Motivating parents / by Mohammad Ilyas Burney and Faiyaz Ahmed Lari

Motivating parents In some parts · of the Pakistan countryside, parents had tq be convinced that the injected vaccines were not some secret form of family planning which might make the women infertile by Mohammad llyas Burney and Faiyaz Ahmed Lari WoRLD HEALTH, Jan ./Feb. 1987 "Every child asks : Will you give me love, protection and immunization." With these words a bright- ly coloured poster issued by one of Pakistan's provin- cial departments of health seeks unashamedly to stir the feelings and sentiments of every parent. In effect the poster is saying: normal parental affection is not enough; it must be channelled into positive action that will support and sustain the child's life and well-being. Provincial health administrations and the federal authorities through- out Pakistan have encouraged post- ers, newspaper messages, radio and television announcements to propa- gate and publicise the immuniz- ation of children against six pre- ventable diseases of childhood. The government launched its Ex- panded Programme on Immuniz- ation (EPI) in 1979, coinciding with the International Year of the Child. The plan then was to protect 60 per cent of the nation's children aged under five by 1983 and 100 · per cent by 1987, and at the same time to consolidate and continue im- munizing new-born babies and preg- nant women. The result should be a 90 per cent reduction in the numbers of cases and deaths from the six diseases by 1990. In the event, the anticipated an- nual coverage was not achieved, and the progress made was mostly among the populations of cities and towns. So in January 1983 the gov- ernment launched a three-year Ac- celerated Health Programme (AHP) aimed at intensifying immunization of young children against the six target diseases. The objectives were quite specific: to protect nearly 15 million children aged up to five years and about seven million preg- nant women. The long-term targets were to reduce the numbers of cases and deaths by 90 per cent before 1990, and the anticipated benefits were to avoid seven mil- lion cases and 677,000 deaths. Two other components of AHP were the prevention of deaths from Feeding time in the queue for vacci- nations. Pakistan 's accelerated health programme puts great emphasis on motivating the community and, through the community-the parents. Photo W HO/P. Pa l mer 19 Motivating parents diarrhoea! diseases by using oral rehydration therapy (ORT) and community health education to alert the widest possible spectrum of the public to the value of EPI and ORT. Nevertheless, immunization re- mains the most important part of the programme, and accounts for 80 per cent of the US $42 million allocated-a tenfold increase on previous spending on EPI. The gov- ernment made facilities available to ensure better communications and to boost public motivation and community participation in the pro- gramme. A joint review team comprising 24 national representatives and 16 people from international bodies assessed the early progress and con- cluded that " on the basis of this review, we believe that the achievement of AHP in less than two years is remarkable." The team observed that "immunization coverage has risen rapidly, particu- larly in Punjab, where 80 per cent of the children are fully im- munized . . . The achievement in the North-west Frontier province is nearly as great and in other pro- vinces is also commendable." The improvements in the im- munization coverage were not uni- form throughout the country, nor were they permanent. After the campaign, most of the temporary employees could not be retained. As a result coverage declined, al- though not to the level existing before the campaign. Alerted by this decline, health authorities have taken action and are again increas- ing the health staff. While the logistics of vaccine and other supplies, competent man- power and managerial skills are all important, the community is re- garded as the most important ele- ment. The success of AHP depends on how the community is ap- proached and motivated, and how the community accepts and re- sponds to the programme. All the avenues of mass media are being harnessed, while visiting health teams made door-to-door house-calls and local religious lead- ers, teachers and village chiefs all cooperated in securing the max- imum possible public cooperation for the campaign. And through the community, the message reaches the parents. 20 In some parts of the countryside, parents had to be convinced that the injected vaccines were not some secret form of family planning, which would make women infertile and render the children sterile. Quite often the team manager would himself receive a shot of tetanus toxoid or take the oral polio vaccine to show that it was harm- less to health. One village refused vaccination because they were convinced that the pir-the local wise man with reputed spiritual powers-had drawn a barrier round the place so that no diseases could penetrate. When the EPI director went. along What's all this about needles? Tension in the waiting-room during an immuni- zation session. Photo WHO/C. Stauffer to visit the village, it happened that the pir was away from the village and some cases of measles had occurred. This made it much easier to convince the people to accept immunization. Since the myth of his "spiritual barrier" was broken, it was possible to immunize all the village children. There was strong resistance in another locality too. The deputy commissioner-head of the district administration-went along to add weight to the argument. Finally the local tribal chief agreed to have the youngsters immunized provided the deputy commissioner would de- clare on oath on the Holy Book (the Koran) that the same vaccines had been administered to his children as well. The official first checked that his children had indeed had all their "shots " and then was able to de- clare on oath that vaccines were good for children's health. The Accelerated Health Pro- gramme has given a new dimension to health education and motivation of communities. The national tele- vision network put out a pro- gramme called "Panic approach". This frankly dramatised the alarm- ing plight of non-immunized chil- dren who had breathing problems from diphtheria, suffered acute con- vulsions from tetanus, skin erup- tions from measles, emaciation from childhood tuberculosis, the acute spasms of whooping cough and the neuro-paralytic complica- tions of polio. One health centre in the capital city, Karachi, wa:s accustomed to having an average of ten people a day seeking vaccination. On the day after the television broadcast, nearly 3 ,000 mothers gathered at the centre with their babies and small children. There was a big management problem. Six immu- nization teams had to be formed on the spot, and all the children got their protection by late that same evening. Eight different films on the "Panic approach" theme were screened over the national TV network during the next six months. The next phase sought to attune viewers to the rewards of having a healthy baby. Besides 14 different films with this theme, television ran a popular puppet show under the title "Uncle Sarjam" aimed at child viewers, which conveyed simple health messages by way of satirical sketches and jokes. Parents too be- came interested. Today a network of 17 radio stations conveys the slogan of EPI and related messages throughout Pakistan in the languages of the people. Each carries at least five slogans or short announcements every day as well as a seven-minute talk about health every week. EPI centres have started up in hospitals, dispensaries, rural health centres, maternal and child health centres, or through outreach and mobile teams. The latter enable even very remote communities in sparsely populated areas such as Baluchistan to have the benefits of vaccination. And again local lead- ers, schoolteachers and religious chiefs play an important role in motivating parents to come forward and have their children protected for a lifetime. • W oRLD HEALTH , Jan./Feb. 1987