So, again, in review, we've talked about three
broad methods of diagnosing training needs, gathering information.
We've talked about reviewing documents.
We've talked about interviewing the people concerned.
And we've talked
about observing the process of providing health
services, observing the health workers perform their job.
And it's important to bring all these methods
together in a process of what we call triangulation.
If you recall how people determine where a
earthquake is actually centered and where help is needed.
They use a process of triangulation.
The shock waves move through the earth, and various sensing centers
pick them up.
You can remember from way back from geometry.
If you have two points, you have a line.
It takes three points to create a plane.
And those three points, if you draw, when they pick
up the timing and the intensity, when they pick up the
shock from the earthquake, if you draw circles around them,
where the three circles intersect should be the point at which.
The earthquake actually happened.
And the same thing, if we have three different
methods of collecting information, they can validate each other.
We can determine, in fact, what is the
core issue that training may be needed for.
Let's look at the example of polio eradication.
We see that records may show increasing number of children receiving
the immunization during state-wide campaigns
but reports from sentinel servailance sites.
Throughout the country show that there are new cases of wild polio virus popping up.
This is a serious problem in Nigeria as we can see from the map.
All those red dots are, and blue dots
are where wild polio virus has been found recently.
And they seem to be clustered in the north central part of the country.
So, even though people are.
Giving feedback
that oh, yes, we're immunizing, so, so many children, something must be wrong,
because we are seeing that the virus still persists.
Again, we look at our reports, and these reports sometimes show that the
number of children being vaccinated during
these house-to-house campaigns are approaching the targets.
But the projected census from the state indicates that these targets may only
represent about 80% of the likely population.
Our census data may be off or the targets may not have been calculated properly.
We find that the issue of calculating population
growth based on census may not be done properly.
The growth rates may have been different in urban versus world districts and so.
You know, even though it looks like we're approaching
targets, we may have been using the wrong denominator.
The wrong baseline.
Also, one thing, in terms of documents that
we've seen in a number of newspaper articles.
in that part of the country, is that the people are
complaining that the government is trying to sterilize our children with vaccines.
So something is not right.
We look like, by the reports of the staff who
are going out doing the vaccination, that we are doing fine.
But based on our recalculation of the census we are not meeting that and
secondly the community members are complaining
that the program is damaging their children.
What is really going on?
It is necessary to use. Interview to check these documents.
Discussions may be held with village elders.
People talk about the fear of sterilization.
They were worried the vaccinators, some of them are male and the women and
children are in the house and the men should not enter into the compound.
These, these strangers who are bringing the vaccine and one elder in the
village discussion said look, here behind those
bushes in the entrance to the village.
Look at all these discarded vials of vaccine.
They haven't even been used.
And then you start to wonder, well, what's going on?
So, you've observed the vaccine being thrown away behind the bush.
You hear the villagers complain about the performance of the health workers, their.
Fears about the vaccine. Then you talk
to the, the health workers.
And again, this is a sensitive issue, so you might have
informal discussions with them, so they don't feel pressured by you.
But then they point out that, yes, there is political pressure.
The President's wife is leading the immunization effort.
If you don't give good reports, then you may be queried in your job.
So, even though the villagers don't want the thing, we still
fill in information that makes it look like we're achieving our targets.
They believe that the village police and customs are an impediment to health.
They have a negative attitude toward the villagers.
And they don't even think it's their job
to question the accuracy and the appropriateness of the
target goals, figuring out the number of eligible children,
doing house census, giving feedback and readjusting their targets.
They just do what they're told to do
because the President's wife wants to see good results.