3 Types of Social Mobilization used in the Global Polio Eradication Initiative
Social mobilization (SM) involves empowering the beneficiaries of health promotion activities to become “active and accountable stakeholders1.” The basic principles are empowerment, equity, sustainability, integration, and cultural sensitivity and gender fairness. SM is the processes of engagement and action that advocates for change. Although it is driven by the beneficiaries, with the help of champions, coaches, and catalysts, it involves all sectors of society including: “decision and policy makers; opinion leaders; bureaucrats and technocrats; professional groups; religious associations; commerce and industry, and; communities and individuals2.” While many theoretical definitions agree on the primary tenets of SM, there are many activities in practice labeled social mobilization. Three broad categories of SM were observed in polio eradication efforts: pragmatic SM, activist SM, and hybrid SM. Effective design and evaluation of SM efforts are dependent on understanding and being able to distinguish the 3 kinds of SM.
Pragmatic SM occurs when community leaders and groups are used in practical ways to “pass along important information to intended beneficiaries and assist the program in performing other important tasks needed to achieve program goals3.” Community actors are used as instruments to achieve predetermined public health goals, such as polio immunization, where their actions may maximize the public health activities. Pragmatic SM in these cases can be successful in increasing rates of immunization and works particularly well where heath education is low and is one of the primary barriers to care. Accordingly, pragmatic SM works poorly in situations where there is resistance to polio immunization. Sustainability is also at stake when community actors are merely used as instruments instead of taking ownership of the cause.
Activist SM, on the other hand, is characterized by community ownership. Activist SM fully commits to the basic principles of SM set out by the WHO mentioned above. Decision-making power is decentralized and rests at the community level. Activist SM is often facilitated by either local community members (as champions) or by NGOs rather than governments. Governments may by threatened by encouraging “marginalized populations to become advocates for their rights4.” Activist SM has the potential to be more sustainable than pragmatic SM, because the community actors themselves take ownership of the initiative and carry it as long as they so choose (and in whatever manner they choose). While this has been effective in examples of water and sanitation, local emergency transportation systems, and in local health insurance schemes, it may be less effective in polio immunization. In northern Nigeria, for example, local communities have taken charge of the national immunization program, choosing to support widespread opposition to polio immunization.
To combat the limited effect of top-down pragmatic approaches and the potential for activist approaches to not prioritize important public health issues (e.g. polio immunization), hybrid SM has developed. As Murphy iterates,
“It is unrealistic to expect communities in every part of the world to identify polio eradication as a high priority and then marshal the commitment, resources, and strategies to immunize all their children. What has emerged over time is a blend of pragmatist and activist elements — a hybrid form of SM — that is characteristic of the most successful polio eradication efforts5.”
In hybrid SM, goals and strategies are negotiated rather than merely predetermined and accepted; community actors are engaged in all steps of the process—planning, implementation, and evaluation—; and, in some cases, more holistic polio eradication programs have resulted in response to community demands. According to Murphy,
“Hybrid approaches combine the best of both pragmatic SM (organizing and coordinating activities) and activist SM (tapping the power and insights of the community). Combining them has resulted in greater success in reaching and immunizing children in high-risk populations. As one example, activist SM can give NGOs new insight into the community, especially on the reasons behind resistance and barriers to polio immunization on which they can build pragmatic responses6.”
Further lessons learned through observing the evolution of SM used in the Global Polio Eradication Initiative include the nature of media, as additional community actors rather than merely channels; of the power of interpersonal communication over relying on mass-media; and the significance of incorporating women in the SM initiatives. As the polio programs evolved, it became clear that the most successful SM strategy to increase polio immunization of children emphasized the roles of the community mobilizers, family visits, and engagement of religious and other influential leaders.
- WHO: Regional Office for the Western Pacific (2003). Social Mobilization for Health Promotion. Manila, Philippines: WHO, p. 2.
- Murphy, Elaine (2012). Social Mobilization Lessons from the CORE Group Polio Project in Angola, Ethiopia, and India. Washington, D.C.: CORE Group, p. 4
- (ibid, p. 4)
- (ibid, p. 5)
- (ibid, p. 6)
- (ibid, p. 6)
- The Global Polio Eradication Initiative. Retrieved March 21, 2013 from http://www.polioeradication.org/Mediaroom/Photos/Photoessays.aspx