This document discusses challenges in providing healthcare to hard-to-reach populations and strategies to address them. It identifies common hard-to-reach groups as children, women, drug addicts, religious minorities, homeless people, and racial minorities. Key challenges include lack of access to services, poor infrastructure, cultural and language barriers, and stigma. Public health workers can help by improving services, data collection, infrastructure, cultural communication, trust-building, resource mobilization, and partnering with local leaders. Tackling stigma, training local healthcare workers, and community involvement in decision-making are also recommended.

1. Hard to reach people
Dr Jameel Kifayatullah

2. Hard to reach people
• Hard to reach or seldom
heard groups are defined as
people that are typically
under-represented in the
planning or development
process, or in wider public life

3. Who are Hard to Reach people/Marginalised
People
• CHILDREN
• LACTATING MOTHERS
• FEMALES OF CHILD BEARING
AGE
• DRUG ADDICTS
• TRANSGENDERS
• RELIGIOUS MINORITIES
• HOMELESS PEOPLE
• RACIAL MINORITIES

4. Why focus on this group?

5. Why focus on this group
• Poor Health outcomes –> To
promote health Equity
• Preventing health
crisis larutan dna scimednap:
sretsasid
• Social justice: equal opportunities
and access to resources
• Public Health impact: Addressing
vulnerable people health needs
prevents the spread of Diseases
• Humanitarian reason:Driven by a
sense of compassion and desire to
help those that are in need

6. Challenges faced by public health worker in
hard to reach people
• Lack of access to basic health services
• Lack of reliable data on the health status of these populations
• Poor infrastructure and transportation in these areas
• Language and cultural barriers
• Lack of trust between public health workers and the community
• Limited financial resources for health interventions
• Low literacy rates
• Conflict or instability in the area
• Political or religious resistance to health interventions
• HIV-related stigma and discrimination.

7. Challenges faced by public health worker in
hard to reach people
• Gender inequality and traditional gender
• Isolation of communities from the broader society
• Insecurity and fear of violence
• Environmental hazards and lack of clean water and sanitation
• Disease outbreaks and epidemics
• Geographical remoteness
• Poverty and lack of economic opportunities
• Migration and displacement

8. 1) Lack of health care access

9. 2) Lack of reliable data on health care of hard
to reach

10. 3) Poor Infrastructure and transport in these
areas

11. 4) Language and cultural barriers

12. 5) Lack of trust between public Health care
Worker and community

13. 6) Limited Financial resources for health care
intervention

14. 7) Low literacy rates

15. 8) Conflict or instability in the area

16. 9) Political or religious resistance to health
interventions

17. 10) Stigma and discrimination
• People with HIV /AIDS
• Transgender or sex workers
• Migrant and Refugees
• People with disablities

18. 11) Gender inequality and traditional gender
role

19. 12) Isolation of the community from the
broader society

20. 13) Insecurity and fear of violence

21. 14) Environmental hazards and lack of clean water
and sanitation

22. 15) Disease outbreaks and epidemics
Ebola virus out brak West Africa
WHO: XDR typhoid outbreak in Pakistan tops 5,200 cases
Chris Dall | News Reporter | CIDRAP News
December 28, 2018

23. 16) Geographic remoteness
• Geographic remoteness is
essentially a measure of a
physical location's level of
access to goods and
services. Large population
centres tend to have a greater
range of goods and services
available than small centres.

24. 17) Poverty and lack of economic
opportunities
• People unable to pay for
vaccinations and basic health
services
• No access to clean water
• Malnutrition
• Lack of shelter

25. 18) Migration and displacement
• Migration is defined as the
movement of persons away
from their place of usual
residence, either across an
international border or within a
state. It can be viewed both with
positive connotations (e.g.
moving to start a new job,
seeking better living conditions)
or with negative connotations
(e.g. escaping political
oppression, conflict, violence,
disaster or human rights
violations)

26. Addressing the challenges as public health
worker
1) Improving the quality and availability of basic health services in these
areas
2) Improving the collection and analysis of data on the health of these
populations
3) Investing in infrastructure and transportation improvement
4) Developing culturally appropriate communication strategies
5) Building trust through community engagement
6)Mobilizing local resources and community involvement
7) Partnering with local organizations and leaders
8) Providing incentives for health workers to work in these areas
9) Tackling stigma and discrimination through education and sensitization.

27. Addressing the challanges
9) Developing and testing new health technologies in these areas
10) Training and deploying health workers from within the community
11) Developing health policies that are inclusive of these populations
12) Involving the community in decision-making and planning processes
13) Using participatory approaches to health promotion
14) Working with local media to increase awareness and understanding of
health issues
15) Investing in research and evidence-based interventions
16) Empowering communities through education and skill-
building(vocational training)

28. 1) Improving the quality and availability of
basic health services in these areas

29. 2) Improving the collection and analysis of
data on the health of these populations

30. 3) Investing in infrastructure and
transportation improvement

31. 4) Developing culturally appropriate
communication strategies

32. 5) BUILDING TRUST THROUGH COMMUNITY
ENGAGEMENT

33. 6) Mobilizing local resources and community
involvement
PAKISTAN POLIO ERADICATION
PROGRAMME MOBILIZATION
• Social Mobilization (SM), as
defined by UNICEF, is a broad-
scale movement to engage
people’s participation in
achieving a specific development
or health goal through self-
reliant efforts

34. 7) Partnering with local organizations and leaders

35. 8) Providing incentives for health workers to work
in these areas

36. 9) Tackling stigma and discrimination through
education and sensitization

37. 9) Developing and testing new health
technologies in these areas

38. 10) Training and deploying health workers
from within the community

39. 11) Developing health policies that are
inclusive of these populations

40. 12) Involving the community in decision-
making and planning processes
• 1. Build community
capacity
• 2. Create social capital
Social capital is a set of shared values or resources that allows
individuals to work together in a group to effectively achieve a
common purpose
• 3. Ensure compliance

41. 13) Using participatory approaches to health promotion
• What are the commonly used
participatory approaches?
• Community mapping, transect
walks, focus group discussions,
gender role analysis, use of
drawings, posters, role-play,
theatre, and songs are examples
of participatory methods. There are
lots of participatory
tools/techniques available to help
guide the process.

42. 14) Working with local media to increase awareness and
understanding of health issues

43. 15) Investing in research and evidence-based
interventions

44. 16) Empowering communities through education
and skill-building(vocational training)
HOPE ENHANCES WOMEN EMPOWERMENT THROUGH
VOCATIONAL TRAINING | Health Oriented Preventive
Education -HOPE Vocational Training to Empower Adolescent Girls - Smile Foundation

45. WHAT INTERVENTIONS DONE
• DEVELOPMENT OF A MICROPLAN
• COMMUNITY MOBILISERS
• MASS MEDIA CAMPAIGNS
• SOCIAL MOBILISERS
• VACCINATION BRIGADES

46. Examples
• Overcoming vaccine deployment challenges among the hardest to
reach:lessons from polio elimination in India
• India was certified polio free by WHO in 2014.
• On August 24, 2020, Nigeria recorded a monumental success
by achieving the aim of a “wild polio-free country” after
completing three years without any case of
wild poliovirus (WPV).

47. Polio Eradication in Nigeria - The Rotary
Perspective (Hardcover)

48. References
• https://www.dawn.com/news/1628652/literacy-rate-stagnant-at-
60pc
• Ifad.org
• https://coregroup.org/wp-content/uploads/media-
backup/Polio_Initiative/smreport-online.pdf
• UNICEF
• WORLD HEALTH ORGANISATION
• USAID
• https://www.childrens.com/health-wellness/5-ways-to-end-mental-
health-stigma

49. References
• https://botswana.unfpa.org/en/news/leaving-no-one-behind-use-
drones-overcome-healthcare-challenges-hard-reach-areas
• https://www.unicef.org/niger/press-releases/health-workers-trained-
covid-19-infection-prevention-and-control
• https://www.murderbooks.com/book/9786604636531
• https://www.slideshare.net/sarynieman/participatory-approach

50. References
• https://arynews.tv/do-boond-pakistan-ki-khatir-polio/
• https://www.smilefoundationindia.org/blog/vocational-training-to-empower-adolescent-girls/
• Overcoming vaccine deployment challenges among the hardest to reach: lessons from polio
elimination in India Alejandra Bellatin ,Azana Hyder, Sampreeth Rao, Peter Chengming Zhang
,Anita M McGahan.
• Eradication of wild poliovirus in Nigeria: Lessons learnt. Osmond C. Ekwebelem ,Obinna
V. Nnorom- Dike , Abdullahi Tunde Aborode , Nicholas C. Ekwebelem , Job
C. Alekeb, Ekenedirichukwu S. Ofielu. Public Health in Practice Volume 2, November 2021,
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