The Importance of Communication in PEI / EPI By Shabnam Afzal Communication officer UNICEF

What is Communication The word communication is derived from a latin word “Communicare” means common, to give a share, to reveal to have some thing in common. The process of exchange of ideas, feelings, facts or information between two persons or more than two persons “It is the process in which you understand someone message and make him/her understand of yours”

SMCR Model Sender Message Channel Receiver FEED BACK

Verbal & non-verbal communication Verbal communication involves. Greetings Dialogue / information Counselling Non-verbal communication involves Posture and expressions Paying attention Showing patience Dressing with respect to local traditions

Channels of communication Print Media News papers / Magazines Letters Memos Billboards / Posters / flyer Electronic Media Radio TV Internet Telephone

Perception No person sees things exactly the same way as another. Each has a unique set of experiences , a unique perceptual filter, through which he or she compares and interprets messages., While communicating , receiver uses that filter to give meaning to or make sense out of the experience

What do you see?

PERCEPTION Do not assume that what you say or the Visual aids you use is fully understood by others, ask for feedback to ensure that your message is received as intended.

Group Exercise NOTE FOR FACILITATORS: Use the Facilitator’s guide for this Exercise 8 - “Perceptions” - The Young Woman / Old Woman picture

VISUAL CUES Draw a quadrangle. Within the right side inside the quadrangle draw an arrow half way extended upwards. Now draw a triangle beneath the quadrangle on the right side, just touching it. On left side draw a circle beneath the quadrangle not touching any .

We only see tip of an ice berg Behavior Experiences Values, believes, emotions Submissions

We Communicate better when we understand how people see How people see shape what they know What they know shape what they believe What they believe shape how they act

Attitude & Behavior Attitude The way you think The way you believe Collection of actions exhibited by human beings and influenced by: Culture – Attitude – Emotion – Authority - Genetics. Response ( Action or reaction ) of an individual / group to a stimuli

Target audiences Primary Directly involved with the woman/her child: Father Mother Grand father Grand mother Mother-in-law Husband Secondary Not directly involved but play important role in community/society Health care providers, LHWs TBAs Religious leaders Community leaders

Research on effectiveness related to behavior change shows that: Isolated communication actions focusing on behavior change at individual level usually are not sustained … Instead, a more effective approach includes: Many different types of communication activities at different levels, for a sufficient time and according to the needs of states/districts/communities

Orbits of Influence and Multiple Levels of Engagement or Support Policy/Regulations Institutions Community Family/household Individual Orbits of Influence and Multiple Levels of Engagement or Support

Behavior Change Communication An Interactive process with specific audiences / beneficiaries to develop tailored messages and approaches using a variety of communication channels for developing positive behaviors Providing information that people need in a wrapping that is acceptable to them

Social Mobilization Involves planned actions and processes to reach , influence and involve all relevant segments of society across all sectors from the national to the community level , in order to create an enabling environment and effect positive behavior and social change

Advocacy Mobilizing support of key individuals for your cause Advocacy is the act or process of supporting a cause or issue. We advocate a cause ore issue because we want to ; Build support for that cause or issue Influence others to support it Try to influence or change legislation that affects it

Research shows: Unvaccinated children tend to have uneducated mothers – which requires special attention and focus on health education with mothers 2/3 of mothers (rural/urban) confirmed LHWs have talked about vaccination and encouraged them to take children to health facility Parents of unvaccinated children have less exposure to media and rely more on face to face interaction and information sharing

Interpersonal Communication

IPC Interpersonal communication is the process of understanding b/w two or more persons. Advantages: Message can be tailored according to area. Feed back is possible. Questions can be ensured. Disadvantages: Human resources intensive. Takes time. Untrained communicators can give wrong messages.

Examples of Good Interpersonal Communication Skills ???

Good Communication Skills Verbal and non verbal communication (explain the difference and how both work!); “Active" listening in which the health worker or contact demonstrates to the parent/caregiver that they are heard and understood; Re-phrasing what the caregiver has said to make sure it is correctly understood; Use of open-ended questions. The questions require more than one word answers (examples of these?!); Non-threatening eye contact; Providing complete attention; and – Being polite, respectful and not showing a bad or uncaring attitude toward the child or the caregiver.

Other Basics Related to Enhanced Interpersonal Communication Skills Use simple clear language or local language as much as possible; Greet people upon meeting and be courteous; Dress appropriately and respect local culture; Look at the person when talking and showing both interest and concern. Answer those questions you know the answer to truthfully; refer to others those questions which you do not know – and don’t shy or insecure about this. Summarize to show that you have understood

PROBING QUESTIONS Are you Dr. Javed Iqbal? What is your name? Questions can’t be answered with a “yes” or “no” response. Are you Dr. Javed Iqbal? What is your name? Do you know how to prepare ORS? Can you tell me how ORS is prepared? Has your child been fully immunized? How many and at what site your child has been vaccinated?

NON-VERBAL COMMUNICATION GESTURE: Yawning. Frowning. Slouching in a chair. Looking at watch. Arms crossed. MESSAGE: I’m tired, bored. I don’t like you. I’m not interested. I want to leave. I’ve had enough.

The IPC Do’s Polio team members should: DO treat families, care-givers and community members with respect DO remain patient with parents and not get into arguments DO listen to reluctant parents’ concerns or questions DO answer any questions and address concerns with reason DO promise to bring to the attention of higher authorities any non-immunization health issues that they are concerned about

The IPC Don’ts Polio team members should never….. NEVER force parents into accepting OPV or any form of immunization NEVER be rude to parents because they are not informed or have misconceptions about immunization NEVER Attack a parent’s values NEVER Immunize without consent NEVER Joke that vaccine will make children sick or sterile

Addressing Concerns and Questions

IPC Vaccinators, Mobilizers all members of the polio team are health educators Must be equipped to answer the tough questions parents may have (consider approach and manner) Must be able to provide accurate information (and use support materials if needed)

Health Care providers interact with the community ….. Static EPI / fixed sites Out Reach services public places and Health ceners

Barriers to Immunization Two Types of Barriers Behavioral Non behavioral

Behavioral Barriers Lack of understanding of importance of immunization. Mothers don’t know about immunization schedule. Do not know about subsequent doses. Fears of side effects.. Husband doesn’t want mother to take child for immunization. Mother’s perception of unpleasant treatment at facility Refusal to have child immunized for religious beliefs. Do Not follow immunization schedule properly –

Non – Behavioral Barriers Families have limited access to immunization services Health facilities are far away Long waits at health facilities Staff absent Lack of vaccine/D. Syringes Inappropriate vaccination timings

Possible Actions Orient community leaders, encourage them to promote immunization Improve IPC skills of health workers Promote immunization in media Ensure health workers can explain to parents when to come for next immunization? Health workers can explain possible side effects and what to do? Develop child-to-child programmes – students can adopt families in community to ensure they know when to seek services

Possible Actions Provide training for health workers Ensure parents are aware of: Outreach services. Dates. Times. Location

Individual Exercise What are some common questions that parents ask (or you think they may ask) about OPV, the polio program, or routine and other health services? Write down these questions – and let’s see if others can answer (and how they would answer?!) …

Possible/Sample Questions Does OPV cause children to become sterile? Is the vaccine given only to Muslims or certain groups? Is an infant less than two months old too young to get the vaccine? Is it safe for a sick child to get the vaccine? Why do vaccinators come to deliver OPV when other health concerns are much greater? Why do vaccinators come so often, isn’t so much medicine harmful for the child?

Role Play Apply good communication skills Parent questions the harmful side effects of the vaccine and is concerned that the child might die if they take the vaccine. / Religious concerns What information shall be given to the mother when she comes to vaccinate her child

Group Role Plays Role Play Scenarios: Group A: Parent says the child has already been immunized through routine immunization and therefore doesn’t need to be immunized again. Group B: Parent says that her child has a fever, doesn’t want her child immunized. Group C: Parent questions the harmful side effects of the vaccine and is concerned that the child might die if they take the vaccine. Group D: Parent uses some “hidden resistance” – the vaccinator has seen a young child, but the parent either says the child has already been immunized in this round, that the child is older than five years old, that there is no child in the house, or that the child in the house is a neighbor’s child.

Advocacy: To create visibility for the National Emergency Action Plan and national ownership about the threat of Polio in Pakistan and what is required to eradicate it Social Mobilization and IPC: Intensify efforts in highest risk UC’s, with 300+ new communication staff in UC’s and Districts by year end Reaching High Risk Groups: Strengthen data collection to be able to better identify high risk groups and reach them with appropriate communication strategies Data Collection Tools: Revise existing tools and add new tools rapidly guide communication strategy and action in the field we must advocate for national ownership of the real and present threat of polio in Pakistan and what everyone needs to do to eradicate it. To this end, visibility for the President’s Plan and the key polio messages will be expanded through various channels of mass media and more targeted engagement with the media at Federal and Provincial level Social mobilization will shift from the current strategy of District level mobilization, and will be taken down to the UC level. 300+ new communication staff will be placed in highest risk UC’s and districts by year end. High risk groups will be more clearly identified together with WHO, through strengthened data collection and analysis, and specific communication strategies will be developed for these groups at UC level Data collection will be expanded to provide deeper analysis on communication issues like refusals, stronger monitoring to assess the impact of greater engagement at UC levels, and rapid assessments that can help revise strategies quickly in the field when situations change

Improved Service Delivery trateg Strategic Principles IEC and Social Mobilization Advocacy and Training Improved Service Delivery Improved Service Delivery Care Taker Participation Push Pull Ask for someone to explain or describe this slide and where our focus is in terms of communication work!!!! PUSH PULL Immunized Child Immunized Child

Positive Behavior It is important that the community feels and understands that their children health is their responsibility

Conclusion Only once barriers are analyzed, can effective action be planned to overcome these. Once barriers to immunization are overcome, more of the population should be demanding immunization. .

Thank You