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The Power of Engagement: Best Practices in Microplanning

In this video, Oluwaseun Akinyemi discusses some best practices for using microplanning learned from polio vaccination campaigns. (Step 2.7)
OLUWASEUN AKINYEMI: Hello. “Planning and Management, Beyond the Basics.” These are the themes we’ll be exploring in this module, the power for engagement, reaching special populations, the importance of politics, as well as the power of incentives. We’ll start with the first theme, the power of engagement, “Best Practices in Microplanning.” Microplanning fulfills its potential when it is more than a paper exercise. Microplanning is particularly a powerful tool when it is used as a platform for community engagement, program improvement, and health system strengthening. Some of the people refer to microplanning as community action plan or bottom-up planning. Best practices in microplanning involve ensuring that there is community participation. According to a Bangladeshi health officer, he said, “We made microplanning more participatory.
The community was involved in the microplanning. Political leaders would participate as well. By this kind of microplanning, when we were doing things precisely, we could see the whole of Bangladesh.” So it is very important to engage community members in microplanning, particularly community leaders directly in the microplanning process. Engaging community members, particularly community leaders, directly in the microplanning process has multiple benefits. It not only results in better data. It also builds stronger relationships and strengthens community engagement and buy in. According to health official from the Democratic Republic of Congo, “The microplanning that was implemented from the polio campaign extended to microplanning routine immunization activities and integrated even with maternal and child health intervention.” So we see that detailed microplans are powerful.
They also take substantial work. Challenges [INAUDIBLE] across health programs fulfill microplanning’s potential for broad health-system benefits. From this slide, we see examples of integrated microplanning from two countries, Nigeria as well as DRC and Somalia. From Nigeria, polio Geographic Information System, GIS, mapping was used to plan for routine immunization. And also in DRC and Somalia, we see microplanning included in routine immunization, routine immunization information. And this also shows availability of supplies as well as capacity of health worker. So we see that microplans are very powerful. They could be used to strengthen routine immunization, ensuring availability of supplies, and in management of human resource for health.
From India, a health official said, and I quote, “Polio brought that microplanning, which was not that robust and real micro in any other program, for bringing out those people. Polio brought out unserved and left-out populations like the brick cleans, the buses, or the construction workers, or slum migrant workers into the program focus. So it has created a system in the government itself which is still be used for other public health programs. And it’s helping a lot.” So from this quote, we see that microplans also help to promote equity by putting the spotlight on populations that might not easily be seen such as the poor, the migrant population, other population that are disadvantaged. So microplans, in that sense, are very powerful.
Again, another quote from Pakistan from a global-level policy maker, “To eradicate polio, you have to keep on vaccinating children time and time again, both in these poor villages in Pakistan, for example, there is some resentment by parents saying, oh, you keep coming back and vaccinating for polio, but we haven’t got any water, or we haven’t got any food, or my children just got measles.” So this is true in many developing countries. People are getting skeptical. And sometimes they’re becoming suspicious about the frequency of the polio vaccination. But what is the solution to this? Again from Pakistan, from that same global-level policy policymaker, they said, “So we responded to that by rotary setting of what we call health camps.
We don’t only do polio. They check for all sorts of things. And they give measles and TB. And we’ve set up permanent transit camps on the borders using whole shipping containers which are being converted into units that they can use to vaccinate children through health camps, provide information, you know, on all sorts of issues.” So we see that in order to deal with the issue of hesitancy as the result of the frequency in polio vaccination, there are some other very innovative methods are being developed in many countries.
Some people call it polio plus days, where they had other things than the polio vaccine in terms of during the campaign, like measles vaccine, like TB vaccine, like vitamin A, and in some places, insecticide treatments. So the question is, what would be involved in this sort of microplanning? I’d like you to take a moment to reflect on this. How would it be different than the usual microplanning?
From India, again from a health official from India, they said, “There were shortages of health manpower. And the microplanning was done in such a way that it could move people around and make sure that the vacant positions are not affecting the program delivery.” So microplans can be transformative when they are used not only for making work plans for a campaign, but for taking substantive action to improve health services. This is particularly true in reaching mobile or otherwise hard-to-reach populations which may show up on a health system readout for the first time through the microplanning process. Usually when we rely only on administrative data our census figures, it might not take into consideration migrant populations.
But when we do microplan, we are able to identify migrant population or other population that are disadvantaged. And we can better plan for them and make provision for them during campaigns or in the health system planning. What steps does this kind of engagements involve? I’d like us to discuss the example of the Social Mobilization Network strategy in Uttar Pradesh called SMNet from India. How is this relevant for the engagement for microplanning and reaching hard-to-reach populations? The SMNet’s goal was to improve access and reduce family and community resistance to vaccination.
The partners trained thousands of mobilizers from high-risk communities to visit households, promote government-run child immunization services, track children’s immunization history, and encourage vaccination of children missing scheduled vaccination, and mobilize local opinion leaders. These social mobilizers maintain detailed maps of their communities and visited their assigned household at least once each month to promote polio vaccine campaigns. Using specially designed registers, CMCs tracked pregnancies and routine and polio vaccination status of newborns, children under five, and pregnant women, sending their register data to their supervisors monthly. They also level data that were aggregated at community and district levels, provided critical inputs for microplanning as well as for senior staff to provide rapid feedback and provide regular supervisory capacity building to staff.
As the campaign became more organized, campaign implementers used real-time data in nightly government-led debriefings to support rapid situation analysis and problem solving, especially for hard-to-reach areas.

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

In the lecture, this quote is shared to highlight innovation through integrated microplanning, through an example of overcoming vaccine hesitancy in a community:

“To eradicate polio, you have to keep on vaccinating children time and time again, but in these very poor villages in Pakistan, for example, there’s some resentment by parents, saying, ‘Oh, you keep coming back and vaccinating for polio, but we haven’t got any water, or we haven’t got any food,’ or, ‘My children just got measles …’ So we responded to that by Rotary setting up what we call health camps, which don’t only do polio … they check for all sorts of things and they give measles and TB … and we’ve set up permanent transit camps on the borders using old shipping containers, which have been converted into units that they can use to vaccinate children through health camps, provide information, you know, on all sorts of health issues.”

— Global-level policymaker

Reflect on this quote and the reading “The Power of Microplanning” to respond to this question:

What would be involved in microplanning in this scenario? How would it be different than microplanning completed for regular vaccination campaigns?

Post your thoughts in the discussion.

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