Those who made it happen

by Mahboob Shareef

I have many varied and rich experiences from my 35 years with UNICEF. I have been a witness to the gradual social development of a newly created independent country––Bangladesh, where I come from. Soon after Bangladesh gained independence in 1971, UNICEF and other international development partners initiated relief operations towards a massive rehabilitation phase.

From the late 1970s, UN agencies had been supporting the Bangladeshi government in developing successful short, medium, and long-term development programmes. By the mid 1980s, development agencies began citing Bangladesh as a model for how fast a war-ravaged country could come out of emergency. UNICEF Bangladesh, with its strong field presence, had consistently supported the government in relief, rehabilitation, and development. As a second-generation Bangladeshi programme staff (from 1975-2010), I feel proud to have been part of this dynamic process.

In early 1975, I joined the Operations Section of the BCO heading the Transport Section and supporting NGO operations. Immediately after completion of one year, I was posted to Comilla to head one of the twenty Field Offices. Comilla was of strategic programme importance due to the presence of the Rural Development Academy, an important NGO providing significant support to a cooperative movement for rural development and women’s entrepreneurship. As a result, my duty station became a favoured place for UNICEF to host meetings, workshops, training, and field visits. This helped me to connect with many senior colleagues from Headquarters and Regional Offices, who in many cases went on to become UNICEF leaders. Formal and informal interactions with these high-level officials helped me immensely to develop my understanding of UNICEF’s strategies and priorities, and influenced my career path within UNICEF.

I consider myself privileged to have had the opportunity to lead a group of committed and dedicated UNICEF colleagues, as well as highly motivated counterparts, to make the EPI a success. The EPI has often been referred to as a “Near Miracle in Bangladesh.” It set an example––how a low middle-income country can fast track its public health interventions when there is political will to do so.

Until the mid 1980s, Bangladesh was lagging behind in immunization coverage compared to other countries with similar social and economic conditions. Having realized the inherent weakness of Bangladesh’s EPI strategies and the inadequate commitment from top political leadership, Mr. James P. Grant decided to travel to Bangladesh in 1985. With his charismatic leadership and unique quality he secured commitment from high-level political leaders. The then President of Bangladesh promised to mobilise the entire state machinery to speed up EPI and eventually achieve UCI. Mr. Grant did not stop there. He decided to meet with top-level Planning Ministry cadres to secure their commitment in allocating necessary financial resources to meet the local costs of the EPI, while UNICEF pledged to provide supplies, training, vaccine and the cold chain. He also met with top bureaucrats to obtain assurances of required administrative support at all levels. Mr. Grant’s visit was very strategic and reinforced national commitment for EPI at different tiers of the government machinery.

Mr. Grant returned in the late 1980’s to see for himself how the commitments from political leaders had been translated into action and how UNICEF was managing and leveraging its critical role. Some staff members from the field, including myself, had the opportunity to meet with Mr. Grant. He wanted to know how we could further engage subnational level political leadership in social mobilization. A piece of advice he shared with us was to engage in evidence-based advocacy. I also attended one of the press briefings of Mr. Grant on EPI. We were amazed at his exceptional quality to effectively articulate the important role of the media in propagating ORS, Breastfeeding, Iodised salt and Immunization to reduce child mortality.

Within UNICEF, the Representative declared EPI as a corporate priority and asked programme and operations staff to support it with total dedication and all resources. He decided to place the right people in the right place to lead EPI––pragmatically shifting the EPI team from the Health Section and under his direct supervision. Additional staff dedicated to EPI was hired in all seven field offices with the responsibility to strengthen the capacity of local government and community leaders in planning, implementing and evaluating the project––setting area specific targets, training frontline workers, planning and implementing locally appropriate social mobilization campaigns/advocacy materials to create demand for EPI services. This ensured sustainability by establishing networks and building a mechanism for the delivery of combined primary health care services through community level immunization sites. These field-based EPI officers are the unsung heroes of the success of EPI in Bangladesh.

During the immunization surge operations, I was posted in Chittagong to lead the largest Zone Office with responsibility to monitor regular programmes including EPI, overseeing shipping operations, and planning and implementation of an integrated programme for the tribal population in the three Hill Tracts Districts. In early 1989, the newly appointed Representative came with a mandate to achieve UCI in three years. He decided to first familiarise himself with the country by travelling to all of the seven UNICEF field offices and meet with UNICEF staff, government counterparts, and other partners on the ground. He came to Chittagong for a three-day mission. On the last day of this visit, I hosted a dinner at my house, which was attended by government and NGO Representatives. When all the guests departed, the Representative and the Chief of Field Operations proposed that I move to Dhaka to lead the EPI programme. I was taken aback with this offer but soon realised that this is the call of duty and I must accept. The Representative then talked to my wife and informed her that I would be leaving for Dhaka immediately, initially for six months. Accordingly, I moved to Dhaka the next day without realising that my career in UNICEF was turning in a new direction.

My usual work would start at 7 A.M. The Representative also used to come earlier than many staff. One morning, he informed me that the government had appointed a new Health Secretary–– UNICEF needed to liaise with him for the Health Programme including EPI. He wanted to be the first person to meet with the Secretary on his first day in office. I secured the appointment on the same afternoon. As soon as we entered the office of the Secretary, he echoed exactly what the Representative told me in the morning. This meeting had a tremendously positive effect on our relationship with the Secretary during the course of EPI acceleration. I had easy access to him and we travelled together to different low performing districts with a view to improving vaccination coverage.

We used innovative communication strategies––the most successful social mobilisation campaign that was ever launched. Several groundbreaking promotional activities were adopted to raise social awareness on child survival and create demand for quality immunization services. It included the participation of the First Lady in promoting EPI at the National Immunization Day (NID) inauguration creating tremendous interest, and generating immense media coverage. She held a number of press briefings on child survival and development programmes.

Designing and popularizing Moni Logo was another successful strategy. Through a KAP study it was found that undertaking intensified immunization services required an easily identifiable logo. It was therefore decided to design a logo, which would become synonymous with the immunization programme. After several field trials, we settled for a character named “Moni”, a child that symbolises both genders––the logo would include six arrows symbolising six immunizable diseases with a ring of protection. Over time, the Moni-logo became the symbol of EPI and had a great impact on raising public awareness and demand creation for immunization. Many companies printed the Moni logo on their products. Encouraged by the success of the Moni logo as an effective communication tool, other social programmes began to adopt the same approach and designed programme logos to promote their cause.

By the early 1990s, media interest in EPI had developed considerably. Support of local film and TV stars added a new dimension to the social mobilisation campaigns. They came forward to offer free of cost services and appeared in TV/Radio spots, posters, banners etc. They also frequently interacted with the media. The visit of UNICEF’s Goodwill Ambassadors at that time, Imran Khan and Audrey Hepburn was significant.

The ED appointed the world famous Pakistani Cricketer Imran Khan as UNICEF’s Goodwill Ambassador for Sports. The Representative decided to use the popularity of Imran Khan for promoting EPI. An invitation was sent to Mr. Khan who happily accepted. He spent a week in Bangladesh. As the UNICEF officer responsible for the coordination of Mr. Khan’s meetings with the government and partners, I had the opportunity to interact with him and accompany him to all events including a visit to Chittagong where the Mayor hosted a reception in his honour. That opportunity was fully utilized by Mr. Khan who spoke about child immunization to the media and public. He also met with the Head of government, and participated in several fundraising and media events. Mr. Khan’s visit was widely covered in print and electronic media and generated excitement amongst the public with regards to the EPI programme.

As EPI had become a national programme and was beginning to show results, many NGOs, social and cultural groups, mass media, and youth organizations also decided to join the EPI social mobilisation campaign. Active engagement of partners from different strata of society directly contributed in spreading the word about the benefits of immunization to all parents and caregivers.

Media coverage for UNICEF supported programmes was another key component. Until the mid 1990s, TV and Radio were the monopoly of the government. Due to the expressed commitment from the President and First Lady for EPI, state run media channels fully collaborated with UNICEF. One of the most successful media programmes was a three minute prime time production to promote messages on children’s issues; more importantly on immunization and girls’ education. With UNICEF’s technical support, TV spots were developed in which renowned TV stars participated pro-bono. The broadcasting of these high-quality TV spots during prime time added a new dimension to the EPI social mobilisation campaign.

In addition, the media became very generous in covering stories from the field about immunization and the activities of the UNICEF Representative. At one stage it became almost a routine for the UNICEF Representative to appear on the primetime national TV news immediately after any news pertaining to the President of the Country. I would not be exaggerating if I say that in those years and with this widespread media coverage, the UNICEF Representative became a household name in Bangladesh.

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