Courtyard women strategy: innovative approach to community outreach in conflict-affected areas of Afghanistan

Conflict in Afghanistan and Pakistan has made efforts to immunize children more difficult and perilous for health workers and citizens alike. Although polio workers are not often directly targeted, in areas of active conflict polio eradication partners face immense challenges in extending services without compromising the safety of the immunization workers.

In this type of environment, polio teams have looked to define ways to take advantage of quiet periods when fighting has abated, and to encourage people to be more pro-active in immunizing their children whenever an opportunity exists. One strategy relies on opportunistic immunization that occurs when polio workers see a lull in fighting in an area that was previously inaccessible, and then quickly marshal their forces to immunize children in those communities.

To succeed, it is critical to ensure child caregivers receive information on the need to immunize their children and of immunization services. To help increase this awareness requires local leadership to own and actively support polio eradication efforts. Local leaders can inform polio workers of lulls in conflict, and also use local networks to inform people in communities about available immunization services.

The demand for oral polio vaccine (OPV) is further driven by the deployment of local social mobilizers who work with communities to help them understand the threat of polio and the necessity of immunization, both during supplementary immunization activities (SIAs) and routine immunization.



A key innovative strategy in place to further drive this demand is the ‘courtyard women strategy’. This activity brings trained female health workers into compounds to meet with mothers and other female child caregivers to engage in guided discussions about polio eradication, routine immunization and other basic child survival topics. As mothers are the primary caregivers of young children (the most vulnerable to polio), it is essential to increase an understanding among this target group of the need to immunize and increase empowerment to ensure children receive OPV and other vaccines. In areas where the ‘courtyard women strategy’ has been put in place, there is evidence that routine immunization and coverage during polio SIAs has increased.