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The Importance of Context

In this lecture, Malabika Sarker discusses different community engagement strategies tailored to different contexts.
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MALABIKA SARKER: We have watched the video on Pakistan and also saw the pictures in Afghanistan, and had a glimpse how challenging the context can be and how the context is important in terms of polio eradication. The context is particularly important for distinguish and identifying strategies for community engagement in standard scenario versus special or tough situation. While social mobilization is the primary approach used for community engagement in polio eradication, it is often insufficient as practiced and additional strategies are needed. In our study of community engagement during polio eradication, we can explore how context leads to differences and about what those additional strategies are.
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For the purpose of simplicity and clarity, when looking at context, we should first differentiate what we might consider a standard context or situation from what we might call special situation or for vulnerable population situation. Although the special situations may occur all too often, in some cases standard social mobilization is enough. Let us define the situation when the community has a reasonable trust in the government entity that is providing the health interventions such as vaccination. In addition, in this situation, there is adequate security and the population is accessible. The key issue in this situation is that the community is not sufficiently informed about the health program.
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The purpose of community engagement thus in these settings, as we’ll see, is often finding ways to increase the effectiveness of social mobilization. We are moving the community from accepting outreach and being consulted with minimal involvement to increasing collaboration and leadership with the health program. So what is special situation or vulnerable population? There are many potential situations that we might call challenging when trying to implement the health program in a community. We are unable to cover them all in this lecture. But in our study of polio eradication, the common situations we identified where special strategies [INAUDIBLE]. Low levels of trust in the government entity that is providing the health interventions such as vaccination.
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Or political insecurity creating changes in many ways, including community fear of participating in a health program, health worker fear of traveling to the health program or increasing distrust, and the interruption in supplies. Inaccessible or migrating population, making it more difficult than standard in locating, communicating with, engaging the community in the health program and bringing health service to the community. Some contribution of the above and other situations involving special or vulnerable population. In this situation, the task is attempting to get the community to a sufficient level of involvement versus more [? data ?] collaboration and leadership over the health program. Look at the photo. This is an example of special situation.
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Dressed in Rotary End Polio Now hats, I’m surrounded by bright banners, the cross-border health workers. Also watch out for children traveling across the border, presenting signs of acute flaccid paralysis, an indicator of potential polio infection. Vaccinators also speak to the parents, educating them about the importance of vaccines and the other immunization services that they can get free of charge in the country they are crossing to. For many, without free professional health, this is a crucial service. Most arrive unaware of the benefits they can gain to protect their children’s health. And this information is not always easy to come by.
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While standard social mobilization request less effort, but more exploring innovative and unique way to engage effective mobilizers or using mass media for deeper engagement. The special or vulnerable population, the dynamics is very different. That include building trust to over-resistance or cease-fire, days known as days of tranquility, when vaccinators are able to immunize children.

Malabika Sarker, MBBS, MPH, PhD James P. Grant School of Public Health, BRAC University, Bangladesh

Please review the reading Involvement of Civil Society in India’s Polio Eradication Program: Lessons Learned

Now, think about your context. Compare it to the chart on slide 2 in the attached slide deck and starting at minute-marker 0:23 in the lecture. Think about the lessons-learned outlined in the reading. Consider these questions:

What might work for your scenario – “Standard” mobilization or mobilization tailored to special or vulnerable populations? Why have you stated this?

Take a moment to share your thoughts in the discussion. Then, read other learners’ posts. Choose one and respond with a question to learn more about their context.

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