In the reading this week about strengthening delivery of interventions through program assessment guides, the issue of delivering health care to neglected populations is raised. Many people are looked over in the implementation process due to diverse reasons: remote location, migrant or transient communities, ethnic or religious minorities, very low income households or communities, children of single mothers, institutionalized children, etc. The author encourages reconsideration of how interventions are implemented, and calls for notice to be taken of these neglected groups and individuals. It is suggested that a community-based approach be taken to resolve this problem. Through this approach, people or organizations that the caregivers may come into contact with can be used as a platform for delivering supplies, education, and advocacy, and these people or organizations are referred to as contact points. I think that using a community-based approach to solving this problem is the right direction to take, although I am skeptical of how using contact points as a platform will be implemented to create inclusion of a diverse range of people. There are no instructions or suggestions mentioned in the article regarding what to do once a contact point is established. It is not clear whether or not merely establishing contact points will produce inclusion of neglected peoples. I think that reaching these distant or unknown groups will be more complex than just having a sort of advocate who is aware of the intervention.

From my experience in Senegal, I can say that it is true that there are many people who live in remote areas, and are not included in the studies and health interventions that I saw being conducted in Senegal. These programs were taking place in the main cities, rather than in remote locations, and thus anyone who was distant from a main city rarely received any services or benefited from interventions. In addition, I found that there are groups of people who are excluded based on other factors, such as religion. For example, the Christian population in Senegal was only about 4% of the population. Therefore, most interventions in the area targeted the majority religion, which is Islam. I could see this was a problem in the family planning clinic, because even in a community setting, some people were neglected due to the persistence of social pressures. It was apparent that in the clinic, Muslim women were the ones in charge, and that they placed a certain pressure on patients to act in a similar fashion, i.e. engage in sexual activates within the confines of what is excepted in Islam. As a Christian woman myself, I think that I would feel uncomfortable placing myself in a situation similar to this one, in which the majority leaders were placing certain pressures, even subtle or unintentional pressures on me to act or behave a certain way.

How exactly will contact points include these people? What implementation tools can we give them to accomplish the goal of implementing an intervention, which does not exclude any special target groups? How will minorities or neglected peoples, react to delivery of supplies, education, or advocacy by people who do not identify with or understand their own beliefs or culture? Is it possible to have neglected peoples be the contact points for their own target group?