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4. Radio Strategy: Sponsor a continuing series of radio programs around public health broadly. Polio 
issues will be prominently featured, but not exclusively. Programmes will achieve better uptake 
if they are interactive, via call-ins, debates, etc. The benefit of a radio strategy is that it has 
broad penetration in both rural and urban areas. 
5. Mobile Health Information Strategy:  Craft Mobile Health programs for Somalia that enable 
individuals to easily get information on various diseases as well as on the closest healthcare 
facility. Reverse SMS efforts could be used to push out information and health alerts to mobile 
users in Somalia. Given the percentage of mobile phone uptake in Somalia, this strategy has the 
potential for a high degree of effectiveness. 
6. Internet Strategy: Develop a Somali language web presence that raises awareness of polio, and 
seeks to disabuse rumors. Make it active, and craft it in such a way that it continually draws in 
users. Ensure it is mobile accessible. 
7. Direct Engagement Strategy: In order to reach people directly without media, one could engage 
clan as well as religious leaders to help change their opinion, and through them the opinion of 
their followers. In addition to the media strategy, it will be key to understand and cover the 
whole spectrum of information diffusion and opinion formation in Somalia. 
The use of 
community leaders and harnessing the power of oral tradition — Somalia has a famous history for 
poetry — could also be another option for awareness raising in more remote areas. 
Overcoming political and security issues 
The key barrier to achieving effective vaccination levels in the short term is political and related to 
security. AI-Shabaab presents the key impediment at present. The group's opposition to door-to-
door vaccination campaigns, its vehement dislike of international aid organizations, and its increasing 
centralization and conservatism all present long term challenges to vaccination campaigns. While it is 
tempting to view these trends as indicative of an increased Salafist influence within Somalia, in all 
likelihood they are primarily rooted in Somali culture and Al-Shabaab's violent history. 
Given AI-Shabaab's military capacity, it is not advisable to simply wait the group out. Rather, 
strategies to bring them on board with public health efforts are key. In part this may involve a 
reliance on increased outreach to religious authorities and communities in Al-Shabaab areas, 
intended to put public pressure on the group to change its stance on the vaccine. 
The following Strategies may be of utility. 
8. Partnership Strategy: First, continue funding of NGOs operating in Al-Shabaab territories, while 
working to identify Islamic NGOs which can help to develop health care facilities in Al-Shabaab 
territory. Al-Shabaab messaging has claimed that the poliovirus vaccine is manufactured in 
Christian countries. One means of countering this perception is through either messaging or, if 
the vaccine is indeed coming from Christian countries, identifying an Islamic source for the 
vaccine. 
9. Media Strategy: Engage with Salafist/conservative clerics to open up a discussion on polio and 
vaccinations in Somalia. The goal would be to shift attitudes amongst Somali Al-Shabaab 
members and those living in Al-Shabaab territories on polio vaccination efforts. Potential media 
channels would include radio, TV, and Internet. It may be difficult to eliminate the spying 
concerns for some militants, but engaging on the issue of whether vaccinations are safe should 
be possible. This is also a potential avenue for diaspora engagement. 
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In the graph below, the various strategies laid out have been prioritized according to their likely 
impact on the polio eradication campaign, as well as on their feasibility. Feasibility was assessed 
along three criteria: cost, time and risk. In particular, the issue of risk is pertinent for those 
interventions seeking to have impact in Al-Shabaab controlled regions. 
Assessment of measures to overcome barriers to polio eradication in Somalia 
High 
Impact/reach of 
vaccination 
campaign 
Low 
Short term strategies: 
Easy to implement with 
moderate impact 
©o
O
0
O 
O 
Medium term strategies: 
fiAoderatedifficulty of 
implementation with 
medium impact 
long term strategies: 
Difficult implementation 
with high impact 
Easy 
Ease of implementation 
Hard 
9. 
Recommendations 
1. Information/Attraction/Ac 
cess 
2. Improving overall 
healthcare services 
3. Assessment of public 
opinion on commurety 
level 
4. Redostrategy/to raise 
awareness 
S. Mobile strategyto raise 
awareness 
6. Internet strategy to raise 
awareness 
7. Direct engagement 
strategy to raise 
awareness 
8. Partnership strategy to 
engage with Islamic 
institutions 
Media strategy 
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Areas for Future Analysis 
Whereas this report provides an initial analysis for strategic understanding of key considerations for 
strategic purposes, any intervention selected must be predicated on an up-to-date and nuanced 
basis of information. 
There are a number of avenues for future analysis that emerge from this report. In particular, it 
should be noted that there remains a lack of community-based information on perceptions in 
Somalia, particularly in areas difficult to access. 
By necessity, the rapid assessment, upon which the report was based, was constrained in its sample 
size, and in the economic and geographic diversity of interviewees. While there was a strong 
consensus amongst interviewees on some specific findings — such as recent shifts in knowledge of 
polio, increased societal acceptance of the vaccine, and increasing access to healthcare — it is 
important to test these findings with a larger pool of respondents, in both urban and rural locales. 
Possible areas for follow on research include: 
• 
Community-level surveys focused on perceptions of polio, vaccinations, and access to healthcare. 
These would be conducted in rural areas of south, central, and northern Somalia. 
• 
Community-level surveys in ethnically Somali areas in Kenya and Ethiopia, as well as the refugee 
camps in the border regions, focused on perceptions of polio, vaccinations, and access to 
healthcare. The aim would be to identify whether there is regional applicability to the findings in 
this report. 
• 
A survey of religious leaders in Somalia, aimed at identifying perceptions of polio, views on the 
vaccine and the vaccination process, and viewpoints on Al-Shabaab's anti-vaccine stance. A 
secondary goal could be to identify potential participants for pro-polio vaccine messaging 
activities. 
• 
Professional surveys amongst Somali medical personnel to identify their views of the polio 
vaccination process. A key goal will be to identify whether health worker concerns uncovered in 
this study are common throughout Somalia, and whether any vaccination implementation 
partners have been successful in minimizing activities of concern. 
The one area where work has been on-going is to map in greater detail the local leadership structure 
of Al-Shabaab and determine individual views on polio and the vaccination campaign. This has 
proved challenging and has raised security concerns for interviewers. In part, this is a reflection of 
the centralization of decision-making within Al-Shabaab and the erosion of local latitude amongst 
commanders on the ground, as outlined in the report. 
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