Artikel Ilmu Komunikasi

BRAC assisted the government in five major supply-and-de-mand aspect of the programme.according to Abed et al.these were :

1. assistance creating demand : BRAC health workers visited each household .educating mothers and fathers on the six deadly diseases and telling them to get their children immunized when the government health workers reach their village .they also organized public meetings in each village before immunization day in order to increase awareness of and demand for vaccinations.
2. assistance in planning and advocacy : before immunization started in a sub-district.advocacy and planning exercises were organized with government officials and local elites .BRAC workers facilitated by helping the local Epi staf in organizing these meeting and making decisions regarding the role of various persons
3. assintace in training : BRAC provided training to mid-level and lower-level government staff on social mobilitazion and management aspects of ept.BRAC also selected and trained local volunteers to work for ept.
4. assintance in policy formulation : BRAC was represented at the national steering committee on ept,headed by the health secretary.with inputs and feedback provided to this committee,BRAC assisted the government in formulating and modifying policies .also was representatedat sub-district-level coordination committees and participated at the weekly communication sub-committee meetings.in Dhaka
5. assistancein research and monitoring : undertook research and evaluation activies .through process documentation it regulary made observational studies on various aspect of the programme.the research and evaluation division conducted independent coverage surveys .moreover depth study on the perception the profile volunteers.result from such studies were fed back headquarters for incorporation in programme plants.


In total .assisted the government in 147 out of 460 subdistricts of Bangladesh .the value of involvement became most apparent in February 1991.when the result of the national coverage evaluation survey were announced.the result reflected directly the support and similar support from rangpur-dinajpur rural services in the very north of rajshani.where was achieved.demonstrating how ngos and government can happily collaborate in universal social programmes.

It is interesting that nearly 75 percent of mothers were also aware of the number of injections.such a high degree of knowledge and awareness was the consequence of intensive field visits person-person contact and communication.as well as close supervision effected by the programme.training has been immensely useful in enhancing the completencies of the field personnel.nearly three fourths of all the procedures taught were correctly applied at the vaccination sites.more strikng was that the involvement of the community in palnning and reaching out fpr cliens.contributed to an anhanced coverage and a decrease in drop-uots.

National immunization weeks


In 1990.it was decided that there was definitely a need to concentrate social mobilization efforts for a final drive towards the goal.since it is difficlt to maintain the energy needed for such activities over a long period of time,it was decided that three national immunization weeks would be held at the end of September .october and November .during these weeks there was an increase in social mobilization activities but no requested change in time.place or frequency of service delivery.throughout the country during these weeks.an enormous number of activities took place : review meetings,rallies,exhibitions,television and radio announcements and left outs.with special emphasis on measles vaccination coverage,which was far behind other antigens.
Coverage levels rose significantly during October to December 1990 in spite of the fact that the country was raked by political turmoil in the overthroe of a president the programme carried on,indicating that the process of social mobilization had taken it much beyond a normal government pragramme to wide-scale societal owner ship.

the iringa region in Southern Tanzania has a population of approximately 1.200.000 the majority being smallholders in 620 villages. 168 of which were included in the original programme. the number of underweight children declined from 50 percent in 1984 to 37 percent in 1988 and 35 percent in 1990. Severe malnutrition declined from 6 percent in 1984 to 2 percent in 1988 and 1,4 percent in 1990. what brought about this sharp improvement in the nutrition status of children?
the iringa project was supported and initiated by WHO and UNICEF. However, these agencies did not produce a “blueprint”for the project in New York, Geneva or dar-es-Salaam. Instead the strategy involved people from the national to the village level who reviewed the causes of malnutrition in a cyclical process of assessment, Analysist and action. They discussed the reasons for high mortality rates in a conceptual framework which included:
1. basic causes such as the availability of resources and the political/economic structure.
2. Underlying causes such as household food security, child care practices and the state of health services and
3. immediate causes, the interrelationship between malnutrition and disease.
the process involved a great deal of advocacy and awareness creation at all levels, including village campaign, mass media such as newsletters and films, training programmes and the involvement of cultural and youth groups. A number of mobilizing agents were identified including important allies in the Party and Government, local government, village committees and village health workers. It also involved extensive monitoring systems, the most important being the weighing of children and use or growth cards by the village themselves. Finally, the programme included the strengthening of critical services such as immunization, diarrhea and malaria control, and the care and feeding of children.
It is evident forum the above that this programme through its extensive process of analysis and social mobilization, went much beyond what world normally be understood as a nutrition programme. It is an important achievement for accelerating overall development in Tanzania.
To a large extent, social mobilization for EPI and other programme has begun such a transformation in the health a nutrition sector iin many countries around the world. Of cour programme must be strengthened and sustained. Where Epi has been built on the existing health care system such as Bangladesh the task will be easier. Where a parallel delivered system has been built, systematic integration is probably necessary for long-term sustainability. Much more effort will be need to achieves this. In many countries, however, social mobilization for health and nutrition goals has set the stage for achieving the goals of other programmes such as environmental sanitation are based education.
on the other hand, in the push for acceleration in Bangladesh and other countries, some important lessons of social marketing experiences were missed. The most important channel of communication the health worker, was not identified and through strengthened soon enough. The early and methodical application of some social marketing research method would have helped to avoid this problem. Social mobilization, therefore, just like social marketing, does not represent a complete model for development communication. The science side of communication is sometimes missed in the efforts to decentralize control and push for programme acceleration. It is worthwhile exploring further the model of communication given on page 137 which includes all there element: advocacy, social mobilization, and programme communication. the latter should include the planning and research activities of social marketing. the possibilities concerning this model are further explored in the next and final chapter of this book.

The project, carried out by the Government to Tamilnadu, covered 40 percent of the State’s rural population and involved 9.000 Community Nutrition Centre stafled by one Community Nutrition Worker (CNW) each. They were supervised by 900 Community Nutrition supervisors (CNS) and all were trained by 173 Community Nutrition Instructresses (CNI) at the Block (district) level. The target group was children, age 6 months to 3 years, a post-exclusive breastfeeding age group that is not otherwise enrolled in the State’s child feeding programmes. The main components included :
1) monthly weighing and growth charting
2) short-term supplementary feeding for the malnourished
3) Intensive counseling
4) Deworming and closes of vitamin A
5) provision of iron folic acid tablets to all pregnant women and
6) education on home-based management of diarrhoea
Babies whose growth was faltering were given a supplement but as soon as they reached normal growth levels the supplements was taken away. In spite of what might be regarded as a disincentive for progress, an independent evaluation revealed a decline in children enrolled in supplementary feeding from 40 to 25 percent during the project period and a 55.5 percent reduction in severe malnutrition during the first 72 months, 24 percent over the next 38 months, 35 percent over the following 38 months.
Communication materials produced to support worker-client interaction were not well used. the supplementary feeding provided a drawing card for reaching the malnourished in the community and a procces of intensive contact and counseling followed, supported by mother’s and children’s clubs.
The lessons learned on the training side were:
1. Selection on WNWs from the community with a criteria that they be good communicators.
2. Intensive training of well-educated CNIs who then developed and continually adjusted their own training syllabi for the local need of CNSs and CNWs
3. Training carried out at block headquarters (non-residential and similar in setting to nutrition centres)
4. Follow-up supervision by those involved in training
5. Great emphasis placed on interpersonal communication skills of CNWs during training and follow-up supervision by CNSs
6. Only 10 CNWs to each Cns, allowing for intensive supervision and monitoring.
another successful nutrition programme is the Iringa Nutrition Programme in Tanzania (see panel on page 142). although the contribution of malnutrition to child mortality was the starting point, this programme benefited from a very thorough process of problem identification with the involvement of villagers, district and national-level officials. As the programme evolved a broad-based process of social mobilization took place, leading to a large number of the development activities with the participation of local people. The iringa Nutrition Programme is perhaps one of the best examples where villages-level communities have become involved in social mobilization process through full participation in programme analysis. In setting and adjusting programme goals and strategies and in programme implementation. in fact, the best elements of the Iringa Nutrition Programme have been replicated in other areas of Tanzania, covering an area three times the size of the original programme at less than half the cost per child.
The Iringa experiences has become the back-bone of Tanzania’s child survival and development programme. However, it remains to be seen if a programme such as this, which involves a high degree of long-term participatory analysis and action, can be widely replicated in other areas of Africa and the developing world with which do not have the social structures of Tanzania, a country with 25 years of experiences in grass-roots socialism. in the final chapter the Iringa approach is discussed in more detail in the context of conclusions I have arrived in my thinking about social mobilization and community participation.
conclusion
it has been said that, social mobilization brings about the – internalization of programme objectives by the people, thus ensuring the creation of consumer demand, availability of human, material and financial resources, and multisectoral inputs. When all social group aspire to the attainment of a nation objective which transcends political barriers, means are found solution are developed and innovations become commonplace.

The experiences in social marketing breastfeeding practices in Brazil provides another salient example with lessons for communicators. A number of studies revealed the sharp erosion of breastfeeding practices and high death rates after weaning in children between the ages one to five month. the programme, launched in 1981, targeted a broad spectrum besides mothers: Doctors, Health service, Hospital, the Infant food industry, employers, decision-makers and local communities. The main components of the programme were:
1. Education and motivational campaigns
2. Modification of maternity hospital systems
3. Provision of facilities for pregnant and lactating mothers in the community and workplace
4. fostering appropriate legislation for manufacturers of breast-milk substitutes and
5. information/education on maternal nutrition and weaning practices.
in 1985, a mass media campaigns was launched, involving nearly 100 television stations, 600 radio stations, press ads, messages on lottery tickets, utility bills and bank statements all over the country. It also involved 1,5 million booklets for mother, flipcharts for health workers, manuals for community leaders, pamphlets and bulleting for doctors, slide-sound sets and a top-quality advocacy film.
However, perhaps the most salient lesson to be learned from the experiences was the alliances estabilished to support the programme. in all, five ministries and three professional medical and nutrition groups were involved in a National Working Group which formulated plans and stimulated action at the national and state level among their employees, members, and associated institutions. At the community level mothers’ groups were formed and breastfeeding was promoted through extension workers, university students, the church and other voluntary groups.
An evaluation of the programme in 1990 revealed an important increase in the median duration of breastfeeding in Greater Sao Paulo from 84 to 146 days between 1981 and 1987. It also revealed reduction in infant mortality due to diarrhea, respiratory infection and other infections of 32 percent, 22 percent, and 17 percent, respectively.

However, immunization is not the only programme for which people can be mobilized. I have sumamarized, below, other causes and means of mobilization which have supported the goals of child survival and development and which complement Epi. Making it easier to achieve UCI. In number of countries, experience with the promotion of breastfeeding practice has proven quite successful. for instance, in Brazil in addition to a very well-designed social marketing programme, all feasible and practical allies came on-board, resulting in a quantified decline in child morbidity and mortality (see panel on page 139).
in the southern Indian state of Tamilnadu, the social welfare department has mobilized villager through the delivery of community-based nutrition programme. in the Tamilnadu integrated nutrition project, village women have been identified and trained as community nutrition workers, based it villages nutrition centres (see panel on page 140). They are paid and honorarium not a full salary. Not only has the programme had an impressive impact on the nutritional status of children in the programme areas, the community nutrition centres now act as the focal point for the health system in every village, a place where health workers can efficiently deliver immunization and other service to mother and children.
Although the Tamilnadu Integrated Nutrition Project, like Epi, was designed outside of the communities it intended to service, it was sufficiently decentralized in its implementation so as to give ownership to district and lower-level personnel. this is an essential ingredient for sustainable social mobilization. Even though there may be apparent efficiencies in allowing people the district level to take different approaches to training or to develop alternative communication materials, the freedom to incorporate such variations may be the key to motivating people and sustaining programmes.

Vaccinators were given training in social mobilization and flip charts and flash cards were created to support their discussion with beneficiaries. This kind of communication is crucial in getting people to return to complete the full course of vaccination. However, a national, qualitative Needs Assessment Study carried out in 1991 revealed that training was much too general in nature. On-site observations revealed that not more than a quarter of workers actually counseled mothers about side-effects or told them when to return. It was also found that at 40 percent of urban sites and 9 percent of rural sites observed, workers gave incorrect information on programmatic matters such as the tetanus toxoid schedule, appropriate age for vaccinations and the number of visits needed. At these sites, less than 10 percent were observed to use flip charts and flash card in their talks with caretakers. Less than 19 percent of those who counselled mothers ensured that the mother had understood the massages given.
During household visits there was little rapport-building with mothers and vaccinators almost never examined the vaccination sears. Few gave information on the need for immunization, when they would return or what the mother should do if there were problems following vaccination. There were also differences in how workers dealt with poorer mother, acting rushed ot rude not giving information unless asked and often not answering questions at all. Workers were also noted to break the serial sequence of mothers waiting at vaccination sites so they could serve friends and richer clients.
Focus group research and in-dEpih interviews with mothers of unvaccinated children also revealed that lack of information was the main reason for their failure to participate. In addition, some people were turned away for reasons which should not have prevented vaccination such as mild illness of the child, missing vaccination cards, switching outreach sites, the percEpiion that children were too old to vaccinate or the fact that the vaccinator had filled his/her quota and refused to do more. This indicates that some of the workers are not clear about a number of technical aspects of the programme and refresher training is needed.
One key finding was that Epi is not yet reaching a large percentage of poorer families. Of the mothers coming to Epi sites, a disproportionate number had only one or two children. Whereas approximately 40 percent of currently married woman have one or two children, during the study period 64 percent of clients attending urban center and 54 percent attending rural sites had one to two children. This indicates that a good deal of motivational works is needed to bring in these left-outs, a large percentage of whom are form the poorest sector, with larger numbers of children.
The exhaustive 1991 Needs Assessment Study is now being fed in to programme planning for management, monitoring, and surveillance, logistics, training and communication for the remainder of the 1990s. A massive retraining programme is required, with emphasis on motivating caretakers through interpersonal communication and counseling. Without such as strategy it is difficult to see how other health services can be effectively added to the health workers agenda at Epi outreach sites.
Conclusion
In spite of these constraints, the Needs Assessment Study revealed that health and family planning workers had been motivated by their participation in the programme. They feel upon. In some countries this is called “Epi-Plus”, a goal-oriented approach to achieving integrated health care.

It is evident from the above that the Epi communication strategy in Bangladesh took quite a departure from what is usually understood as social marketing. The striking difference was the wide range of partners who became fully involved in the programme through communication and motivational activities. The process did not merely consist of planned mass media and field-based communications. Some of the activities were quit opportunistic. The social mobilization model is more concerned with action than control. It is assumed that unless and until there is very wide-scale ownership in a programme thrust. There will be little chance of wide-scale adoption. However, this is not to say that all of the activities were ad hoc. The creation and dissemination of the moni logo, previously described, was part of a planned and researched social marketing strategy. There are also many other examples as illustrated in the box on page 131.
Research revealed that in urban areas, were living patterns and therefore interpersonal communication channels are very different from rural areas, people were simply not getting information on the place and time of immunization sessions. Further research revealed that public address systems carried by rickshaws are an effective method of getting this information to potential beneficiaries.
An attempt was made to use Muslim religious leaders (imams) as a channel for communicating Epi and other child survival and development massages. Thousands of imam information packages, including supportive Koranic messages, were printed and distributed throughout the country with help from the Islamic Foundation and Worldview International Foundation. However, research revealed that there were many bottle-necks in the distribution system, the information package was too general in nature to be of much help in the Epi programme and comparatively few imams received a proper orientation on use of the information.

Ept Programme Communication

•Moni logo development and wide dissemination
•TV/radio spots for awareness/demand creation and specific programme information
•Interpersonal communication by vaccinators backed by flip-charts and flash-cards. Ept bookmarks for students
•Site markers and flags for outreach sites and fixed centres
•Miking : Announcements of place and time of immunization via public address systems on rickshaws, Other vehicles, Mosque, Etc.
•Imam information packet and orientations on, Ept
•Village theater, folk poets
•Posters and rickshaw plates

It was also determined that imams wanted full training as para-medical service people and looked forward to monetary compensation for their services. They also wanted acces to medicines. These factors proved problematic for their direct involvement in the programme. It was decide that it would be best to concentrate imams’ efforts on other programmes such as the drive for increased sanitation coverage and the use for Islamic schools in primary education.
The most popular communication form in Bangladesh remains poetry and theatre. Village theatre on the immunization theme was organized throughout the country and broadcast on television. An assessment of the programme showed that people readily gained information from this communication from. However, there is little knowledge of the effect of these channels on behavior change.
Posters and signs bearing Epi messages were produced, field-tested and disseminated to sub-district and lower-level health facilities and outreach sites. However, feedback revealed that there was an over-reliance on such printed material, there were problems in distribution channels and often posters were not used in an effective manner.
However, results of basic communication questions on the 1991 coverage evaluation survey provide new insight into needed future directions (see pages 133 and 134). It is evident from these results that, although television has some impact in urban areas, the most important sources of information and persuasion remain interpersonal. A number of studies have revealed that television is most important for reaching middle and upper-middle class people in urban areas with Epi message, people who may be trend-setters or may have influence on national policy. There is some reach of television into urban slums and fringe areas but the extent of this remains in the 20 to 30 percent range.
Radio reaches more people than television with Epi messages in rural areas but good data is not available. Radio appears to have about the same importance as television in urban slums. Likewise, drama and song appear to be the most popular radio format. However, even if radio has a better reach, there is anecdotal evidence that it is less attended to than television and therefore has less programme impact.

Many youth and service clubs contributed extensively to the programme. For instance, the Boy Scouts, whose leader was a senior secretary in the government, inaugurated their own immunization badge. The Girl Guides arranged to have their headquarters used as an immunization site. Rotary International joined hands With UNICEF and the World Health Organization in 1984. Providing all of the polio vaccines needed to immunize the children of Bangladesh through its Polio Plus programme. There are 72 Rotary Clubs in Bangladesh with a total membership of the moni logo at the head of a parade of school children.

2000 representing various profession as well as the commercial for, A Bangladesh Polio Plus national Immunization Committee was formed and both members rotary and Rotaract, the youth wing contributed to service delivery, educational seminar. Rallies walkathons, parades and other awareness-creation and mobilization actives materialized.
The national Anti Tuberculosis Association of Bangladesh an new was contracted to print and place monition plates on the back of rickshaws all over the country to put stickers and posters on ferries. Bused and trains and to distribute Epi slides to many cinema halls. The Voluntary Health Services Society an umbrella group for smaller national NGOS played a major role in publishing Tika-Dak the official newsletter of the programme, and Tika-Barta the statistical bulletin. They also held rallies and fora to promote Epi and trained NGOS in how to carry out Epi activities.
In addition to the above allies, many NGO operational partners joined the Epi programme: Worldview International Foundation. World Vision Radda Barnen and a host of other agencies, large and small. Strengthened the immunization programme throughout the country, providing training for vaccinators, managers and communicators: providing immunization services in areas where Government services cannot easily reach providing many of the communication materials and actives which supported programme expansion: and mobilizing local talent and resources. It is doubtful that the immunization programme could have achieved its rapid rise in coverage without the strong support of both large and small NGOS throughout Bangladesh. Although some of the activities involved contracts, many more happened because people wanted to join with the programme and integrate it with their own. This was quite surprising for traditionally. NGOS are quite competitive in Bangladesh and often do not see eye-to-eye with Government. Even more surprising is the fact that they remained involved through the difficult period that last three months of 1990, when the President was being overthrown by a popular uprising. This is because the process of advocacy and social mobilization had taken immunization beyond the political sphere to the point where it had come to belong to the people as a whole.

Collaboration between different ministries and departments is sometimes hard to achieve. In Bangladesh, the Ministry of Health and Family Welfare asked its female family planning field staff to assist predominantly male health assistants with vaccinations. The involvement of the former was seen as essential for reaching women and children. The Ministry also had to collaborate in a service-delivery programmed with the Ministry of Local Government which is responsible for immunization in over 80 urban centres.
In order to facilitate the process, UNICEF identified allies in the administration who advocated for such cooperation. The Cabinet Secretary, the highest level eivil servant, became an excellent advocate for the programmer. The Cabinet Division of the President’s Secretariat issued several instructions to Deputy Commissioners to get directly involved in monitoring implementation committees. Deputy Commissioners were asked to ensure coordination among social sector agencies of Government and NGOS for proper implementation of the programme. Municipal officials also become involved through directives from the centre. However, as the programme matured and became more institutionalized, more and more initiative was taken at the local level.
The awareness created throughout the civil service ranks led other ministries to get involved, such as the Ministry of Education which launched a project involving primary schools in Epi social mobilization at the community level: activities for the yearly “Education Fortnight” and the incorporation of Epi in the regular essentially a children’s programme. It was considered a logical step to involve school children who are often the most educated members of Bangladesh families. They were asked to pass the immunization message on to their parents.
The Ministry of Religious Affairs participated in sending 150.000 packets to Imams and religious leaders all over the country, requesting support for immunization activities. In 1990 the symbolizing the millions of immunization which must continue if Uci is going to be sustained. It also donated commercial space in rallway stations.
Inter-ministerial and inter-agency cooperation was extended event further. The ministry of Education held school rallies across the country. The ministry of social welfare and women’s affairs instructed their staff to get involved in Epi social mobilization activities through their vast network in villages.

In Bangladesh, through the negotiating skill of UNICEF staff various corporate partners come forward to associate themselves with what they considered a popular social movement. Their realized that if their products could be linked with Epi, their companies image would benefit. The first to come on-board was Dhaka. Match industries, partly owned by Swedish Match Company. Dhaka Match put the moni logo on the back of their “Seven Horses” brand which. at the most remote parts of the country.
The match-box created a wave of enthusiasm and many business house came forward. Bata Shoes Company donated space on their signs and shoes boxes. Fisons Bangladesh Ltd. Provided support in the form of counter displays and posters to 20.000 pharmacies which carried their products. Bangladesh Auto cars painted the Epi. logo on the body work of their public transport and Spark Ltd. displayed it on their cartons and boxes billboards. General Electric printed it on their cartons and boxes and Lever Brother produced a poster, free of charge, for their sales outlets. Dhaka University’s Institute Of Business Administration included corporate mobilization in its curriculum, a recognition of the efforts generated by Epi.

Partnership developed in one sector often lead to alliances in another. For example the editor of an entertainment weekly Ananda Bichitra played a major role in organizing a support group of entertainment stars who donate their time and images to assist the cause of children. Called “We Are For Children” its members posed for posters, addressed rallies, toured outlying areas, appeared in television spots and gave press interviews to support Epi. By publicly endorsing Epi they became highly-visible advocators for the programme. Community theatre groups also mounted plays in different parts of Bangladesh, supporting immunization and linking it with other social issues. Well-known theatre stars acted in these plays giving Epi high visibility and immediate recognition.
Star value was added in other ways too. In a country crazy about football, the captains of the two main rival teams posed for posters and acted in television spots, saying that while there is a rivalry in the field there is unity when it comes to children’s immunization. “Star” attraction peaked in 1989 when UNICEF Special Representative for Spots, International cricket Star Imran Khan, visited Bangladesh to promote Epi. Over 250 arcticles appeared in various Newspapers. He made the nightly news on both national radio and TV with commentary ranging from cricket. His material plans and of course Epi and children. He run a number of cricket sessions with young players and talked to huge crowds on the benefit of immunization.
The prestigious Dhaka Club not only hosted a fund-raising dinner in his honour, it also auctioned his bat and donated the proceeds to UNICEF. Rotarians, who were already partner on the programme through their PolioPlus Programme, gave a reception with the Vice President at host NGOs held a reception when Imran Khan addressed city volunteers for Epi, providing inspiration and recognition to the contribution made by the NGO sector.
UNICEF began to involved celebrities in raising awareness and funds for its programmes in 1945. Well-known entertainment personalities such as Danny Kaye, Sir Peter Ustinov, Liv Ullmann, Tetsuko Koroyanagi, Harry Belafonte, Sir Richard Attenborough, and Audrey Hepburn have travelled to many developing countries, often accompanied by local and international reporters and film and television crews. Besides Imran Khan, UNICEF has appointed other special representative such as Julio Iglesias, the Spanish singer; Youssou N’Dour, a popular musician from Senegal; and most recently, Roger Moore, and Sir Edmond Hillary, The presence of such personalities, on location and international attention on programme for children.
When Audrey Hepburn came to Bangladesh in October 1989 her highly profiled partly because her films are still popular amongst Bangladesh’s elite and partly because “We Are For Children” played host to her in Dhaka and made it into a star event. The largest single gathering of film stars in Bangladesh took place at the national film studio where she was received by Shabana, the top heroine of Bangladesh who had taken her tetanus shots on camera, appealing to all woman to do the same. Addressing Bangladesh’s largest ever gathering on United Nations Day, Audrey Hepburn created a sense of togetherness between the United Nations and the people of Bangladesh, symbolizing the joint effort to give the children of the world a better chance.
The visits of Imran Khan and Audrey Hepburn achieved a high level of advocacy, leading to Epi’s secure place on the Government’s agenda.

The support of the electronic media grew out of the links developed during the course of mobilizing the press. In November 1988, UNICEF commissioned a study by the Press Institute of Bangladesh on the feasibility of free commercial time on radio and television for child survival and development issues, with a special focus on Epi. The study entitled “Public Service Broadcasting: A Case for Bangladesh” was carried out by three well-known journalists, including, Shahidud Hug, the team leader and Editor of the Bangladesh Time, who also had served on the MacBride Commission on the New World Information Order, the conclusion of the study was that the cost of allotting free time would be greatly offset by the benefit s obtained in better service delivery in the health and welfare sector. In fact, the report became an advocacy tool which allowed UNICEF Executive Director, James P. Grant to successfully ask the Presiden of Bangladesh to grant three minutes of prime commercial time for children on radio and television every day.
Television spots on immunization became a common feature and in addition many regular programmes and documentaries were created on Epi by Government television and radio producers. They found time for Epi in programmes dealing with other issues such as family planning and the control of diarrhoeal diseases.

In 1987, when most of the service delivery was in place throughout the country, the Press Foundation of Asia, the Press Institute of Banglandesh and UNICEF launhed an introduction to EPI, creating a nationwide journalist network and encouraging an atmosphere of participation, learning and exchange. About the same time the DevPress project of the Association of the development Agencies in Banglandesh began to create a news netwok on EPI through the monthly distribution of press informations packets to the regional media. Soon a core group of supporters in the regional media were identified.
By 1990, EPI was no longer development news-filter. It became programme worth reporting on and debating. The press became a natural ally and a watch-dog. The initial poor coverage of EPI proved to be a positive factor in motivating the system to accelerate activities. Additional adrenalin was supplied by a revamped development features syndicate called Devfeatures, operated by the center for sustainable development. Building on accumulated experience, this organization created an active network of over 100 community and regional newspaper began to carry moni on their pages as part of their commitment.
These activities helped immensely in major national programme initiatives at the community level. At first they involved general advocacy on the goals of Epi and some of the technical issues involved as well as the need for community support. However as the programme evolved and the journalists understanding matured, event such as National Immunization Weeks were covered by the press and by radio and television news with little or no prodding by Government or UNICEF staff. Epi became one of the most intensively-covered health issues in the 40 dailies and 125 weeklies published in Bangladesh. This kind of general and somewhat uncontrolled advocacy by partners in the press was very important for sustaining a supportive environment in administrative and opinion-leadership cireles.

In 1985, the government of Banglandesh realized an Expanded Programme On Immunization (EPI) was needed to increase immunization coverage levels which had only reached two percent. It is decided that a revitalized plan of action was needed if UCI was to be achieved. New, service delivery was put onto place in a stage-by-stage manner over four years, beginning with eigth sundistricts and eventually all 460.
In may 1986, an EPI communication plan was finalized to support this expansion. This plan set out the major steps to be taken in accelerating demand for immunization by bringing together various social allies in a procces of social mobilization, a procces which facilitated one of the most successful social programmes in the history of Banglandesh.
In February 1991 and February 1992, two independent coverage evaluation surveys were carried out to determine the success of the programme. The result demonstrated that 62 and 65 percent of children of the target age group were fully immunized in 1990 and 1991, respectively as the demonstrated in the graph below. In addition. It was found that two out of four divisions of the country achieved Universal Child Immunization in 1991.
Achieving UCI in half the population of one of the most densely populated countries on earth represented a remarkable achievement for Banglandesh, a coutry which had never before broken the barrier of 33 percent coverage in social programmes. Achieving UCI is a starting point for the eradication or elimination of major diseases and for an overall improvement in material and child health and it is worthwhile reviewing what went into the social mobilization procces for EPI to determine what made the difference, how the programme can be sustained and what element can be applied to other programmes.
One of the first elements of the communication programme was the search for a symbol which people would recognize easlly. Since moni is aterm of endearment for children of both sexes, a character was drawn to suit the term. Six arrows, symbolizing the six immunizable diseases, and a ring symbolizing protection were added.
Moni became one of the most successful elements of EPI communication. In marketing terms it is a simple appealing and easily identifiable trade mark. Moni was placed just about every where to raise awareness and support demand creation.
The multiple uses of the moni logo were paralleled only by the multiple partners who came on-board to help create demand and implement the programme. Media in Banglandesh rapidly became an instrument for development during the period 1985-1990. Much of that development was a direct result of the activities involved in the EPI programme. Lets tis take a close look at how this happened.

The global programme launched by UNICEF and the world health Organization to immunize chilldren troughout the world is the greatest public health success story of the 1980s. By the and of the 1990, over 80 percent of under-one children had received immuniozation for five deadly diseases (tubercolosis, diphtheria, whooping cough, tetanus and polio) and 78 percent had received immuniozation against measles, probably the greatest killer of the children when combined with malnutrition, diarrhea and acute respiratory infection. It is estimated that, annually the programme is already saving 3,2 milion children from the premature death and 2 milion from the agonizing live of polio victim.
The Expanded Programme On Immunization (EPI) drew many lessons from the successful international campaign to eradicate smallpox. Althougt the concept of giving a protective inoculation of smallpox material was pradticed in China and West Africa for centuries, it was not until 1798 when Edward Jenner successfully experimented with a cowpox vaccine, that the seeds of widescale protection were planted. Smallpox did not discriminate community leaders were amongst the first to be vaccinated, a fact which helped accelerate its spread around the world within 10 years. However, massive vaccine production was not possible before 1842 and it was not until 1958. When the new ease of international travel brought with it the dengers of widespread infection, that a global vaccination and eradication programme was launched. The campaign involved massive immunization and surveillance and containment strategies supported by highly-developed logistics, information and communication system. In many area of the world, for the first time, the personnel and resources of government health structures were effectively energizeg and mobilized for a single goal within a giving time frame.
When the last ease of smallpos was reported and successfully isolated in Somalia. In October 1977, the success could not ignoreg. Many had claimed that the answer to solving the world’s helath problem was integrated health delivery and that vertical programmes, such as a drive to eradicate one disease, were discruptive ti this process. However, the fact speak for themselves. As late as 1967 it is estimated that there were 10 to 12 milio eases of smallpox in 33 countries, causing an estimated 2 milion deaths annually. By 1977, the scourge was erased from the face of the earth forever.
However, of the six deseases targeted by the global EPi programme, probably only polio can be totally eradicated of the other all but tetanus can be controlled by herd immunity the phenomenon of near-zero transmission rates which depend on coverage level of a least 80 percent. Otherwise know as Univesal Chilldren Immununization (UCI). Thefore, EPI had lesson to learn from the eradication of smallpox but could not take that experience as a total model to follow. Whereas smallpox vaccination is no longer necessary. At least 80 percent of newborns will have to be immunized each year for the foreseeable future. An important difference, therefore, is the need for sustained service delivery.
To many sustainability is equated with a fully-functioning, integrated, primary health care system supported an owned dy the community. However, when Epi began. The vaccines had been available for 20 years and still, two thirds of the world’s children had not been vaccinated. UnicevExecutive Director. James P.Grant. decided that taking the position “that universal immunization must await economic development and the coming of a permanent health clinic to every village is simply a sentence of unnecessary death and disability for many millions of today’s children and for even more millions of those who are still not born. There was, in other words a moral imperative to procced with an accelerated, vertical programme which could use many of the lessons of smallpox eradication but which would add another element, sustainability through social mobilization.
Through social mobilization, immunization breaks out of its “institutional and technical imprisonment” and “is debated by heads of state in international fora”. “is demanded by illiterate mothers and a wide spectrum of people” come to participate in its implementation. In social mobilization the concept of “the community” is expanded to include many social allies: heads of state and other political leaders, various ministries, district and local government authorities, community region leader, NGOs, service club, journalists, filmmakers, artists and enternainers to name the most common examples. In social mobilization in other words the procces take the programme beyong a vertical intervention directed by a single chain of command to horizontally spreading currents of energy which eventually cover most of a society. In this way a vertical programme becomes horizontal.
There are many experiences with social mobilization for EPI to draw upon. I will narrate the story of social mobilization in Banglandesh draw some conclusions and then synthesize some experiences with EPI anf other health and nutrition programmes in the final section of this chapter.

SOCIAL MOBILIZATION FOR CHILD SURVIVAL AND DEVELOPMENT

In chapter two and three, I concluded that social marketing efforts in health and family planning have only been able to complement other initiatives and that on closer analysis, some of the most successful experiences in social marketing have relied very much on interpersonal communication and motivational effort by community-based workers and volunteers. The participation of the local community is essential. However a missing element in these projects has been the participation of the larger community: the mobilization of various support groups and the organizations to ensure programme goals are understood and accepted widely. This is the essence of social mobilization. A concept which I have outlined in Chapter one and for which I repeat the definition here:
Social mobilization is the process of bringing together all feasible and practical later-sectoral social allies to raise people’s awareness of the demand for a particular development programme to assist in delivery of the resources and services and to strengthen community participation for sustainability and self-reliance.
To some, “mobilization” has s very military ring to it and may bring to mind forced literacy and family palnning campaigns, or the collectivization of Chinese, Tanzanian or Ethiopian villages. As outlined in chapter one, the origin of the concept is not clear. However, adding the “social” dimension to “mobilization” implies an element of choise and active partipation. The terms has not been derived from the pen of the development philosopher. Rather, it has been synthesized from various experiences in health population, nutrition, literacy, and enveiromental programmes.
Instcad of worrying more about derivationsand cefenitions, it would be more useful to discover how the concept has evolved in the context of the of largest and most successful health programmes of this century.