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Submit the investigation findings using form below

PART C: Community Influencer

PART C: Community Influencer 5

Date of interview

District

Union Council

Community leader’s name

Community leader’s official title

Have the influencers identified in SM plan been engaged in pre & post campaign activities?

Radio Field

Yes

What role, if any, did the leader have in supporting the last campaign?

Any other relevant information about the community leader?

Q1 How visible are polio information, communication and education (ICE) materials in the community (ideally, before the polio campaign or generally if investigation is undertaken afterwards)? (Observation)

Q2 What materials did you see?

1. Poster

2. Pamphlet

3. Banner

4. Street Theatre

5. Hoarding

6. Mobile float/transit point

7. Town crier

8. None of the Above

Q3 Do people in this community accept routine immunization services?

Q4 Do people in this community support polio immunization services?

Q5 Is this community secure for polio workers?

Q6 How accessible is this community in terms of geographic/residential characteristics (e.g. remote, no bridge over a river, scattered settlement, slum, high rise etc.)?

Q7 Does the community have any special populations that are at increased risk of being missed by immunization services?

1. Nomadic populations

2. Migrant workers

3. Internally displaced people

4. Ethnic minority

5. Religious minority

6. Orphans, street children, or other vulnerable children (Specify: )

7. None mentioned

Other

Q8 In your opinion, what are other local barriers or challenges to implementation of polio campaigns?

1. No female team member

2. Language barrier

3. Poor IPC skills

4. Repeated knocks & campaigns

5. Unnecessary engagement of LEAs

6. Lack of sensitization of community towards polio

7. Non local team members

Other

Q9 In your opinion, what could be done to overcome these barriers or challenges you mentioned?

Any additional comments?

Polio OBR Survey

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