WEBVTT

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[THEME MUSIC]

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OLUWASEUN AKINYEMI:
Reaching special population.

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Reaching every child.

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Population residing
in mountains, deserts,

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remote areas, hard-to-reach
areas, dense urban populations,

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and insecure areas raise
significant challenges

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for polio programs.

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Sometimes managers
are torn between ease

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of equity and management of
financial material resources

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in terms of getting
to the last child.

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So microplans for
these areas need

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to consider some very
important issues.

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Seasonal changes that
intensify isolation--

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snowfall, floods.

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[? After ?] [? these occur, ?]
for example,

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in some places in Nigeria,
during the rainy season,

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some areas are cut off
because there are no bridges.

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Likewise in some
places like Afghanistan

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or some other places, there
are periods of snowfall

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which make some communities
very difficult to reach.

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Some other things that need
to be considered in microplans

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include access points for
mobile, nomadic, and refugee

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population, as well
as collaborating

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with neutral stakeholders in
area of conflicts and unrest.

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So planning campaigns,
tracking children, monitoring

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and evaluation require
substantial time, innovation,

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and personnel.

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Is there other information
that microplans

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for these areas should include?

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Please take a moment
to reflect on this.

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How about slot slums?

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Strategies In
Peshawar, Pakistan.

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Often unrecognized,
lack infrastructure,

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are low priority areas
for health authorities.

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That describes urban
slums in many cities.

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Low on equitable coverage
of health services

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and other important
care services.

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Some people have
described urban slums

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as people who suffer
in the midst of plenty.

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For example, in Pakistan,
the urban population

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rose from an estimated 43
million in 1988 to 73 million

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in 2014.

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Civil dispensary delivers
health services to slum.

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Community-based
polio vaccinators

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come to these facilities
to review field books

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containing housing maps
and vaccination records.

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And as you can see
in the picture,

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polio vaccinators make a
list of unvaccinated children

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for follow-up.

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And in turn, they
also refer individuals

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to the health facilities to
receive other routine vaccines

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and services.

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So the question is, what
are some of the challenges

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involved in trying to reach
every last child in such

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a population?

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What best practices
could help with them?

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Where would integrating
services in this scenario

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be particularly important?

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What is needed in
this regard in terms

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of planning and monitoring?

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By integration of services,
we mean other things

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that we might add
to the polio vaccine

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in terms of maybe other
vaccines or other commodities.

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Now in this graph, we see
the geographic distribution

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of polio cases and
Global Peace Index.

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On the left, we see years
with polio virus cases

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from 2006 to 2015.

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And on the right, we see
average Global Peace Index

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within the same period of time.

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And as you can see,
on the left, areas

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where polio virus cases
are still an issue--

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for example, Nigeria, Chad,
and some of those countries,

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we can see that
on the right there

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are still areas where
the average Global Peace

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Index is also still poor.

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So we can summarize
or conclude from that

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that polio seems to linger in
areas where there are conflicts

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or where the Peace
Index is poor.

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So final struggles
of polio today

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are in areas of
conflict and insecurity.

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With 95% of polio cases
between 2012 to 2016

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occurred in these settings.

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Conflict and
insecurity critically

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affect the functioning of health
systems and service delivery.

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That is planned activities
come to a halt, access

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to [INAUDIBLE],, and safety of
workers become a challenge.

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Addressing these
barriers require

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planning and implementation
of special strategies.

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What are the strategies
available for running health

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programs in conflict areas?

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The first we'd like to
discuss is the hit and run,

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which is when teams
are accompanied

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by local leaders
and law enforcement.

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That is no vision signs,
no finger marking,

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no house marking.

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They just enter the community,
vaccinate for just a few hours,

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and they leave.

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They do not return
for a few days.

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So it's, like the name
suggests, hit and run.

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They do what they have
to do, and they get out

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of the community.

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We also have permanent
health teams,

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where health workers
identify in non-secure zones,

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and plans are drawn
collaboratively,

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and vaccination is conducted
at a predetermined date, time,

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and location.

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Data are collected--
and vaccines--

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at the end of the day at the
designated time and location.

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So here we have health
workers in that area

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who plan along with
health managers who

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conduct vaccination at
a predetermined time,

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and so on, who collect the
data of people vaccinated

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as well as vaccine usage.

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And they are within
the community.

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Lastly, on strategies
for conflict areas,

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we talk about firewalling.

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And in firewalling
area, you cordon off

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risky or non-secure
zones before entering,

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and vaccinate children
from high-risk zone

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when they enter these
surrounding secure communities.

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So it's like we provide
a place of refuge.

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And whoever enter into that
place of refuge is vaccinated.

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So that is firewalling.

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And those are the three
strategies we like to discuss.

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Now we'll go to some
more country examples.

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We'll start again with this
quote from an Afghani health

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officer.

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Say, "This is a neutral
program implemented

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in government-controlled
areas, and we have agreements

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with the opposition
groups for implementation.

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They--" that is the
opposition groups--

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"recommend a coordinator, if
he is qualified, we hire him.

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He should be a trustworthy
person respected

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by the community.

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He should be able to talk
to parents and elders.

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We cannot hire a person
who is not literate,

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who is involved in conflict, who
is armed and is not neutral."

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So we see here a kind of--

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we can call it firewalling
or permanent health

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team, where a neutral person
implements this vaccination

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program in
government-controlled areas.

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And There this agreement with
the opposition so that they all

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agree that children in this
area will be vaccinated.

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So in Afghanistan, access
has been very difficult.

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And in insecure
areas, microplanning

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is carried out in concert
with opposition groups.

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Like we said earlier,
one of the best practices

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for microplanning is
involving the community,

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is assuring buy-in, is assuring
bottom-up approach to planning.

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A lesson from the GPI
is a critical importance

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of the program, remaining
non-partisan at all levels.

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So when we do
microplanning, we want

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to be sure that we talk about
community participation.

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We don't want it to be
[INAUDIBLE] by politician.

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We want it to be as
neutral as possible.

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Now let's review some
of the best practices

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that we have spoken about.

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The first is that we
need to engage community.

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We cannot overemphasize
the importance of community

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participation.

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Then, secondly, there is
use findings for action.

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Microplanning must
not remain on paper.

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It's not just a paper
exercise, but it's

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an exercise that should
improve our execution,

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our implementation strategies.

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Thirdly, we need to integrate
microplanning across programs.

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So microplanning
is not necessarily

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for polio immunization
or vaccination only.

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You can use microplanning
in [INAUDIBLE]..

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You can use it other
health programs.

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These are the best practices
we'd like you to take note of.

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[THEME MUSIC]

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