Polio is at the brink. The total number of global polio cases has decreased by 99% since 1988.
For UNICEF Polio Innovation Lead Asch Harwood and his colleagues, that isn’t good enough. Whereas the Global Polio Eradication Initiative (GPEI), of which UNICEF is a key partner, has been successful in eradicating the overwhelming majority of global polio cases, the final 1% has proven elusive. “We’ve reached a point where current methods are no longer working. We need to think outside the box.”
Polio flourishes in areas where awareness of and access to vaccination are scarce. These are communities in which literacy rates and income levels are low, and access to technology is limited. The average person in these communities might not be aware of vaccination services or might feel pressure from local leaders to avoid vaccination.
Today, polio circulates in Afghanistan and Pakistan. In Nigeria, the only other country where polio is endemic, the total number of polio cases is 6 as of 2015 though health authorities have not detected a new case of polio since 2014. Nevertheless, polio eradication can only be certified once the afflicted region demonstrates that transmission has been blocked for at least 3 consecutive years.
How can these people be reached, and what will enable that communication?
This is the prompt Asch Harwood and the polio communication team at UNICEF are attempting to answer. “It’s UNICEF’s job to make sure that people understand why vaccinations are important,” says Asch.
To reach the remaining 1% of cases, Asch and his colleagues are focusing their efforts on creating demand for the polio vaccine in those communities most at risk. In Afghanistan and Pakistan, this means working within potentially dangerous areas.
To reach these populations, polio communication teams engage in social mobilization, a communication for development (C4D) approach that seeks to change behavior by motivating a wide range of players to raise awareness of and demand for a particular development goal through dialogue.
Going into this project, Asch recognized the potential of mobile phones as a point of connection with people in communities most at risk for polio infection. After researching and testing various services that would allow him to build SMS and interactive voice response (IVR) applications to establish automated bidirectional communication at scale, Asch and the polio C4D team settled on RapidPro.
Asch points to user experience as the key factor that led the polio team to adopt RapidPro: “I’ve played with a lot of the other IVR tools, and you guys have definitely designed the best user experience I’ve seen so far.”
As an innovation lead, ease of use allows Asch to bring new ideas to life. “Probably the most powerful part of it is that because I was able to demonstrate it, I was able to get the buy-in necessary to help us start prototyping and piloting.”
The RapidPro platform allows Asch and his colleagues to build flowcharts or “Flows” that disseminate and collect actionable information geared toward improving vaccination awareness via a combination of SMS and interactive voice response (IVR). Asch chose to use IVR because the information he desires to disseminate exceeds the 160 character SMS format.
For example, registered social mobilizers in target communities might receive an automated phone call from UNICEF’s team announcing a survey aimed at better preparing them for their jobs. The automated voice recording will ask a question in Urdu — in this case, a quiz question about the symptoms of polio — and then ask the user to press the number that corresponds with their response. If the user answers correctly, the Flow will provide additional information before moving to the next question. If the user answers incorrectly, the Flow will respond with the correct answer and provide an explanation before moving forward.
The goal is to equip registered social mobilizers with the information they need to affect harmful discourse and raise the awareness necessary to increase the rate of vaccination within their communities.
The polio unit’s RapidPro deployment integrates with Twilio’s Global Reach to make international calls. The success rate of these calls is cause for optimism: In an analysis of 7,000 calls made through Twilio connections to social mobilizers all over Pakistan, it was found that only 7% failed to connect. This indicates that mobile network coverage in Pakistan is extensive.
The project currently reaches upwards of 2,500 social mobilizers within Afghanistan and Pakistan. In the coming weeks, UNICEF plans to increase that number to 7,000, focusing on females in high-risk areas. Asch and his colleagues expect IVR to be particularly powerful in low-literacy settlements.
Next, Asch will be in Nigeria working closely with the Nigeria polio communications team to begin prototyping RapidPro applications with social mobilizers in that country.
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