The Importance of Politics: Hierarchies and Accountability

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

In the lecture we hear that, in many countries, cooperation and coordination for vaccination campaigns began with the national government, who then introduced the plans to the state and district governments. For a globally coordinated effort, international agencies must start from the top in order to ensure collaboration and buy in.

Reflect on this model of planning and management. Consider the following question and post your answers in the discussion:

• What are some challenges in setting up a top-down hierarchical system, where all core partners and donors first work with the national government, and then introduce the program to the state and the local governments?
• How might such a structure affect local acceptance and reception of the program?