitive approaches made significant gains in reaching traditionally missed, hard-to-reach, pastoral communities with polio information, improved communication capacity, and expertise, and contributed to the successful outbreak closure. The PCN experience in the Somali Region, one of Ethiopia's lowest-performing regions for health indicators, provides important communication lessons for the long term relevant to polio eradication and other public health programs. Due to the focus on building capacity in areas such as monitoring and data collection, generated social data demonstrated impact of communication approaches and has contributed to a better understanding of the behavioral and environmental factors affecting the demand for, and uptake of, health services in Ethiopia's Somali Region.Ethiopia is the second most populous country on the African continent, with a population of 90 million in 2015 (Central Statistical Agency of Ethiopia [CSA], 2015), and shares international borders with Djibouti, Eritrea, Kenya, Somalia, Sudan, and South Sudan. It is one of the fastest growing economies on the African continent (Federal Democratic Republic of Ethiopia Ministry of Health [FMOH], 2015). Only 16% of the population lives in urban areas. The majority are settled in rural areas, engaged in farming in the highlands and pastoralism in the lowlands (CSA, 2012). Administratively, the country is divided into nine regional states and two city administrations, with regions further divided into zones, woredas (districts), and kebeles (subdistricts). The Somali Region has nine administrative zones consisting of 68 woredas and 786 kebeles (Ethiopia Somali Regional State Bureau of Finance and Economic Development [ESRSBOFED], 2013), with a population estimated at 5.1 million (Federal Democratic Republic of Ethiopia, 2013). The backbone of the health system in Ethiopia is primary health care, which-through its flagship Health Extension Programme, established by the FMOH in 2003-provides promotive, preventive, and curative community health services (FMOH, 2012).In 2014, Ethiopia announced achievement of MDG4 (Millennium Development Goal 4), 2 years ahead of schedule-reducing the under-5 mortality rate by two-thirds between 1990 and 2012-significant progress for a country that formerly had one of the highest under-5 mortality rates in the world (United Nations Inter-agency Group for Child Mortality Estimation, 2014).Since its inception in 1980 ...