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Vertical vs. Integrated Approaches

Here, Malabika Sarker discusses challenges and strategies in engaging communities in vertical programs.
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MALABIKA SARKER: The specific pros and cons associated with vertical and integrated approach are well known, the vertical approach being a disease-specific, top-down approach that makes it easier to opt in funding and measure results, and the horizontal approach being a more comprehensive approach that seeks to treat all the underlying issues related to health system. Let’s return to the Nigeria example. To what extent are the challenges we reviewed a few slides ago related to the vertical nature of the program? What about in the Pakistan example? To what extent are the challenges related to the vertical nature of the program?
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The problem with the vertical approach is this is often disease-specific, hospital-based, medically driven program focusing on single problem, and often undermine community engagement and not sustainable. The integrated approach includes community engagement and participation, focusing multiple intervention. Out of this conviction grew India’s Social Mobilization Network or SMNet. In [INAUDIBLE],, thousands of mostly young women from the communities they worked in who met with parents and caregivers individually to understand their concerns and explain the purpose of the polio drops. Social mobilizers enlisted local influencers, religious leaders, teachers, and doctors to support vaccine campaign and help them talk to parents. They hosted mothers groups that addressed health issues beyond polio, including hygiene and health, breastfeeding, and nutrition.
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Groups running the SMNet, UNICEF, and the core group Polio Project developed indicators to measure the performance of social mobilization so they could prove to the data-driven epidemiologist and physician running the polio program that the approach was working. Let’s take a look at this butterfly diagram developed by the SMNet, our Social Mobilization Network in India, India’s polio communication program. The program incorporated several messages. Breast feeding, [INAUDIBLE] with the polio messages. Most polio staff embraced this because, after years of polio messaging, they could do more. The answer of this question I’m asking you to think, can engaging communities be as simple as providing service? After finishing this lecture, I would also like you to think and try to answer the following questions.
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Given your experience and the information provided in the lecture and the case study, how would you apply what you have learned about community engagement during polio eradication efforts to the non-polio situation described? Also to identify potential communities or community groups in the case study that might have different views about Ebola and how it is controlled. Finally a few more questions to think about.
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Describe what you see as the critical problem related to community engagement in this situation, but also describe in detail at least one strategy you would recommend– to clarify the key actors in your strategy and what those actors should do, describe the expected results, and describe at least one potential negative response to your strategy and how you might prevent that response. Thank you.

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

In the video, the lecturer asks: can engaging communities be as simple as providing services?

What do you think? Share your thoughts in the discussion.

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