Communication Indicators - Afghanistan 2008

This document was provided as background to the panel for the Afghanistan Communication Review for Southern and Eastern Afghanistan in Kabul.

The tables included in the document outline a series of indicators to be gathered and analysed as a regular aspect of polio communication programming and review. They are divided into epidemiological, process, and outcome indicators, as well as examples for presenting summative analysis. Training using these indicators has been provided, though the Communication Review process found that more training and support will be required to ensure they are used properly and consistently. Below is a brief description of how each of these can be used to strengthen communication planning, implementation, and monitoring:

Expanded Programme of Immunisation (EPI) Data:

Epidemiological data collected through campaign assessments, non-polio accute flacid paralysis (AFP) case investigations, and polio case profiles offer insight as to the social, cultural, and geographic issues relevant to the communication strategy and operations. The following indicators should be gathered and presented as part of the regular communication and Polio Eradication Initiative (PEI) operational assessment and planning.

Indicators:

• Number of missed children.
• Number of non-AFP case profiles indicating low or no-dose children.
• Analysis of polio case profiles to track for trends.
• Mapping of risk groups to plan targeted communication activities.

Process:

Process indicators provide information that allows programmes to monitor activities and outputs related to implementing strategies. The quality of an intervention can be described in its early stages by examining process indicators. Additionally, through the monitoring function, programmes can detect when activities begin to deviate from the intended strategy or when the activities, as described, are not feasible given field realities.

Indicators:

• Community mobiliser presence in the field.
• Community mobiliser retention from round to round.
• Percentage of personnel who were trained/present in the field.
• Percentage/number of high-risk areas (district/cluster/sub-cluster) with plans in place prior to the campaign.
• Percentage/number of district and cluster communication focal points who attend planning meetings.
• Percentage of poorly covered villages with maps and issues identified.

Outcome:

Communication objectives for PEI need to address common aspects of source credibility, knowledge, attitude, and behaviour. The use of communication outcome indicators allows a programme to better understand the communities with which it works, and to tailor communication activities to address any number of issues that might contribute to or hinder the objective of immunising children. Outcome indicators, such as knowledge of the campaign, can also be correlated with end behaviours, such as whether the child was immunised at the end of the supplemental immunisation activity (SIA).

Indicators:

• Source of information.
• Knowledge of campaign.
• Attitude about oral polio vaccine (OPV)/PEI.
• Behaviour with regard to PEI and routine immunisation.

Summative Analysis:

Summative analysis provides information that relates to how well the communication activities:

1. met the communication objectives, and
2. contributed to the overall campaign objective of immunising children.

Short-term immunisation rates should not be used to evaluate communication activities, as other opportunity barriers might have prevented access to health services, such as teams not arriving at households, limited access, or other factors. However, long-term immunisation measurements can be correlated with communication areas to demonstrate correlation of interventions with improvements in community acceptance or improved health-seeking behaviours.

Indicators:

• Immunity gaps in community mobilisation (CM) districts versus non-CM districts.
• Refusal rates in CM districts versus non-CM districts.
• Percentage of refusals vaccinated after CM intervention.
• Percentage of missed children in high-risk (HR) areas where special activities are in place over time.
• Cross-tabulate the indicators above from process/communication outcomes by immunised/non-immunised children.

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