The large northern state of Uttar Pradesh (UP) was once India’s ‘polio central’, regularly recording more cases of children paralysed by polio than any other state or province in the world. It’s the most populous state in India and one of the poorest; almost 40% of the population lives on less than US 50 cents a day. Some of the Muslim communities in UP are among the most underserved in India. Cities and villages are densely populated, with high birth rates and large numbers of young children, poor sanitation, very few flushing toilets and a lack of health services - perfect conditions for the polio virus to spread. To make matters worse, in the early 2000s, parents and caregivers in Muslim families were refusing to vaccinate their children against polio because of rumours and myths about the oral polio vaccine and so child immunity levels against polio were low.

Big Improvements

Uttar Pradesh has not recorded a case of wild poliovirus type 3 since April 2010, or a case of wild poliovirus type 1 since November 2009. The state also hosted the last case of wild poliovirus type 2 ever recorded in the world – in Aligarh, in October 1999. After more than a decade of hard work, almost all children below the age of five years in UP are being vaccinated against polio. Surveys after polio immunization rounds have shown less than 2% of children below the age of five years remain unvaccinated, and sero-surveys show that the community has extremely high immunity to wild poliovirus. A sustained approach by UNICEF and its partners, including government, WHO-NPSP, Rotary, the NGO group CORE and others, focusing on missed children and areas and populations most at risk has delivered this result. Since 2009, efforts have been intensified in the 66 blocks in UP identified in the Government of India’s 107 Block Plan (see Convergence Section). High-risk groups such as the children of migrants and nomads are also vaccinated at transit points while they are on the move, in a sustained effort to reach every last child with the oral polio vaccine.

Social Mobilization

The Social Mobilization Network (SMNet), a highly motivated and well trained network is at the centre of the UNICEF programme in UP. The SMNet has 5,600 members working at the village, block, district and sub-regional levels. Almost 5000 Community Mobilization Coordinators (CMCs) are working in 277 blocks in 48 districts in the state. Around another 1,300 CMCs are organised by CORE, a group of international NGOs and long-time partner in India’s polio eradication effort. CMCs live in the communities they work in, 99% are women, most are Muslim and many are working in a public role outside their homes for the first time. CMCs ensure that most children in high-risk areas of UP are vaccinated at fixed-site booths, on the first day of a polio immunization round.

The CMCs work in high risk areas, identified by the polio programme. Each CMC surveys the area she is responsible for, noting in her field book any children younger than five years. She updates this survey ahead of a polio immunization round, noting pregnant women, new born babies and guest children. She visits families, counselling them about polio and routine immunization, holds mothers meetings, organizes rallies, goes to schools and madarsas to hold classes on polio and recruit the 'bulawa toli' or children's group and then encourages her community to take part in polio immunization rounds. During the round, CMCs accompany vaccination teams as they go from house to house, making sure they identify children and vaccinate them easily.

These CMCs are supported at the block and district level by Block and District Mobilisation Coordinators who report to Sub-Regional Coordinators. There are 500 staff working at the block level (as BMCs), around 75 staff at the district level (as DMCs and District Underserved Coordinators) and around 14 staff at the sub-regional level (as Sub-Regional Coordinators and Sub-Regional Training Coordinators). The SMNet is guided and directed by the state polio programme team in the UNICEF Field Office Uttar Pradesh, based in Lucknow.

Due to the communication and counselling work of the SMNet, and support from religious leaders through the Underserved Strategy, the number of resistant households in CMC areas has fallen to less than one per cent.