Author: Aijaz Ali Khuwaja, August 11 2015 - Polio is now a bone of contention between Pakistan and rest of the globe. A warning by the Chairman of Independent Monitoring Board (IMB) published in various sectors of the press has warned the Pakistani government to take transformative action to fix the country's appalling Polio programme. Globally, the Pakistani nation is facing isolation due to Polio. The question is how and when Pakistan will come out of the Polio crisis. Will Polio take our remaining national pride and isolate by comity of nations in near future? Our Prime Minister is now more worried so he called emergency meetings and discussed the issue of Polio with the Chief Ministers of all four provinces. The world has eradicated polio through community participation and ownership. Our all-government and non-government initiatives are failing due to non-community participation and ownership crisis.
I would like to quote a very recent and important research paper written by Ellen A Coates, Silvio Waisbord, Jitendra Awale, Roma Solomon, and Rina Dey in the inaugural edition of the journal Global Health Science & Practice [Editor's note: Click here to read a summary of this paper, titled "Successful Polio Eradication in Uttar Pradesh, India: The Pivotal Contribution of the Social Mobilization Network, an NGO/UNICEF Collaboration" and to access the full document.] It looks at how, in response to low routine immunization coverage and ongoing polio virus circulation, U.S.-based CORE Group members and local non-governmental organisations partnered with UNICEF in India to create the Social Mobilization Network (SMNet) - a network which has played a pivotal role in stopping transmission of polio in India. It also looks at how important this network remains as India struggles to remain polio free in a world where the virus continues to circulate and 27 million Indian children are born each year. "The SMNet's goal was to improve access and reduce family and community resistance to vaccination. The partners trained thousands of mobilizers from high-risk communities to visit households, promote government-run child immunization services, track children's immunization history and encourage vaccination of children missing scheduled vaccinations, and mobilzse local opinion leaders. Creative behavior change activities and materials promoted vaccination awareness and safety, household hygiene, sanitation, home diarrheal-disease control, and breastfeeding. Program decision-makers at all levels used household-level data that were aggregated at community and district levels, and senior staff provided rapid feedback and regular capacity-building supervision to field staff. Use of routine project data and targeted research findings offered insights into and informed innovative approaches to overcoming community concerns impacting immunization coverage."
This research paper is an eye opener for our health practitioners and policy makers at district and provincial levels in Pakistan. I have hardly seen any meetings with the community regarding the Polio vaccination campaign. Our policy makers have never ever studied failures of eradication of Polio in Pakistan. It's a famous saying that "Community is the barometer of success or failure of any intervention". Is there any proper community involvement? No. When the polio campaign starts, local health officials, doctors, nurses and other related staff of the health department are called by the District Administration to discuss/finalise polio vaccination plan. There is no community involvement from planning to implementation level. Every Polio campaign is solely run by the Government Health Department and there is no community participation regarding decision making about the Polio campaign and door to door drive. Like all other Government initiatives, Polio is also facing a "crisis of ownership" by the community.
India has achieved the target of polio eradication through proper mobilisation and involvement of local based civil society organisations, opinion makers and leaders/elders of society. In Pakistan only officials of relevant health departments have been involved from decision making to Polio vaccination. So it's impossible for Pakistan to eradicate polio. We are the world's only nation which is struggling for polio eradication. An important goal of the Millennium Development Goals (MDGs) is Polio Eradication, which India achieved last year. Every year 27 million children are born in India but still they have achieved most of their MDG targets, especially health related targets.
I would like to suggest that the health department and district administration in Pakistan must involve community based organisations at the Union Council level before the start of each polio campaign. The District Administration can make a "Polio Eradication Network" at each Union Council level, which ensures proper participation of all communities in the Polio vaccination campaign. There are many lessons in the above mentioned research paper for our planners and implementers of the Polio campaign and we can learn from India and China. Campaign ownership by the community is a must and their involvement at each and every stage will eradicate Polio, otherwise all other efforts will be in vain. Polio is a case of mobilisation so we need strong community mobilisers and for this purpose community groups/civil society/Rural Support Programs can be supportive. Polio will never be eradicated through single government efforts. We all know corruption in health departments at national and provincial, district, tehsil [sub-district] and union council levels. Unfortunately, Polio vaccination/campaign days are favorable days for all health departments/civil hospitals due to corruption/nepotism and submission of wrong bills of ice, petrol, hired vehicles and others. A proper monitoring system at each and every union council level is required in the days of a Polio campaign. Should Pakistan not be able to eradicate polio, then the world might rethink our status as a civilized nation. God save us if world nations think and harm our remaining harmony because of Polio issues. This is the right time to act now and eradicate Polio from Pakistan.
Image credit: Associated Press (AP)