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Skip to 0 minutes and 8 seconds OLUWASEUN AKINYEMI: Reaching special population. Reaching every child.

Skip to 0 minutes and 14 seconds Population residing in mountains, deserts, remote areas, hard-to-reach areas, dense urban populations, and insecure areas raise significant challenges for polio programs. Sometimes managers are torn between ease of equity and management of financial material resources in terms of getting to the last child. So microplans for these areas need to consider some very important issues. Seasonal changes that intensify isolation– snowfall, floods. [? After ?] [? these occur, ?] for example, in some places in Nigeria, during the rainy season, some areas are cut off because there are no bridges. Likewise in some places like Afghanistan or some other places, there are periods of snowfall which make some communities very difficult to reach.

Skip to 1 minute and 14 seconds Some other things that need to be considered in microplans include access points for mobile, nomadic, and refugee population, as well as collaborating with neutral stakeholders in area of conflicts and unrest. So planning campaigns, tracking children, monitoring and evaluation require substantial time, innovation, and personnel. Is there other information that microplans for these areas should include? Please take a moment to reflect on this. How about slot slums? Strategies In Peshawar, Pakistan. Often unrecognized, lack infrastructure, are low priority areas for health authorities. That describes urban slums in many cities. Low on equitable coverage of health services and other important care services. Some people have described urban slums as people who suffer in the midst of plenty.

Skip to 2 minutes and 16 seconds For example, in Pakistan, the urban population rose from an estimated 43 million in 1988 to 73 million in 2014. Civil dispensary delivers health services to slum. Community-based polio vaccinators come to these facilities to review field books containing housing maps and vaccination records. And as you can see in the picture, polio vaccinators make a list of unvaccinated children for follow-up. And in turn, they also refer individuals to the health facilities to receive other routine vaccines and services. So the question is, what are some of the challenges involved in trying to reach every last child in such a population? What best practices could help with them? Where would integrating services in this scenario be particularly important?

Skip to 3 minutes and 16 seconds What is needed in this regard in terms of planning and monitoring? By integration of services, we mean other things that we might add to the polio vaccine in terms of maybe other vaccines or other commodities. Now in this graph, we see the geographic distribution of polio cases and Global Peace Index. On the left, we see years with polio virus cases from 2006 to 2015. And on the right, we see average Global Peace Index within the same period of time.

Skip to 3 minutes and 55 seconds And as you can see, on the left, areas where polio virus cases are still an issue– for example, Nigeria, Chad, and some of those countries, we can see that on the right there are still areas where the average Global Peace Index is also still poor. So we can summarize or conclude from that that polio seems to linger in areas where there are conflicts or where the Peace Index is poor. So final struggles of polio today are in areas of conflict and insecurity. With 95% of polio cases between 2012 to 2016 occurred in these settings. Conflict and insecurity critically affect the functioning of health systems and service delivery.

Skip to 4 minutes and 51 seconds That is planned activities come to a halt, access to [INAUDIBLE],, and safety of workers become a challenge. Addressing these barriers require planning and implementation of special strategies. What are the strategies available for running health programs in conflict areas? The first we’d like to discuss is the hit and run, which is when teams are accompanied by local leaders and law enforcement. That is no vision signs, no finger marking, no house marking. They just enter the community, vaccinate for just a few hours, and they leave. They do not return for a few days. So it’s, like the name suggests, hit and run. They do what they have to do, and they get out of the community.

Skip to 5 minutes and 42 seconds We also have permanent health teams, where health workers identify in non-secure zones, and plans are drawn collaboratively, and vaccination is conducted at a predetermined date, time, and location. Data are collected– and vaccines– at the end of the day at the designated time and location. So here we have health workers in that area who plan along with health managers who conduct vaccination at a predetermined time, and so on, who collect the data of people vaccinated as well as vaccine usage. And they are within the community. Lastly, on strategies for conflict areas, we talk about firewalling. And in firewalling area, you cordon off risky or non-secure zones before entering, and vaccinate children from high-risk zone when they enter these surrounding secure communities.

Skip to 6 minutes and 49 seconds So it’s like we provide a place of refuge. And whoever enter into that place of refuge is vaccinated. So that is firewalling. And those are the three strategies we like to discuss. Now we’ll go to some more country examples. We’ll start again with this quote from an Afghani health officer. Say, “This is a neutral program implemented in government-controlled areas, and we have agreements with the opposition groups for implementation. They–” that is the opposition groups– “recommend a coordinator, if he is qualified, we hire him. He should be a trustworthy person respected by the community. He should be able to talk to parents and elders.

Skip to 7 minutes and 39 seconds We cannot hire a person who is not literate, who is involved in conflict, who is armed and is not neutral.” So we see here a kind of– we can call it firewalling or permanent health team, where a neutral person implements this vaccination program in government-controlled areas. And There this agreement with the opposition so that they all agree that children in this area will be vaccinated. So in Afghanistan, access has been very difficult. And in insecure areas, microplanning is carried out in concert with opposition groups. Like we said earlier, one of the best practices for microplanning is involving the community, is assuring buy-in, is assuring bottom-up approach to planning.

Skip to 8 minutes and 40 seconds A lesson from the GPI is a critical importance of the program, remaining non-partisan at all levels. So when we do microplanning, we want to be sure that we talk about community participation. We don’t want it to be [INAUDIBLE] by politician. We want it to be as neutral as possible. Now let’s review some of the best practices that we have spoken about. The first is that we need to engage community. We cannot overemphasize the importance of community participation. Then, secondly, there is use findings for action. Microplanning must not remain on paper. It’s not just a paper exercise, but it’s an exercise that should improve our execution, our implementation strategies. Thirdly, we need to integrate microplanning across programs.

Skip to 9 minutes and 35 seconds So microplanning is not necessarily for polio immunization or vaccination only. You can use microplanning in [INAUDIBLE].. You can use it other health programs. These are the best practices we’d like you to take note of.

Skip to 9 minutes and 57 seconds [THEME MUSIC]

Reaching Special Populations: Reaching Every Child

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

Dr. Akinyemi describes the following scenario:

“Some people have described urban slums as people who suffer in the midst of plenty. For example, in Pakistan, the urban population rose from an estimated 43 million in 1988 to 73 million in 2014.

Civil dispensary delivers health services to slums. Community-based polio vaccinators come to these facilities to review field books containing housing maps and vaccination records. And as you can see in the picture, polio vaccinators make a list of unvaccinated children for follow-up. And in turn, they also refer individuals to the health facilities to receive other routine vaccines and services.”

Consider the best practices discussed throughout this lecture, as well as concepts covered in the Microplanning lecture, and reflect on the following:

  • What are some challenges in trying to reach every last child in such a population?
  • What best practices could help in this scenario?
  • Where would integrating services in this scenario be particularly important?

In the discussion forum, describe at least one strategy you might apply to the scenario in Pakistan. Then read other learners’ posts, and respond to atleast one post with a question to clarify their scenario.

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