WEBVTT

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ANNA KALBARCZYK: Hi, everyone.

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I'm Anna Kalbarczyk,
and I'm here

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with Dr. Malabika Sarkar
and Dr. Assefa Seme.

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And today, we'll be talking
about ethical issues

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and human resources for health.

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So the question I'd like
to pose to you today

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is do you think it's ethical
for the international alliance

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to require or even
encourage health workers

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to be in conflict areas, or
areas where their safety might

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be at risk?

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Malabika?

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MALABIKA SARKAR:
Actually, definitely,

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we need to provide the service
in the conflict region,

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because we cannot
leave anyone behind.

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And we cannot put a risk,
like an all for life,

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because there's ethical issue.

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But it is ethical,
as long as we take

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the correct measure for
the security and safety

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of the health workers.

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So I strongly believe
that definitely, we

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need to give the service
to those populations.

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Those are already vulnerable
and disadvantaged,

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and we cannot deprive them.

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But we have the moral,
ethical responsibility

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to secure and ensure the
safety of the health worker

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so that they can actually
complete their task

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successfully and effectively.

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ASSEFA SEME DERESSE:
Yeah, I totally

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agree with Dr. Malabika's idea.

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When we talk about
this condition,

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it has to be from both sides.

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People should get the service.

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They shouldn't be left behind.

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But they should get
the service in a way

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that the service
givers should also

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be not affected in terms of
health, in terms of safety.

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And then in terms
of all the support

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that they need, in providing
the service for the need.

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ANNA KALBARCZYK: Is there
an additional layer to this,

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as we talk about the
international alliance

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encouraging people to be
working in these areas?

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Right, I mean,
we're thinking then

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about many people who might not
work in those areas themselves,

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might not live in
those countries.

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What are maybe some
implications of that?

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MALABIKA SARKAR: Actually, the
prime responsibility, I think,

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is the national government.

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Because the
international alliance,

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they don't actually
structure the system.

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They don't give the guideline
where to go, what to do.

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So the national government,
they know the context.

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They know the capacity
of the health worker.

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They know the situation.

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They know what do they need.

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So the national government
has more responsibility

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to kind of develop a guideline
to help them to develop

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the capacity to ensure
even if there's a conflict

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and there are other rebel groups
or the political volatility,

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then they need to talk to
them and then ensure days

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of tranquility or ceasefire.

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So the more
responsibility, to me,

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is the national policy
policymaker rather than

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the international alliance.

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ANNA KALBARCZYK: Any
reflection from you?

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ASSEFA SEME DERESSE: In addition
to the national government,

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we should also think of
the local government,

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particularly when you go to
developing countries in Africa,

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for example.

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We have such states,
local government,

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who are responsible
for the safety

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and for everything in the
district or in their areas.

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So as Malabika
said, in addition to

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the international
government's responsibility,

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the local have the main.

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But the international
donors and the partners

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can support the local government
and the national government

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financially, and
with some sort of aid

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so that the safety of
health workers in reaching

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the hard to reach areas,
the conflict zones, and also

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the war zones, can be issued.

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ANNA KALBARCZYK: And
we've also had discussions

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about how there are other
challenges within the health

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care workforce, right, so
people not getting paid on time

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or not being compensated
well for their time.

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How do you think that's related
to asking, then, health care

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workers to work in zones where
their safety might be at risk?

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MALABIKA SARKAR: I think
one of the major issues

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is that, do we
have the database?

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Do we know exactly--

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there should be a kind
of a live database

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that we should know exactly
how many health workers are

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affected in the unsafe areas,
and also segregation by sex,

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segregation by the
level, so exactly we

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know that what is the magnitude.

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Because we cannot come to a
solution that we don't know

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in the database.

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So that's very important.

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And in terms the health workers,
those who work in that area,

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definitely, they will require
more financial incentive

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and support, because they
are endangering their life

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and risking their life
for providing the service.

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So if they have the
double burden of anxiety

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at one hand not getting
paid, and also the risk,

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that will not ensure
the quality of service.

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So whatever the objective,
that will be completely

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spoiled if we don't ensure that
all these, not only the safety,

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but the financial
security, the support

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they need, creating an
enabling environment for them.

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So that's much,
much more important

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for the workers in
the conflict region.

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Definitely, it's
important for everybody,

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but we need to pay
attention and to make sure

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that they should not be punished
because they are working

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and they're in an unsafe area
and they're risking their life.

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ANNA KALBARCZYK: Maybe that
allows a follow up question.

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I mean, you talk about
an enabling environment.

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When we talked yesterday, you
mentioned mental health, so not

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just physical safety of
people, but also mental safety.

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Could you maybe talk a
little bit about that today,

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or you, Assefa?

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ASSEFA SEME DERESSE: Yeah.

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I mean, the health
workers, the support

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that the health workers
need in such areas

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is not only the
physical support,

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but the emotional support.

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And because both the
national government

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and the international
partners should make sure

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that beside all the
financial support

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the health workers
should get in time,

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they should be
emotionally supported.

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They should make sure that
they are safe where they

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know that they are working.

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They should also make sure
that health workers can

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be reached at any time
if there is anything that

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is going to risk their life.

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So ensuring that emotional
and mental support

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is one of the
requirements that we

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need to give to
the health workers

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in order to ensure some
visibility for the people.

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MALABIKA SARKAR: Just continuing
that, what Dr. Assefa said,

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I think it's an irony that
when we send the health

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workers to an unsafe region,
we don't actually prepare them.

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We only get the
technical training.

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But it's very important
to actually make

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them prepare, like
the coping strategy,

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because it's not only
whenever I'm in danger,

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but I'm also working
in a situation

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where people are suffering.

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So there is no
kind of curriculum

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that actually addresses that
issue, the coping strategy

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for the health worker for
their own mental health,

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well-being, but also how
to deal with the patient's

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suffering outside the disease.

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Of course, they
have the disease,

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but they also have
a lot of trauma.

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And as a health worker, they
cannot deny themselves, OK,

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I don't want to hear about
your pain or suffering.

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I am here only to give
you the antibiotic.

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But you don't prepare them.

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And in addition
to that, whenever

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there is an a traumatic
event happening there,

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that unsafe area, there have
to be immediate steps taken so

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that those who are suffering
from post-traumatic

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syndrome, how can we reach them,
how can we ensure-- and not

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only to them.

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I do believe that there's also
responsibility to reach out

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to the family members.

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Because sometimes
the family members

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are very worried when
they are working there.

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And they need to be
also be supported,

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so that we can create a
very stable environment

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in that particular area
for the health worker,

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so that they're prepared and
ready to provide the service

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and to take necessary steps
and the coping strategy

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to deal with this, the
suffering, this situation.

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ASSEFA SEME DERESSE:
Yeah, one more

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point, Malabika
has reminded me is

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when we talk of the
emotional support,

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it is not only for the
health worker and so,

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but some health workers
leave their families behind,

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their loved ones
behind, and they'll

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go to these hard to
reach or conflict zones

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for you know this provision.

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But we should make sure
these health workers can--

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not even frequently,
but at some regular time

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should go back to
their families,

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visit them, or should
arrange in a way

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that the families
could come there,

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visit them, have two,
three days vacation,

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and then this will really
give them a sort of support.

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ANNA KALBARCZYK: So we've
talked about a couple

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of different
solutions addressing

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some of these challenges.

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And maybe as a final wrap up
thought, I'll ask each of you

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to give me what you think
might be a solution,

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and maybe we could
think about it

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from a government level
or even sort of a more

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international level,
in terms of protecting

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people's welfare in these hard
to reach and conflict areas.

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MALABIKA SARKAR: For
me, I think the problem,

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I said that very
important to create

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a database, who are the
sufferings so that then we

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can have--

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we should not go for
a blanket approach.

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We should have a very
context specific,

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target specific approach, and
looking at the gender issues,

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whether the women are more
likely to suffer and become

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the victim that
compared to maybe

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the male colleagues,
or maybe vice versa,

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depending on where they are.

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So the database, and
then a context-specific,

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the problem-specific
solution, which is which

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should not be a static solution.

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The solution has to be
very evolving there,

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depending on so
that policy makers

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and the implementers
need to be very flexible,

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and then to decentralize
the authority that they

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can make a quick decision.

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Sometimes, we wait for
the central decision

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that OK, I can't do anything.

00:10:36.500 --> 00:10:40.310 align:middle line:84%
So there has to be
the balance in terms

00:10:40.310 --> 00:10:42.560 align:middle line:84%
of the flexibility and
the decision making,

00:10:42.560 --> 00:10:45.590 align:middle line:84%
decentralization of
the financial authority

00:10:45.590 --> 00:10:48.140 align:middle line:84%
and also the decision
making authority, and then

00:10:48.140 --> 00:10:52.050 align:middle line:84%
very much context-specific,
problem-specific,

00:10:52.050 --> 00:10:55.240 align:middle line:84%
the solution, not
a blanket approach.

00:10:55.240 --> 00:10:57.380 align:middle line:84%
ASSEFA SEME DERESSE: Yeah,
I agree with Malabika

00:10:57.380 --> 00:11:00.080 align:middle line:84%
that not all hard to reach
have the same problem.

00:11:00.080 --> 00:11:01.820 align:middle line:90%
The magnitude could vary.

00:11:01.820 --> 00:11:05.000 align:middle line:84%
So we have to stratify, who
is affected most, which gender

00:11:05.000 --> 00:11:09.110 align:middle line:84%
group is affected most, and
which areas are affected most?

00:11:09.110 --> 00:11:12.030 align:middle line:84%
And in terms of intervention,
as we said earlier,

00:11:12.030 --> 00:11:14.840 align:middle line:84%
we have to involve
the local government,

00:11:14.840 --> 00:11:16.490 align:middle line:84%
the local government,
because we love

00:11:16.490 --> 00:11:21.170 align:middle line:84%
the local leaders and the
local religious leaders,

00:11:21.170 --> 00:11:24.160 align:middle line:84%
or community leaders, who
can take part, really,

00:11:24.160 --> 00:11:27.740 align:middle line:84%
in terms of securing the
safety of health workers.

00:11:27.740 --> 00:11:30.530 align:middle line:84%
Then involving the
local government,

00:11:30.530 --> 00:11:33.590 align:middle line:84%
plus cooperating with the
international community,

00:11:33.590 --> 00:11:35.690 align:middle line:90%
in terms of getting support.

00:11:35.690 --> 00:11:40.050 align:middle line:84%
So if all act
together, then there

00:11:40.050 --> 00:11:41.830 align:middle line:84%
would be a solution
to bringing health.

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00:11:42.330 --> 00:11:43.880 align:middle line:84%
ANNA KALBARCZYK: Well, thank
you so much for your time today,

00:11:43.880 --> 00:11:46.380 align:middle line:84%
and for this great discussion
on human resources for health.

00:11:46.380 --> 00:11:47.082 align:middle line:90%
Thank you.

00:11:47.082 --> 00:11:47.555 align:middle line:90%


00:11:47.555 --> 00:11:48.680 align:middle line:90%
MALABIKA SARKAR: Thank you.

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[MUSIC PLAYING]

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