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Skip to 0 minutes and 7 seconds OLUWASEUN AKINYEMI: Let’s talk about health equity and polio eradication. Let’s start with the example of polio vaccination nomads in Chad. Some populations, such as nomadic tribes, they are constantly migrating. The Global Polio Eradication Initiative has developed innovative ways and targeted strategies to reach such populations. The intervention strategy described on this slide resulted in an increase in the numbers of children vaccinated in all districts, though coverage rates were still low. Still another example of polio vaccination of nomads in Chad.

Skip to 0 minutes and 50 seconds The polio vaccination was a combination of appointment of staff to oversee implementation, engagement of partners, both at the national level and at the international level, participation as shown by tribal leaders, and promoting intersectoral collaboration, both animal and human health services, and by showing the flexibility and capacity of vaccinators. So please take a moment to reflect, why do you think these strategies were successful? What do you think should be done in order to support policy queries and sustainability of the gains that were achieved to this work with nomadic populations in Chad? Think about the kind of challenges or limitations they were trying to overcome and the appropriateness of these strategies.

Skip to 1 minute and 43 seconds Now going on to other marginalized populations like refugees and migrants and how to ensure equitable access for this group. Currently, this population is of interest because of the global migrant crisis. And health systems, many health systems are not prepared for this influx. However, they need to adapt to these realities and accommodate this migrant population. In many climes, refugees have limited access to public health services, including immunization. However, this will put the host population at risk if this migrant population are not immunized. The reason for migration of the refugee population is also often complex and not solely within the purview of the health system to resolve.

Skip to 2 minutes and 34 seconds However, given the number of migrants and the conflicts and inequities faced by the world today, working to strengthen the services are available to this population is a moral and ethical obligation and necessary in order to achieve many global health goals, including polio eradication, as well as universal health coverage and sustainable development goals. Undocumented migrants and female migrant workers are about the most vulnerable of these migrants subgroups. No true universal health coverage may be achieved without paying attention to refugee and migrant health access. So why are eradication programs often better than control programs at reaching the world’s most disadvantaged population? I’d like you to take a moment to reflect on that.

Skip to 3 minutes and 27 seconds Why do you think eradication programs are better than control programs at treating the world’s most disadvantaged population? The answer is that they have to be. To get to 0 cases, you have to get all the cases. And that means reaching the most disadvantaged and inaccessible people, the people that many control programs don’t reach. Now let’s talk about the ethics of equity and eradication. The Chad example shows how polio eradication has been motivated to and has successfully reached some of the world’s most marginalized people with the polio vaccine. However, we sometimes did not provide them with other health benefits.

Skip to 4 minutes and 12 seconds The importance of equity in health, particularly polio eradication, is highlighted in these slides, as well as several other slides later in the lecture. The key message is that socioeconomic circumstances is disproportionately represented as a driver of health status. Therefore by implication, if the issue of inequity is dealt with, a major proportion of all problems will be resolved. For example, wherever water and sanitation and routine immunization are in place and of high quality, polio often disappear with few or no campaigns. Therefore, improving these two systems globally will also have huge impact on health equity beyond polio. So it’s not just enough to provide campaigns or to provide routine immunization.

Skip to 5 minutes and 3 seconds We also have to provide an ideal environment to eliminate the transmission of polio virus by ensuring availability of potable water as well as adequate sanitation. Still talking about the ethics of equity and eradication. I’d like you to consider this question in a moment. Is it possible to eradicate through the slow route of trying to improve WASH and RI, rather than relying on polio campaigns? Is it realistic to expect that this will be provided to nomadic population, population affected by a conflict or the most marginalized homeless and everywhere in the world? I want you to take a moment to reflect on that. Is it possible?

Skip to 5 minutes and 48 seconds Again, I’d like you to consider whether it’s ethical to reach the world’s most disadvantaged population, and then only provide them with polio vaccine when polio is not the most serious health issue affecting them? Imagine going all the way to reach the population in a very difficult to reach area of your country, and then only getting there with polio vaccine, where there is an outbreak of measles, or the children have diarrhea, or they’re suffering from malaria, and then they are wondering what is it about the polio? Why are you only coming all the time with polio? So what will you do if you are the director of polio program in Chad?

Skip to 6 minutes and 27 seconds Will you only go with polio vaccine and when you reach people, you have no other service to offer but polio vaccine? Now let’s look at ways in which polio program has helped to reduce inequities in other programs. This potential of improving routine immunization through polio infrastructure has worked to reach some other places better than others. It requires a lot of work and initiative. So there is a potential of improving routine immunization to reach all population by leveraging on polio infrastructure. And this has been leveraged on in many countries of the world. The Globe Polio Eradication Initiative has improved funding of immunization in other areas such as microplanning, cold chain, and providing support to shudder the cold chain works.

Skip to 7 minutes and 23 seconds What’s your opinion on other areas that polio infrastructure resources could be used to support routine immunization? I’d like you to take a moment to reflect on that.

Skip to 7 minutes and 37 seconds Take a moment to talk about policy queries and program sustainability. Policy queries to mainstream social determinants in both health and other sectors will have long term sustained impact of positive health outcomes. To ensure that our programs not only address health equity, but that they are sustained over time is essential. For this policy coherence when different government, departments, policies, complements rather than contradict each other in relation to the production of health and health equity. Adequate budget allocation, political commitment across all relevant sectors to overcome challenges in bringing poverty across all socioeconomically deprived communities is essential. Adequately resourced plans and programs to address equity within the implementing environment includes provision of services, infrastructure, information, and communication.

Skip to 8 minutes and 42 seconds As you may see in the picture on the right, the woman is providing information to the community members and it is very critical in ensuring policy coherence and program sustainability. Adequate information– adequate correct information is very critical. Still on policy coherence and program sustainability. So existing power structures and political economy should be sensitive and responsive to address health equity and social justice within the community. When these happen, it is a win-win situation for everyone. But when they do not, then alternative strategies are needed. So how do health system influence equity? In every country the last case of polio are always among the poorest, most disadvantaged people living and working in the worst conditions in the community.

Skip to 9 minutes and 40 seconds Over the years, health sector strategy has transformed from a disease centric style approach to– let me take that again. Over the years health sector strategy has transformed from a disease centric silo approach to health systems strengthening approach. Achieving equity in health outcomes remain a challenge among the socioeconomically disadvantaged social groups and individuals. Therefore, there are many health equity indicators within the core health system’s building blocks that are essential for measuring health inequity outcomes. This demands a partnership strategy beyond the government structures and involve key stakeholders, institutional and development partners for advocacy and effective implementation of health programs based on distributive justice and human rights principles.

Skip to 10 minutes and 36 seconds Therefore, the health sector needs to take the lead by analyzing the social determinants of health among disadvantaged multi-generalized group and excel the impact of the action on these groups.

Health Equity and Polio Eradication

Oluwaseun Akinyemi, MD, MPH, FWACP, FRSPH, PhD
College of Medicine, University of Ibadan & University College Hospital, Nigeria

Please review the reading Polio outbreak among nomads in Chad: Outbreak response and lessons learned. Then, consider this excerpt from the video:

I’d like you to consider whether it’s ethical to reach the world’s most disadvantaged population, and then only provide them with polio vaccine when polio is not the most serious health issue affecting them? Imagine going all the way to reach the population in a very difficult to reach area of your country, and then only getting there with polio vaccine, where there is an outbreak of measles, or the children have diarrhea, or they’re suffering from malaria, and then they are wondering what is it about polio? Why are you only coming all the time with polio?

So, what might you do as the director of polio program in Chad?

Post your thoughts to this excerpt in the discussion.

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