CORE Group: Working Together in Health for Mothers, Children and Communities

Dr. Filimona Bisrat, Secretariat Director

Consortium of Christian Relief and Development Association (CCRDA), Secretariat Host Organization

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See how CGPP Ethiopia celebrated World Polio Day 2017.

The CORE Group Polio Project (CGPP) began in Ethiopia in November 2001 and has addressed a variety of challenges by reaching hard-to-reach communities with vaccination services and surveillance. As a country at high risk for importation from neighboring conflict-affected Somalia and South Sudan, Ethiopia continues to maintain high immunization rates and excellent surveillance. The country has been free of wild polio virus since January 2014.

CGPP has focused on reaching underserved rural, pastoralist and semi-pastoralist areas to facilitate opportunities to vaccinate and for case search and reporting to maintain acute flaccid paralysis (AFP) surveillance quality. CGPP-Ethiopia has trained and placed about 12,000 community volunteers and health workers along the vulnerable borders of South Sudan, Kenya and Somalia.

CGPP-Ethiopia presently collaborates with six international NGOs (CARE Ethiopia, Catholic Relief Services, Save the Children, World Vision Ethiopia, International Rescue Committee and African Medical Research Foundation) and five local NGOs. These partners are implementing activities in 85 woredas (districts) of five regions in the country – reaching a total of 2,585,648 children under 15 years annually.

Survey results from 2015 revealed that knowledge among mothers and caretakers about polio is high at 95.1 percent but knowledge on the importance of polio birth dose is low at 54.8 percent. The most prevalent reasons for not having a child vaccinated included lack of healthcare workers coming to give the vaccine at the village, lack of awareness about the vaccine, and an absence of a health facility in the locality.

The seasoned and well-regarded CGPP team recognizes that sustained efforts and attention to a range of barriers to seeking immunization are needed to strengthen surveillance and routine immunization for polio.

Dr. Roma Solomon, Secretariat Director
Project Concern International (PCI) Secretariat Host Organization

India’s interruption of the wild polio virus in 2011 remains a gold standard of CGPP’s work. No longer endemic, India in 2017 supports large-scale vaccination campaigns, ensures robust disease surveillance systems and readies with response plans for potential outbreaks.

Not too long ago India had been one of the stubbornest places on the globe to eradicate polio. In 2009, India reported 741 polio cases – more than any other country in the world. By 2010, India cut its reported cases to 42, just a small proportion of the 1,352 global cases. In a remarkable accomplishment, India completed 2012 without a single case of wild poliovirus. The country was certified polio free in March 2014.

Formed in 1999, CGPP-India coordinates and supervises the overall country program. CGPP-India operates through three CORE Group member organizations: PCI, Adventist Development and Relief Agency and Catholic Relief Services. CGPP-India operates in 12 high-risk districts in the Uttar Pradesh state, reaching an estimated 1.2 million children under 5 through 1,100 social mobilizers. The work of the three NGO partners is conducted through eight community-based organizations.

Due to the high quality of surveillance in India and now waning resistance to polio vaccination in concentrated sub-populations, the CGPP program in India focuses on social mobilization and detailed, sub-district level micro-planning to overcome resistance to improve supplemental polio immunization and routine immunization coverage.

A three-tier network of CGPP mobilizers effectively sustains the changed behavior of the target audience.

1. Community Mobilization Coordinators (CMCS)
   Each CMC is responsible for mobilizing about 500 households, including holding commu¬nity meetings, bringing local influential people to home visits, and holding health camps. Each CMC maintains immunization status records for all the under five children in their assigned areas and for those participating in vaccination campaigns.
2. Block Mobilization Coordinators (BMCs)
   Each BMC is responsible for social mobilization activities at the block level and overseeing and leading the CMCs.
3. District Mobilization Coordinators (DMCs)
   Each DMC is responsible for supervising the BMCs and conducting social mobilization activities throughout the district.

Check out “Eradicating Polio: CORE-PCI’s Experiences in India” by Robin Wyatt with over 100 beautiful images telling the story of CGPP and PCI’s efforts to make polio history.

Ahmed Arale, Secretariat Director

Catholic Relief Services, Secretariat Host Organization

The Horn of Africa region was hit by a wild poliovirus outbreak in April 2013 with a record number of cases: 194 in Somalia, 14 in Kenya and 9 in Ethiopia. While the outbreak occurred primarily in Somalia, it quickly spread into Kenya and Ethiopia. All the Somalia polio cases belonged to cluster N5A that was known to have been circulating in northern Nigeria since 2011. At around the same time the Global Polio Eradication Initiative (GPEI) had entered a new phase with a significant reduction in case counts in endemic countries and a heightened recognition of the risk for the international spread of the virus. In May 2014, WHO declared polio a public health emergency and issued recommendations requiring proof of polio vaccination for travel to and from polio-afflicted countries. The Core Group Polio Project Kenya and Somalia was created to prevent and respond to any future outbreaks by building upon existing NGO child survival experience and expertise.

The Kenya and Somalia Secretariat is based in Nairobi and supports polio eradication activities through networks at community, sub-national, national and regional levels. The project works directly with 80 health facilities in Kenya’s six counties and 16 health facilities in Somalia’s two regions. CGPP Kenya-Somalia work through five international NGOs and one local organization – International Rescue Committee, Catholic Relief Services, World Vision-Kenya, Adventist Development and Relief Association and Somali Aid, a local NGO.

CORE Group is well-situated to contribute to regional planning, monitoring and evaluation, and the creation, adaptation, and dissemination of M&E and social mobilization tools for use by NGOs, PVOs, ministries of health, UN agencies, and others active in polio eradication in the region. The Kenya-Somalia team also represents the CGPP at regional meetings, forums, and planning discussions giving voice to the NGO/PVO and community perspective.

The greatest challenge to HOA polio eradication is the potential for cross-border transmission of wild poliovirus through mobile populations, and the CGPP has accordingly choses to focus on improving eradication efforts among cross-border communities and mobile populations. CGPP-HOA also works closely with the CGPP Ethiopia and South Sudan programs in cross-border collaboration.

Dr. Samuel Usman, Secretariat Director
Catholic Relief Services, Secretariat Host Organization

CGPP launched polio eradication activities in Nigeria in 2013 with sub-grants to three NGOs to contribute to the goals of the national emergency action plan in high-risk areas by integrating with ongoing child health services. CGPP joined the other implementing partners under the general operational auspices of the National Polio Emergency Operations Center (EOC) and state EOCs. The project has emphasized capacity building to improve the health and well-being of children and women through collaborative action and learning. The project has promoted collaboration between CGPP members, their local NGO partners, the national EOC, local Ministries of Health, WHO, UNICEF, Rotary, CDC and local levels of government.

Nigeria has made dramatic progress in the last several years by shifting from the country with the highest number of cases globally in 2012 (101) to 50 cases in 2013, six cases in 2014, and no cases from July 2014 until August 2016. After being declared free of poliovirus, Nigeria has been again designated as a polio-endemic country after the discovery of wild poliovirus circulating undetected in Borno State for five years.

Under the leadership of the Secretariat Director, the CGPP Nigeria Secretariat coordinates and supervises the overall country program. CGPP implements interventions in partnership with International Medical Corps (IMC) in Borno and Kano States; Catholic Relief Services (CRS) in Yobe and Kaduna states and Save the Children in Katsina state. The work of the three NGO partners is conducted through eight community-based organizations. The project is reaching more than 1.1 million beneficiaries with Routine Immunization and Polio Eradication interventions across the five program states and in 32 Local Government Areas.

Although only one partner of many, CGPP-Nigeria has played an important role in introducing the voice and skills of civil society to Nigeria’s polio eradication efforts and contributing to community level promotion of immunization and case detection. The CGPP continues to support community based surveillance, outbreak response, and enhanced immunization systems through 2,000 community mobilizers implementing many of the tools and strategies that CGPP developed in other countries.

Anticipated Results Over Life of Project

CGPP aligns its plans and activities with the national EOC. The strategic priorities identified by the national EOC, after consultation with immunization partners and local stakeholders to achieve the set goal, targets and milestones, include: (1) building resilience towards certification; (2) enhancing SIA quality in prioritized vulnerable areas; (3) utilizing special approaches for insecure areas; (4) mounting timely and adequate polioviruses outbreak responses; (5) enhancing routine immunization; (6) intensifying surveillance and tracking documentation deliverables towards certification; (7) withdrawal of tOPV; and (8) polio legacy planning. All strategies will be underpinned by strict adherence to the accountability framework which continues to guide the National Polio Eradication Emergency Plan (NPEEP, 2017, NPHCDA).

Anthony Kisanga, Secretariat Director
World Vision, Secretariat Host Organization

Formed in November 2010, CGPP-South Sudan supports a strong community-based surveillance network, nationwide campaign monitoring and critical cross-border work. The CGPP strategy of working with and through local NGOs has made CGPP South Sudan one of the only partners able to maintain Acute Flaccid Paralysis surveillance and social mobilizations activities despite the current conflict.

CGPP-South Sudan partners with three local NGOs: BioAid, Support for Peace and Educational Development Program (SPEDP) and Universal Network for Knowledge Empowerment (UNKEA) for community based AFP surveillance. Community-based surveillance efforts are focused in the three conflict-affected northern states of Jonglei, Upper Nile and Unity and in Kapoeta East in Eastern Equatoria State. More than 3,000 volunteers search for active cases of acute flaccid paralysis (AFP) to complement the formal WHO surveillance system.

Additionally, CGPP-South Sudan leads nationwide independent campaign monitoring by conducting post campaign evaluations of the country’s four annual SIAs. The quality and coverage of each campaign is evaluated by about 300 local teachers who are trained by state supervisors. CGPP targets approximately 2.6 million children under the age of five through countrywide independent campaign monitoring to evaluate campaign implementation. This data is used to review vaccinator success and problems during review meetings at the end of each day’s work during the campaign and to evaluate the percentage of children missed at the end of the campaign.

In collaboration with WHO, UNICEF, CDC and the Ministries of Health, the South Sudan Secretariat leads the national cross-border collaboration with Uganda, Kenya and the Democratic Republic of Congo. In response to the 2013 HOA wild polio outbreak, the Technical Advisory Group (TAG) recommended that countries implement cross-border collaborative initiatives to strengthen surveillance, routine immunization and supplementary immunization activities to ensure effective coordination and collaboration among countries to reach all children residing along the border and to respond swiftly in case of an outbreak.