WEBVTT

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YODI MAHENDRADHATA:
Navigating politics--

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why do we need consistent policy
engagement in the Global Polio

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Eradication Initiative?

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Politics, for better or
worse, plays a critical role

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in health affairs.

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Health policy processes can
thus be highly political.

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Policy processes sometimes
involving dense networks

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of actors and coalitions with
competing values and interests,

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making things more complicated.

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The national, state,
district, and block level

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have different
political actors with

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different political interests.

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Here, we see, for
example, the organization

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of the health system in India.

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Here, you can see the
levels of functioning

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and how deeply complex
engagement across the levels

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and stakeholders can be.

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I'm sure many of you,
to a certain extent,

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would see more or less
similar complexity when

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you review organograms
of the health

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system in your own country.

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Now, in these types
of environments,

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different levels of
government may actually not

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agree on certain issues,
interests, and commitment.

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At the highest
political level, it

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may be in conflict with
community needs and the project

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goals.

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Differing approaches
and strategies

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may also be adopted by
different stakeholders

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across national, subnational,
and district level,

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especially in
decentralized government.

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So policy engagement in
these types of environments

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requires a
collaborative approach.

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A national policy based on
meaningful participations

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and consensus from
stakeholders from national

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to community level is
really, really important.

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This has somewhat been
achieved in the case

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of polio eradication.

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There has been a very
steady high-level advocacy

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with governments at the
highest level trickling down

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to the lowest level.

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So polio eradication
has practically

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has received the
priority that it deserves

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and the priority that it needs.

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In the Somali
region of Ethiopia,

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for example, the most important
factor for better coverage

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was people's trust, people's
trust to religious, tribal,

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and clan leaders.

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And they have used this fact
to improve vaccination coverage

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by engaging religious, tribal,
and clan leaders to mobilize

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the community.

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So lessons from GPEI
basically suggests

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that engaging political and
this at many level is key.

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This could take form as
hosting policy dialogues

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or stakeholders' workshops
amongst all relevant

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stakeholders throughout the
planning and implementation

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process.

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This may also involve
holding advocacy meetings

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at the national, subnational,
and district level,

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keeping priorities and messaging
consistent across levels

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and stakeholders.

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Here is not a great example
of how policy engagement was

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done for polio eradication.

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Now, this is a study depicting
how Muslim clerics were

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engaged in a polio eradication
initiative in northern Nigeria.

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Now, at the time, polio
eradication initiative

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was suffering serious setbacks
due to vaccination rejection

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by the Muslim
clerics, the imams.

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However, the intense
opposition to polio vaccination

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was systematically
being reversed

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by the active engagement
of imams in areas worst hit

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by the disease.

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A coalition campaign involving
imams, Islamic school teachers,

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traditional rulers,
doctors, journalists

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have been gradually turning the
tide against polio vaccination

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rejection in northern Nigeria.

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This slide here
shows a flowchart

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for the engagement of imams in
a polio eradication initiative,

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illustrating the
different groups that

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facilitated recruitment of the
[INAUDIBLE],, the [INAUDIBLE],,

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and also the regular
[INAUDIBLE] imams into the Polio

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Eradication Initiative.

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This is a really nice example
of an innovative engagement

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and coalition campaign at
the community level for Polio

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Eradication Initiative.

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So I would encourage you to
go through the papers cited

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on this slide for
further details.

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Now, there are
often also competing

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political, economic,
and social priorities

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across government levels, as
well as across ruling parties.

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Eradication efforts in
Afghanistan, for example,

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have been complicated by
civil unrest and insurgent

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occupation.

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Political leaders in these
conflict-affected areas

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have faced competing
political priorities,

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balancing politically savvy
messaging and other health

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priorities for the country.

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The continued war and
conflict in Afghanistan

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have led to health workers'
severe shortage, mainly caused

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by outmigration, poor
and unequal distribution

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in rural or comparative
urban settings.

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Additionally, while
the government

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has remained supportive
of the polio program,

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high profile endorsement
by the government

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has proven to be
counter-productive in areas

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where anti-government forces
may oppose government messaging

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and harm healthcare workers.

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For example, the Taliban and
other anti-government elements

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sometimes issued fatwas
denouncing vaccination

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as an American ploy.

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Additionally, Taliban insurgency
in bordering provinces

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of Pakistan and Afghanistan
have imposed a ban

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on polio campaigns and
targeted healthcare workers.

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The government [INAUDIBLE] to
address issues such as parents

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refusing to immunize
their children

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because of fear
of being targeted

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by the Taliban, which sees
medical teams as a threat

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to its control in the region.

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Now, not only are there
competing priorities,

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but there are also variable
impacts of implementing

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a given policy or program.

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It is important that we
view healthcare challenges

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as multi-sectoral.

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In widely implementing polio
eradication activities,

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in addition to the existence
of fragile health systems

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and poor infrastructure
in many contexts,

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the lack of holistic policy
making has been exposed.

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Some communities may be
reached only by polio vaccine

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and not by any other
health services.

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This can lead to discontent and
a backlash against the program.

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So in designing and implementing
policies and programs,

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it becomes imperative
to consider

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other economic, social, and
cultural impact as well.

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Essentially, any policy
related to any health issues,

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whether it's a disease outbreak
or maternal and child health

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issue, must make
a serious attempt

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to also address many
of the other health

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and non-health outcomes as well.

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Now, given that politics may
create divides in communities,

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it's also important for
public health programs

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to maintain neutrality.

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In Afghanistan, for
example, one solution

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included coordination with
different opposition groups

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to gain access to unsafe areas.

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This was call Days
of Tranquility,

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where all parties negotiated
a ceasefire in order

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to allow children to
access healthcare.

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This has contributed to a
higher vaccination coverage.

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The county program
maintains constant dialogue

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with anti-government elements
at local, provincial, and higher

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level to ensure
program neutrality

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for polio eradication
and support activities.

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Believe that polio eradication
and government health

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workers are neutral,
both in words and action,

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has a significant
impact in gaining

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the trust of communities and
anti-government elements.

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Lessons from polio
eradication also

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highlight the importance of
anticipating government change.

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Periodic change in countries'
leadership and management

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result in changing
priorities and policies.

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You can do a lot of work
getting a government on board,

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and if they lose
an election, you

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may have to start
over at square one.

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When a new governor
came, for example,

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he might try to bring his
own people and friends

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looking for ways to replace
current people in positions.

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Program fatigue, donor fatigue
can also be major issues.

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Recommitting will and
resources to the project

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every year for a
prolonged time period

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can be really challenging.

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Therefore, government
long-term commitment

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can be especially important.

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However, to sustain the
commitment of the government,

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not at the national level
only but in every district

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in itself, is a huge challenge.

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It's not a one-time effort.

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It's for years.

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It's for decades that
you have to sustain them.

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It requires a lot of
commitment and champions

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at the national level,
at the state level--

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not only in the
political environment,

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but also in an
administrative environment.

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In short, it requires strong
and persistent advocacy.

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There are still
many other lessons

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for policy engagement
from polio eradications

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which are worth highlighting.

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Let me just share a
few more, which I think

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are quite important.

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First, transparency
and collaboration--

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in this regard,
polio eradication

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highlights the importance
of sharing experiences

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at the national
and regional levels

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on progress and challenges
for maintaining transparency.

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Second, participatory
planning-- there

00:11:35.690 --> 00:11:39.890 align:middle line:84%
are many case examples from
polio eradication which clearly

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illustrate the
importance of involving

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a wide range of stakeholders
at multiple levels

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in planning all phases and
activities of the program.

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Third, social
accountability-- experience

00:11:54.110 --> 00:11:57.170 align:middle line:84%
from polio eradication
underlines the importance

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of utilizing social
accountability tools

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to get feedback from
committee members

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and to improve service
delivery and governance.

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Last but not least,
ownership-- we

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can avoid interruptions
in public health programs

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if everyone has a
sense of ownership.

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If people understand
at the national level

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that this is an
integrated program, that

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we are all sitting
in the same boat

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and working for the
same common goal.

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So in a nutshell,
polio eradication

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provides us with a wealth of
lessons on policy engagement,

00:12:42.740 --> 00:12:47.390 align:middle line:84%
lessons on navigating politics
by ensuring consistent policy

00:12:47.390 --> 00:12:48.590 align:middle line:90%
engagement.

00:12:48.590 --> 00:12:53.060 align:middle line:84%
This brings us to the importance
of engaging stakeholders

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effectively.

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