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Reaching Special Populations

Watch as Malabika Sarker discusses HR problems presented by working to reach special populations on the road to polio eradication. (Step 4.9)
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MALABIKA SARKER: A wide spectrum of categories considered as special are vulnerable populations. The word simply implies the subsegment of the population. But remember, any of us can become vulnerable if the context changes for any reason, and coronavirus outbreak in 2020 is one of the examples. However, reaching special or vulnerable populations is a well-known challenge in many contexts. The polio virus remains in just a few small pockets around the world. These final hiding places are some of the most challenging settings in which to eradicate a disease. Health workers around the world are working tirelessly to vaccinate every last child in these hard to reach places.
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Some areas are vast and sparsely populated, such as the broad plains and riverbeds, making up areas of the Lake Chad region. Other are densely packed residential areas of Afghanistan, where security issues can sometimes make immunization difficult. In areas of Syria, civil war continues to rage through towns, communities, and families. Polio health workers must deal with all of these challenges. We do not want to leave anyone behind. The effort to vaccinate every last child, health workers traverse mountains, cross rivers, move through the deserts, travel by boat, travel by motorbike, even vaccinate the children whilst traveling by train. Recruiting and retaining skilled and motivated health workers to travel to remote areas and carry out program activities remains a critical challenge.
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Isolated areas often lack health facilities, health care services, basic medical equipment, and medicine. As it is called, sizeable cadres of health workers are deployed to these areas in an effort to reach every child. However, maintaining morale can be difficult due to having to undertake exhausting journeys for many hours, compounded by the lack of adequate accommodation and food. These challenges result in worker fatigue and subsequent failure in reaching program targets. The strategies for enabling health worker to reach special populations include recruiting and training volunteer selected from the community, redirecting the staffs from an existing program, identifying and negotiating with local vigilantes for ensuring the safety of the health workers.

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

A polio workers from Nigeria states;

“Yeah, they are usually bushes, there are hinterlands, that’s understandable, but a particular place where I actually need to complain is, there’s a particular place where I had to cross the river in a makeshift boat, not a proper boat, makeshift boat that our, that they are putting cars on the canoe, I won’t even call it boat, I will call it canoe, call it big canoe with cars and people will go on it, go across the road … What if anything happens on the sea and there is no life jacket provided?”

Reflect on this quote and the solutions outlined in the lecture. Think about the experience of the health workers in these photos. Respond to the following:

  • What do you think motivates healthcare workers to do this work?
  • Despite their experiences of working under tough conditions, what do you think might the workers find fulfilling?
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Planning and Managing Global Health Programmes: Promoting Quality, Accountability and Equity

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