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ANNA KALBARCZYK: Welcome to
this section on health policy

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making.

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I would like to begin with
a reflection question.

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What do you understand by
the term policy engagement?

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What does it mean to you?

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I'll use the material
in this lecture

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to explore different
facets of this question.

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Maybe write down your response
now and come back to it

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at the end of the recording.

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Now I'll ask the question
what is policy engagement?

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It involves governments,
stakeholders, communities,

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and individuals working
together to achieve

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complex societal goals.

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It includes
participating effectively

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in the policy-making process
and aspirations regarding

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how to have a positive
impact on the lives of people

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in different societies
and countries.

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One polio eradication
official in Ethiopia

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said, "There is a
high level of support

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from the political leaders.

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Polio eradication is
given a high priority.

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The planning and
strategy developments

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are supported with
implementing partners.

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And the interest of community
members are reflected in it.

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As the vaccine is
given orally, it

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has high acceptance
and good participation

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from the community side."

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So here we see how engaging
with a variety of stakeholders

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and obtaining support
from political leaders

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can lead a program to
successfully reaching

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populations.

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And this highlights both
the process and the value

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of policy engagement.

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Policy engagement
can serve many roles,

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but largely it helps to increase
visibility of the program

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and garner support across
the national, subnational,

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and district levels.

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Some examples from our data
highlight the importance

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of policy engagement and the
different purposes it serves.

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Here on the slide,
we have a quote

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from a country program
staff in India.

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"One of the things I would
like to highlight-- right

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from the beginning, a lot
of political ownership

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in the program was there.

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So you could see people
organizing for the program.

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I give credit to the government.

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Also, because the accountability
mechanism like the district

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task forces that came into act.

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A district manager could be
accountable for the work, which

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had a big impact and
gave learning lessons."

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Policy engagement has the
power to increase ownership

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of policies by policy makers and
can also help create or enforce

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accountability mechanisms.

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So let's continue
with this question.

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Why is policy engagement
important in health programs?

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Another answer is
that policy engagement

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serves as a tool to
advocate for funds

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in order to sustain the
program in the context of very

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few remaining cases.

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The polio eradication
initiative has come a long way.

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But as with most
programs, the last mile

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is the most difficult. And this
is for a number of reasons.

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You may now be trying
to access the most

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hard-to-reach populations.

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And perhaps you've been
engaging with communities

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and policymakers
for a long time.

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Given political
cycles, individuals

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and decision-making
goals may have changed.

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Continuous policy engagement
can keep the health program

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on the agenda and among a
country's health priorities.

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Policymaking also
brings together

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a diverse group of stakeholders
from across national levels

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to commit and
together chart a plan

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it's this participatory and
collaborative approach that

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can help achieve buy-in as
officials at different levels

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are able to craft the approach.

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One WHO representative
at the global level

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recalled this process
in Ethiopia and said,

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"So he created this thing
called the high-level advocacy

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meetings or something
like that in Ethiopia.

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They were a brilliant
success because he

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was able to get local
leaders of the community

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with these high-level
advocacy meetings

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at Ethiopian state or regional
government levels engaged

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in and committed to polio.

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It was a dramatic change.

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And there happened
to be, because it

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was a regional technical
advisory group,

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there were people from the
Sudan ministry of health there.

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And this door cracked open.

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And we shoved our feet through
and dragged the project

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in with us.

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And a couple of
years later, there

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was a polio project
in South Sudan."

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Now that we've established some
rules that policy engagement

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can play and their value
in promoting and sustaining

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interventions, I would like
to describe this health impact

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pyramid, which
portrays the impact

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of different types of
public health interventions

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to improve health.

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At the base of this pyramid,
it indicates interventions

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with the greatest
potential impact.

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And these are efforts to address
socioeconomic determinants

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of health.

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Then as we move up
the pyramid, there

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are interventions that
change the context to make

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individual default
decisions healthy,

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such as policy interventions,
which is our focus today.

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By engaging with policy
and key stakeholders,

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the aim is to change the
context and thus reach

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broader segments of society.

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Socioeconomic factors
and changing the context

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really overlap
significantly and may

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be perceived as a constituent
of a single domain.

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In the next section,
we'll talk about some

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of the considerations
and approaches

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for changing the context
and for addressing

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socioeconomic factors
through policy.

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