WEBVTT

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SVEA CLOSSER: So polio
eradication's largest,

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most extensive activity is
conducting polio campaigns

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for every child under 5 in large
portions of sub-Saharan Africa

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and South Asia.

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These are enormous projects
that require millions

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of workers vaccinating most
of the children in the world

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multiple times a year.

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So they collect a lot of
data on the efficacy of this,

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because it's through
these campaigns

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that polio would get eradicated.

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So today, we're going to
talk about two kinds of data

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that are collected
through campaigns.

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First, we're going to talk about
tally sheets, or the records

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that vaccinators keep as they
go door to door vaccinating

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children.

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And we're also going to talk
about post-campaign monitoring.

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And this is another
system that's

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used to understand how good was
coverage in the last campaign.

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The first example I want
to bring you-- and again,

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this is a slide from
polio eradication itself--

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is a slide from Indonesia
looking at campaign coverage

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data during a nationwide
campaign in Papua and West

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Papua provinces in 2019.

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And as you can see,
there's maps for each round

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of this campaign.

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And for each map, you
have different parts

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of the country labeled
green, yellow, or red.

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So what this means
is that in red areas,

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there was less than 60%
coverage with polio vaccine.

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In the dark green, there
was greater than 95%.

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So if you were a polio
eradicator looking

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at these maps, what would this
sort of campaign coverage data

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tell you?

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And what steps would
you take based on this?

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The answer here is a
little more obvious

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than some of the other
maps we've been looking at.

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In this case, the
areas that are red

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are areas that have low
vaccination coverage.

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And you might want to
go back and perhaps

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redo a subnational
campaign in those areas,

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or go look more closely
at what was going on

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to leave you with less than
60% coverage in this campaign.

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That coverage is not high enough
to eradicate polio probably.

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So in addition to just
seeing for example,

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how many children
recovered in a given area,

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polio eradication has developed
a series of process indicators

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that they can use to
understand the reasons why

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coverage in a certain area
might be higher or lower.

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So here's an interesting one.

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This particular slide is
from 2005 in Pakistan.

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And what we have here are
three maps of Pakistan.

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And what they're
showing is the percent

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of missing children recorded.

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So this is a little bit of
a complicated data point.

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So let's talk through
this for a minute.

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When a vaccination team goes
door to door, what they do

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is they write down information
on how many children were

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in the house, how many
of them were vaccinated,

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and the reasons that any
children were missed.

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These might be because
a kid wasn't at home,

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maybe they were visiting
their grandparents,

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maybe they were
sick and the parent

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was concerned that they
didn't want their kid

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to get a vaccine
when they were sick

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and they should come back later.

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Incidentally, that is
not really a concern.

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There's no risk to giving
a sick child polio vaccine.

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But it is something that many
parents are concerned about,

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or maybe the parents
were full on refusals.

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In any of those cases,
the vaccination team

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is supposed to write
down on their tally sheet

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but they couldn't vaccinate
the child and the reason why.

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So what this map shows is
overall with all the teams

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tally sheets taken
together, what percent

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of children on those tally
sheets were recorded as missed.

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And you can see in the red
areas of the country what

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the teams told their supervisors
on their tally sheets

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was that over 95% of
children were at home

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and vaccinated when
they came to the house.

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So this is a process
indicator that you

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can use to understand maybe
how thorough a team is being.

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If a team claims that more than
95% of the kids were at home

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and were vaccinated the
first time they came by,

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this is generally an
indication that they're

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trying to cut corners.

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Recording a missed
child means you

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have to go back to cover it.

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So it's more work for
the vaccination teams.

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But it's really not generally
the case that more than 95%

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of children are going to be
at home the first time you

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visit their house.

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So understanding how many more
children are being recorded

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is a way of understanding how
good your coverage actually

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is through somewhat
of an indirect means.

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This information can be
used in a lot of ways.

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You can use this to
think about, what

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are areas where we might
need to provide more training

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or support or supervision
for vaccination teams?

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Maybe what are the
reasons that teams

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aren't recording all of the
children that are missed?

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Now when you think
more deeply about it,

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what could be the
downsides or difficulties

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of using this information?

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Take a minute to
think about that.

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So as it turns out vaccination
teams learned quite quickly

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that this indicator, percent
of most children recorded,

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was important and that
the cutoff was 5%.

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So it actually resulted in
some cases in vaccinators

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manipulating the
data in their favor.

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So you can't always necessarily
rely on indicators like this.

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Instead, you need to go
out and check sample areas

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to actually know the truth.

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Here's another process
indicator from Pakistan in 2005.

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This is another map of Pakistan.

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And this one shows the
percentage of vaccination teams

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that had at least one female.

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So this was really
important, it still

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is very important in
much of the world.

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And in much of Pakistan,
it's actually not

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particularly acceptable
for unrelated men

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to go inside a house to
go vaccinate a child.

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Women, on the other hand,
are welcome into most houses.

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So women have much, much better
access to small children,

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especially to newborn
babies who generally are not

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allowed outside of the
house in some areas.

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So having a woman on
the vaccination team

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is a critical piece of
getting inside the house

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and getting to all the
kids that are needed.

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But in much of the country, over
half of the vaccination teams

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didn't have a woman on the team.

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So this was an important
process indicators.

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So collecting data
on this was a way

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that polio eradication
officials tried

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to think about what are some of
the reasons we might be missing

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children and what
can we do about it.

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So overall, there's
a lot of data

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that comes out of campaigns,
both in terms of coverage,

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but also in terms of process.

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And thinking about analyzing
and presenting this data

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has been a way that
polio eradication

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has tried to improve
campaign coverage overall.

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So to take this example of this
slide we're looking at right

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now, the percentage of teams
with at least one female

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in Pakistan in 2019,
about 15 years later,

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is much, much higher.

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