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ANNA KALLBARCZYK: Hi, everyone.

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I'm Anna Kalbarczyk.

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And today, I'm here
with Dr. Wakgari Deress.

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Dr. Wakgari, I'd like to
talk to you a little bit

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about community engagement.

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In the lecture that the
students just watched,

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they learned about
some strategies

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in community engagement.

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And I want them to
have the opportunity

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to think about how that
might look different

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in different contexts.

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So could you tell me about
some community engagement

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strategies in Ethiopia?

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WAKGARI DERESSA: Yeah.

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Thank you, Anna.

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Thank you very much.

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I'm very happy to be
part of this discussion.

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As you know, Ethiopia
is a big country.

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There's more than 100
million population.

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And there are also
different parts

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of the country where there
are mobile population,

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like in the areas
of, for example,

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the Somali region in the
eastern part of the country,

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the Benishangul-Gumuz in the
western part of the country,

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the Gambela region
in southwestern part

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of the country.

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And also, we have parts
of Oromia, especially

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southern Oromia
bordering Kenya, where

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the population is very mobile.

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And in those areas, there are
more than 4 million population

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living in these remote
areas, low land areas

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where the accessibility,
the problem there,

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the health infrastructure
is very poor.

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The health workforce
is very limited due

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to hostile environment
and other insecurity

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issues in those in those areas.

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So in those particular
areas, we generally

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call it hard-to-reach population
or hard-to-reach areas,

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where there is poor
reporting, where

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there is pastoralist
community, and knowledge

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in this key local population
about health in general,

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and polio in particular,
is very limited.

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So for this reason,
the government

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is currently doing
a lot of initiatives

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to reach this
population, particularly,

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in terms of health service
provision and also EPA,

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improving EPA coverage in the
form of routine immunization,

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in the form of campaign such
as supplementary immunization

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activities, and also in
the form of surveillance,

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polio surveillance,
acute flaccid paralysis.

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And also, in terms of
reaching the last child

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in the community.

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So currently, the strategy
that the government--

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the minister of health has--

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there is a health
extension program.

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And in this health
extension program,

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there are health extension
workers, female health

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extension workers,
who are now working

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best in the health posts.

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And these health
posts are generally

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community based
health facilities.

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So there are more than 40,000
health extension workers

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in those areas.

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ANNA KALLBARCZYK: And these
are all female, you said?

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WAKGARI DERESSA: Yes, female
health extension workers.

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ANNA KALLBARCZYK:
Can you tell me

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why there's such a focus
on having female workers?

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WAKGARI DERESSA: Yes.

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Yeah, generally, it is
assumed that females

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are giving more care for the
family, for the household,

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and also for the children,
who are also a lot of burden

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with the household chores,
the houses including children,

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including overall family,
including the health,

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including the
health-seeking behavior

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are more so dependent
on the woman.

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So like, if you
think pregnancy, like

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if you think a child
carrying, everything

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is about woman in general.

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So that's why the
government has elected

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to make the health extension
workers 100%, they are females.

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And then to support, to
complement the activities

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of the health extension
program, then there

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is also a woman
development army.

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So this women development army
are living in the community.

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And they are organized
in a village.

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And they have
direct communication

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with the health
extension program,

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with the health
extension workers.

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So they mobilize the community
in terms of health promotion,

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in terms of disease prevention.

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Like for example,
when I'm saying

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health promotion,
health services,

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vaccination is one of that.

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Campaign is one
of the activities.

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They mobilize and
sensitize the community.

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And they also work with
the community leaders,

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and also with the
village leaders.

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So this is the general aspect.

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But when we come to the
hard-to-reach areas,

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there are still a
lot of problems.

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There are harder to reach
areas still unreachable, still

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with a difficult setting,
with a difficult situation.

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So the government is
doing even in those areas

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to ensure the participation
of the community in terms

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of their involvement, in
terms of their engagement--

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not only engagement
of doing activities,

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but also receiving the service.

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Like, for example,
antenatal care,

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like EPA service, health
information, nutrition,

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and the same.

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ANNA KALLBARCZYK: And
how do the community

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engagement strategies vary?

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Or how are they tailored
for some of these more

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difficult-to-reach populations?

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And in particular, I want to ask
about the nomadic populations.

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You talked about
them earlier on.

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How does that change the way
that the government engages

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with the communities?

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WAKGARI DERESSA:
Generally, we have,

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over the last
couple of years, we

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have recognized that the setting
of the mobile population,

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the pastoralist
population, is different

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from the highland areas,
the agrarian areas

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where the population
is not nomadic, where

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the population is not moving.

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The population is
settlers, for example,

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in the case of the
highland areas.

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But in these cases, in
the pastoralist area,

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people move from one
place to another.

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But it is not the old people.

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It's not the whole
family which is moving.

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It is those-- the
adults, the men

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who are moving
with the livestock,

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with the cattle in
search of pasture

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and in search of
grazing area, in search

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of water during the
dry season and so on.

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So the woman and the children,
they stay in the family.

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They don't move completely
from their village and so on.

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So when the rain comes, when
the situation gets better

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at the original home, then
those adults who moved away

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for search of pasture or water
or grazing area for the cattle,

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they come back.

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So we are focusing
on the household.

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And the children are not
moving, but still, there

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is a problem there.

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Because there is
a low awareness.

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There is low knowledge
of this community.

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And detecting a
sick child less than

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under the age of 15 years with
the polio virus is a problem.

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But there is recently, which
is called Pastoral Health

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Extension program,
which is focusing

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according to the setting there,
according to difficulty there.

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And they are mobilizing the
kind of mobile health service.

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This mobile health service
is a sort of campaign

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where they go to the family.

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They give vaccination and they
give other health services

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to people in those villages.

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And they come back, and
then they frequently

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do this as a mobile one.

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Maybe the other very
important aspect

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is about the involvement
of the religious leaders.

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It's very, very
important because

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in those mobile population
in those eastern part

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of the country, southern part
of the country, majority of them

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are Muslims.

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So there is a sort of
resistance in terms

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of accepting the
vaccination, for example,

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during the first phase
of the eradication.

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Due to the involvement
of the religious leaders,

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like Muslim leaders
in the mosque,

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and also in the other
areas, like priests,

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they teach the community.

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They teach about the importance
of the routine immunization.

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They teach the importance
of, for example,

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supplementary immunization
activities, the surveillance,

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and also the mobile campaigns.

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And they mobilize and
sensitize the community.

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And the community
awareness has been risen.

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ANNA KALLBARCZYK: Great.

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WAKGARI DERESSA: So it's
very important that the goal

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of the polio eradication--

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I think it is going well, but
still, we have challenges.

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Like I've said there is
a cross-border movement,

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between Ethiopia and Somalia,
between Ethiopia and Kenya,

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between Ethiopia
and South Sudan,

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between Ethiopia and Sudan.

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So people are moving.

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And in those border areas,
on the Ethiopian side,

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on the Kenyan side,
on the Ethiopian side,

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on the Somali side, and so on,
there are insecurity issues.

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And the government
has been trying

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to work with a kind of
cross-border collaboration.

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And this is becoming
a focus for them

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in Horn of Africa, which is
including Somalia, Ethiopia,

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Kenya, Sudan, South Sudan, and
Djibouti, and also Eritrea.

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ANNA KALLBARCZYK: Sounds
like a very complex context.

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Thank you so much for
sharing your thoughts today

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about community
engagement in Ethiopia.

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I appreciate your time.

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Thank you.

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WAKGARI DERESSA: Thank
you so much, Anna.

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Thank you very much.

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[MUSIC PLAYING]

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