Roundtable discussion: The Importance of Engaging National Governments

SVEA KLOSSER: Hi. My name is Svea Closser, and I’m a professor here at the Johns Hopkins Bloomberg School of Public Health. I’m really fortunate to be here today with two experts from two different countries in our consortium, working on this project. We have Malabika Sarker from Bangladesh, and Seun Akinyemi from Nigeria, here to talk about the importance and strategies for engaging national governments in disease control programs. Thank you so much for being with me today, and I really look forward to hearing from your expertise. So let’s start with the obvious question. Seun, can you start us off with what’s the importance of engaging national governments if you are trying to do a global disease control program?

SEUN AKINYEMI: Thank you very much. And getting national government is very, very important in ensuring that a polio program– or any program that all– works at the end of the day. One important reason why it’s important to [? maintain ?] national government is for sustainability. Many times, when donors come, eventually with time, they pull out. So if national governments have not been engaged, they will not be invested in the process to keep on funding the program. And another reason is to ensure ownership of the project so that the country can see the project as theirs, and not just what some people are coming to do from outside.

And a third important reason, for me, is that to improve confidence of the people, because many times, when the community members or citizens of a country– when they don’t see their national government leading a project, they’re kind of skeptical on why these people are coming. But when they see their national government is leading the process, there is confidence. And this is very, very important in ensuring ownership, accountability, and then sustainability. So I think it’s fairly important to engage national government in any program.

SVEA KLOSSER: Yeah.

MALABIKA SARKER: Just to add to what Dr. Seun said, that it’s also important that only the government can scale up a program. It’s no other private or NGOs or faith-based. Only the government can do that. And for that reason, it’s very important to have a responsive public health policy– or the public policy– which can ensure that inclusion and also be equitable, like the delivery of the service. And only the national government can do that, and so it’s very crucial. I agree with completely Dr. Seun that it’s very, very important to include the national government in terms of the strategy, and also the strengthening the partnership.

SVEA KLOSSER: Yeah. So how do you do that? If you were working for the WHO or Unicef– one of these big agencies that are global and working on polio eradication– what are some great strategies for engaging national governments?

MALABIKA SARKER: I think, like, the key for engaging is to ensure that the national government understands that it’s a shared vision. It’s not something that is imposed by the external forces. So as soon as the government realizes that it’s a shared vision, and there’s a mutual respect to each other and it’s in alignment with the national policy, so definitely sometimes, of course, the government might have different priorities. But as soon as that, I strongly believe that the government alleges that it’s a shared vision, and with mutual respect, they will be keen to be part of that. But at the same time, it’s very important to develop the capacity of the government.

Whenever we come with a shared vision or an objective, we need to look critically that, OK, how much capacity building is important, and what is necessary, and to engage government in informing in the capacity building.

SEUN AKINYEMI: In addition to what Malabika has said, I want to add that when engaging national government, you should do that right from the beginning, from the planning phase. So we often talk about community [? backed ?] suspicion versus community involvement. You don’t to involve people when you have done other planning, so you want to bring them home from the planning. Just like she said, so that the planning will be contextual, you factor in the priority of the government and then you design the program together. With that, they will feel a sense of ownership and they’ll be able to take it forward– even when the donors are ready to scale back.

SVEA KLOSSER: Yeah. So there’s a real challenge in this. I think all of what you’ve said makes complete sense, and is very, very important. There’s a challenge in an eradication program, because you have to get every country on Earth to be involved at the same time. And so what do you think about some of the challenges of that? I mean, chances are there’ll be some government that isn’t aligned with those priorities, or maybe is consumed with other problems. You know, what can you do in that situation, or is that just a problem with the goal of eradication? What do you think?

MALABIKA SARKER: Again, like that shared vision, mutual respect, and sense of ownership is important. But here, we also have to realize that the stages of eradication is not the same in each country. The countries have a very different sets of problem. For some countries, it’s almost eliminated. There’s a question for the sustainability. There’s a country still suffering from endemic polio [? education. ?] So the objective, our goal of the program, have to be realistic and country-specific.

Then we can go to different countries and make sure that the countries can participate, because we should not have a blanket approach that every country have to eliminate by 2021, so that if we are very sensitive about the context and the problem and the capacity of the government also. And then, I think, each country can take participant, and then we can achieve the realistic goal and the approach.

SVEA KLOSSER: Yeah.

SEUN AKINYEMI: In addition to that, I think that some [? organizations, ?] of the UN through the World Health Association, We’ll talk about World Health assembly, where all the countries of the world are participating [INAUDIBLE] their ministers of health. I think through such [? organizations, ?] we can ensure that people have a buy-in. Although, when they get to their different countries, this has to be domesticated. But at least through such [? organizations, ?] it’s very important if you can discuss. People can raise objection. We can talk about their own preferences, and then this can be fine tuned. And then it can be domesticated in individual countries [INAUDIBLE].

SVEA KLOSSER: Great. Well, thank you both so much. This has been incredibly illuminating, and I really appreciate your time. Thank you.

SEUN AKINYEMI: Thank you very much.

MALABIKA SARKER: Thank you.