WEBVTT

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[MUSIC PLAYING]

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PIYUSHA MAJUMDAR:
In this section,

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I will give you a
brief introduction

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of social mobilization
network used

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as one of the powerful
community engagement tools

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during the last phase of polio
eradication activities in India

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and how this network actually
addressed the major challenges

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with respect to
vaccine acceptance

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and changed the entire paradigm
by turning the resistant

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population into vaccine acceptor
and also helped in making India

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a polio-free country.

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As it was found that the
underserved community lacking

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trust is the main cause of
resistance to OPV and UP

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in Bihar, a social mobilization
network from the community

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was felt need to compliment
all those activities.

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Although it was very important
to reach out to the mother,

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but there were certain
conservative social norms that

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made it even more difficult for
male vaccinator to enter home

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or even communicate with women.

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So potential women candidates
were selected and recruited

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as community mobilizers
and vaccinators.

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Also, religious leaders
were approached, convinced,

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and they influenced
the community for OPV

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as they were considered as
a person of trust and honor

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in the community.

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In coordination with
local health authorities,

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a social mobilization
network known

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as SMNet which is managed
by UNICEF and core group

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was built based on the
conventional principle

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of community mobilization.

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So the team utilized an
accelerated framework

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that involved person of
trust from the community who

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could open closed doors
and were accepted locally.

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This slide is showing a
pyramid-shaped diagram

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to basically epitomized Social
Mobilization Network, or SMNet.

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SMNet was an
intervention started

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by UNICEF for engaging
community members

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to generate community support
for polio eradication activity.

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As you can see, it's a combined
three-tiered diet structure

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comprising of State Mobilization
Coordinators, followed

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by District Mobilization
Coordinators, and then Block

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Mobilization Coordinators.

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And at the bottom of pyramid are
CMC, or Community Mobilization

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Coordinators.

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Talking more about how this
social mobilization network

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works, there was one District
Mobilization Coordinator

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recruited for every 10 to 15
Block Mobilization Coordinators

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and one Block Mobilization
Coordinator recruited

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for every eight
Community Mobilization

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Coordinators in high-risk areas
and one Block Mobilization

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Coordinator for every 12
Community Mobilization

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Coordinators in known
high-risk areas.

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So talking more about the
community mobilization

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coordinators who were
the backbone of SMNet,

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they were assigned 500 families
in the rural areas and 300

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in the urban areas.

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The main work is
to do the listing

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of all children under five
in families assigned to her.

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They mobilized the family
with eligible children

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to vaccinate and ask
them to come at booth.

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The work also involved
identification

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of all those people who
were likely non-acceptors

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and finally motivate them to
become the acceptors of the OPV

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vaccine.

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So these CMCs work very closely
with the leaders and community

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influencers.

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Between polio rounds, CMCs,
or Committee Mobilization

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Coordinators, they often meet
with community influencers,

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expectant mothers, community
leaders, school teachers,

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Muslim community members
who were used to build trust

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among the community.

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And the strong network
of community, cultural,

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and religious leaders, it acted
as a credible communication

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channel to help gain
community support

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by responding effectively to
the fears and misconceptions

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attached with the OPV

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The Social Mobilization
Network having

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developed various engagement
tools and communication

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materials to mobilize
community members,

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individual, and community-level
behavioral change

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approaches using creative
and innovative communication

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activities.

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So these activities were
done and innovative materials

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were prepared that reduce
the resistance and promoted

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vaccination
awareness and safety.

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As you can see in
the slide, there

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is a butterfly diagram
shown here were developed,

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and it was disseminated across a
wide range of community spaces.

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That includes barber
shop, school, et cetera.

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So this butterfly is
basically a booklet

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which was distributed
to community influencers

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to remind them of the importance
of disseminating the polio

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pulse message.

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There were some other
community engagement

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tools which was used by
Social Mobilization Network.

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First one is partnering
with governmental leader,

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and this partnership
has actually

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created an enabling
environment to ensure

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people's participation
in the program

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and ownership of the polio
immunization program.

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They've also developed a lot
of communication materials

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for CMCs, developed materials
for the group meeting

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among community members,
materials for the community

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influencers, and for the
children studying in school.

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To ensure CMCs have
the knowledge and skill

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for conducting quality
community-based activities,

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they have also planned and
conducted annual trainings

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for building CMC's capacity
to dispel misconceptions

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and fear around immunization
within the community.

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They've also organized classes
and rallies for children.

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One of the most innovative
engagement tools

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is the program
which was conducted

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in the community
focused on harnessing

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the power of children
as motivators.

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And these rallies of children
is also known as [INAUDIBLE]..

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They have also designed
various strategies

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like mapping, tracking,
identification, and coverage

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of mobile population
or nomadic population.

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So, in this slide, we're
going to talk more about what

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happened in UP and Bihar after
the SMNet social mobilization

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network intervention.

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It is an important
strategy used in India

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for community engagement.

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So just look at these two graphs
shown in the slide that clearly

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explained what happened
in UP and Bihar

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after the SMNet intervention.

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The Social Mobilization
Network was a huge success

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for interruption of
polio transmission

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and the polio endemic state
of Uttar Pradesh and Bihar.

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An independent
assessment of SMNet

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carried out in 2013 that
showed that increasing

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the total number of children
immunized against polio

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and ensuring that those
most at risk are protected.

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As it is visible in the graph,
in Bihar, 86% of the cases

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NP-AFP among children
zero to two years of age

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in the intervention
area received

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more than seven doses of OPV
as compared to 18% in 2002.

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The number of cases of zero
to two years old with NP-AFP

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who have received zero doses
of OPV declined from 4%

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to 0% in intervention areas
between 2002 and 2012.

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Similarly, when you
see the graph of UP,

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there is 76% of the cases of
NP-AFP among children zero

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to two years of age
and intervention area

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who have received more
than seven doses of APV

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as compared to 20% in 2002.

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The number of cases of zero
to two years old with NP-AFP

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who received zero doses of
OPV declined from 8% to 2%

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in intervention areas
between 2002 and 2012.

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Since the intervention
areas are highly--

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generally high-risk, poorly
served and vulnerable areas,

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the increase in uptake
of OPV in this area

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was even more difficult
than the better-off areas.

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So this increase in
the uptake of OPV

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can totally be attributed
to the SMNet intervention

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and the other field activity of
the CMCs to a certain extent.

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In this slide, it's
basically the continuation

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of the earlier slide that shows
the example of UP and Bihar.

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As you can see,
there are two graphs

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in the slide that are
depicting the households

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registered to give OPV drop to
their children in Uttar Pradesh

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and Bihar from the year
2007 to 2015 in India.

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Since Social
Mobilization Network

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initiated in Uttar
Pradesh early in 2007,

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so the data was
taken from that time.

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Whereas, in Bihar,
SMNet initiated lately,

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so the data related to
resistant households

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was collected from 2011 to 2015.

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An independent assessment
of a SMNet in 2013

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concluded that it has been
effective and efficient

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at achieving its
goal of increasing

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the total number of children
immunized against polio,

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and it ensured that most
at-risk are protected.

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Between 2007 and 2015,
the resistant households

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declined from 77% in
Bihar and 86% in UP

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where, now, less than 0.5% of
households resist vaccination.

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Now, in this slide, I
want you to deliberate

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on what kind of practical
strategies utilized

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in the state of UP
and Bihar of India.

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Now, take a moment
to start thinking

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about all those practical
and innovative strategies

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that we have discussed
in this presentation.

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You can also think about
different contextual

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considerations, like gender
norms, power dynamics,

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ways to reach
hard-to-reach populations.

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You can also ponder over the
cycle of community engagement

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process prior to taking
action during implementation

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and during evaluation or
reflection or dissemination,

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but all were used.

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There's some example
of strategies

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that were identified
and utilized

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in Uttar Pradesh and Bihar.

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So the strategies are
overall social mobilization

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and awareness-raising,
creating a network of people

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who are known to the community.

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Then comes trust-building
with an influencer.

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Third one is reaching
the special population

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like migrants, hard-to-reach,
subculturally appropriate

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approaches.

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And then comes combating
the security issue.

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And an important one is by
improving technology or using

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innovative measures for tracking
children and [INAUDIBLE]..

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So these are some
of this strategies

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which was used for
community engagement, used

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to eradicate polio.

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What other strategy
can you think of?

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