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Reaching Special Populations

Here, Malabika Sarker discusses strategies for engaging marginalized and hardest-to-reach populations. (Step 5.14)
MALABIKA SARKER: Reaching special populations is a vital component of polio eradication programs. The polio eradication [? liaisons ?] that can be used to vaccinate populations living in hard to reach areas and [? defined ?] including migrating populations by setting up vaccination at transit points to catch migrating populations, or temporary living places for vaccination teams near to where special populations visit. Mobilization, advocacy, and vaccination at places where people already gather, such as where influential elderly routinely meet, or vaccination at [? quack ?] centers, that means informal health providers, where children are taken for care. Visiting community leaders– traditional or religious– ahead of time, to obtain their acceptance of the program, is a vital strategy.
Doing this often helps achieve community acceptance of the health program and the health program workers visiting the community at a later time. Engaging religious scholars or experts to support the program in public communications and local meetings, by clarifying that vaccination does not contradict religious teaching. Encourage local religious leaders to support the program by providing supportive messages during weekly religious services. For example, increasing the number of mosque announcements in areas with large Muslim populations in Uttar Pradesh, India, led to significant measured improvement in the number of resistant households who ultimately accepted polio vaccination for their children.
Similar to the last, but with some difference, is the approach of having community health meetings that include the elders, religious leaders, and all the community to discuss encountered resistance and problem solve with the community. Getting community members to share the goal of polio eradication, address fears around the vaccine and all the vaccinators, and having local members come up with a way to vaccinate all children. For political insecurity, neutrality and trust is the key. In conflict situations, misinformation and distrust are constant companions, and the Global Polio Eradication Initiative has had to work hard to maintain, and sometimes regain, the public trust and belief in its neutrality.
Neutrality can be maintained only if the polio program is conscious of its actions, partnerships, and communications as critical elements of how others perceive its agenda. It is also essential that this belief in program neutrality be strongly held at all levels, from government, to local communities, to the most vulnerable and marginalized population. Community engagement is also key. Because conflict and security issues manifest themselves at all levels, it is just as important to focus on gaining the trust and involvement of local communities by being engaged with and listening to those communities as much as possible. Staff need to be local and supported by trusted local influences.
Information about local issues and concerns need to be an integral part of program planning and implementation. Communities also need to feel engaged, in that they have a voice that is not just heard, but has an impact on program approaches and how they relate to each community’s needs and priorities. There are different other ways that can be taken. Proper coordination with parties to conflict before entering their daily duties. Mosque to mosque approach in areas where house to house strategy is completely banned ULMA, or clergy conferences, to inform the public that polio eradication activities are not against Islam.
A letter from Mullah Omar urging local Taliban commanders to cooperate in polio vaccination campaigns, and reassuring parents that the campaign was a humanitarian activity was a very effective tool for polio eradication. Communicating and negotiating with the rebel, our opponent, can lead to a better outcome for public good. One example is with the support of the Democratic Republic of Congo government in Kinshasa, and US ambassador William Swing, USAID used back-door channels to develop relationships with rebel leaders in the East, and conveyed that eradication would be welcomed by parents, carried no monetary cost, and would be supported by the international health community. Ultimately, groups agreed to permit the vaccination initiative.
Both the president of Congo, Laurent Kabila, and rebel leaders have given their preliminary assurance that weapons would be laid down while Congolese children are sought out and vaccinated.

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

Please review the reading Reflections on Polio Lessons from Conflict-Affected Environments

On page 10 of the reading, review the diagram. Consider your context. For as many of the strategize as you can, give a brief description or bulleted list of how you might make use of that strategy.

Post your thoughts in the discussion. Review other learners’ posts. Respond to one with an additional suggestion for how they might make use of the strategies in their context.

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Building Alliances in Global Health: From Global Institutions to Local Communities

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