INTRODUCTION:

 

As we know, 80 percent of the population of Pakistan is living in rural areas, and the overall literacy rate is not more than 45 percent. Keeping in view the above facts, most of the population have sufficient knowledge about the Malaria, Tuberculosis, Hepatitis B (HBV)& C virus, but, unfortunately, a very large number of Pakistani population know less about Polio!

  • What is polio disease?
  • Why do we administer Polio drops to their less-than-five-years-of-age children frequently / regularly each month?
  • Why is the knowledge of the 80 percent population limited about Polio as compared to Malaria, Tuberculosis, and Hepatitis B & C.

To answer these questions, there is a great need to develop a strong network of communication for effective social mobilization for Polio eradication at the union council level (UC) level in FATA (the Federally Administered Tribal Areas) as well as rest of the country.

AIMS:

  • To eradicate Polio.
  • To improve the awareness of the population about oral polio vaccine (OPV) and Acute Flaccid Paralysis  (AFP)/Polio disease.
  • To make a proper recognition of AFP/Polio in the minds of illiterate Tribal community of FATA.

OBJECTIVES:

  • To get 100 percent OPV targets.
  • To reduce the OPV refusal cases.
  • To involve the tribal community in Polio NIDs [national immunization days] on revolutionary basis.
  • To establish a strong communication network for social mobilization of Polio eradication and Active AFP Surveillance.
  • To improve the routine and outreach Expanded Program on Immunization  (EPI) program at UC level in FATA.
  • To involve the students and teacher in STOP POLIO activities.
  • To develop interest in the TWO DROPS OF POLIO EVERY TIME EVERY CHILD for the tribal community of FATA.

DISCUSSION:
There are several methodologies through which the targets of effective social mobilization/communication and awareness can be achieved.

  • POLIO HUNTERS CLUBS: The World Health Organization (WHO) and Ministry of Health, with joint coordination of provincial education departments, could communicate with a large number of the population through establishing the "Polio Hunters Clubs" in the following manner.

Institutions involved, including leadership roles of those designated AIC (Area Incharge):

College - Teacher, possibly student, as AIC, students as team members
High School - Teacher as AIC, students as team members
Middle School - Teacher as AIC, students as team members
Primary School - Teacher as AIC, students as team members

 
Organizational Structure of the Polio Hunters Clubs -

Principal/Head Master works as Chief Organizer;
Teachers and Students are Members.

Chief Organizer:
He will be responsible for the arrangements of Polio NIDs and will prepare the code and conduct rules of the Polio Hunters Club. Besides this, he will assign duties to the teachers and students as AICs and team members. He will also arrange Polio Debates / Walks, Polio poster competitions in the School / College.

Members:
The members will works as AICs and team members in Polio NIDs. The members will also preach for OPV and will try to clear the wrong concepts of the illiterate tribal community at the house-to-house level in FATA.

 

  • POLITICAL AGENT:

In the Tribal areas, the Political Agent being “The King” of the tribal agency / area can play a vital role in Polio eradication, e.g. the meeting of the tribal elders should be called / organized at the Tehsil level [an intermediate level of government hierarchy] in which the following activities / functions should performed:
1.      Presentation about Polio disease.
2.      Photo exhibition of the Polio Victims.
3.      Assignments of the duties by Political Administration to the tribal elders in their respective areas in Polio NIDs.
4.      The Agency Surgeons / DHCSOs (District Health Communication Support Officers) should provide the Polio Posters (in Pashto) to the tribal elders and especially to the religious leaders.
5.      The tribal elders and religious leaders should establish community-based committees at the UC level. They will cooperate and facilitate the OPV teams in Polio NIDs.
6.      The Political Agent should morally and financially encourage the tribal elders and religious leaders for their core efforts in the war against Polio.
In the FATA, the role of Political Agents, Tribal elders, and religious leaders at the UC level is the golden key to success in the war against Polio.

  • PRIVATE MEDICAL PRACTITIONERS:

The people who deal with medicines are called "Doctors" in the villages at FATA, in spite of the fact that these Doctors might be qualified or quacks, but the tribal population have no alternative choice to replace consulting them in case of any illness.   

    
These practitioners working in the remote areas of FATA and are the most excellent and the most effective source for Polio eradication and active AFP Surveillance. The DSOs (District Support Officers)/DHCSOs should register them and should provide literature/ posters in the Pashto language to the practitioners. They should be involved in Polio NIDs as team members. There must be training / workshops about the signs and symptoms of Polio infection and reporting.

  • SHOPKEEPERS:

In the remote areas of FATA, the general stores in the villages work as the place of general gathering and, to a great extent, the "media center" of the village. The villagers exchange views and opinions about contemporary issues. That is why the concerned DSOs / DHCSOs should provide posters and original photos of the polio victims and brief literature containing a short introduction about the signs and symptoms of Polio in the Pashto language. The visitors / clients in these shops will wish to know about the polio and AFP; hence, their awareness about the importance of OPV will be developed.

  • FREE MEDICAL CAMPS:

The tribal community is very interested to get free medicines in the free medical camps, whether they have any illness or not. The medical staff could provide one leaflet/brochure to the patients in Pashto and also arrange a mobile Polio photo gallery when they conduct a free medical camp in the remote areas of FATA.

  • POLITICAL AND RELIGIOUS PARTIES:

Polio in Pakistan is a natural and national disaster; that is why all the political and religious parties should include “The Polio Eradication Initiative” in their manifestos. The political and religious party leaders should call their workers to effectively involve themselves in Polio NIDs and other health-related events.

  • PRINT & ELECTRONIC MEDIA:

In FATA, the Pashto newspapers and magazines can play the role of communicator for Polio eradication. The Pashto daily “WAHDAT” Peshawar is the most favorite newspaper of the average literate tribal member of the remote areas in FATA. The WHO/ The United Nations Children's Fund (UNICEF) should launch a campaign about polio eradication in the local Pashto newspapers and magazines.

90 percent of the tribal community listen to radio in their extra time; for this purpose, there must be features and dramas on the radio on a weekly basis about Polio eradication, just like the family planning and iodized salt program. Television is a less effective media in FATA about Polio Eradication.

  • THE AGENCY COUNCIL:

The elected and selected Agency councilors should monitor and evaluate the Polio NIDs in their respective UCs. They should also conduct the social gathering of the tribal elders in their catchments areas to facilitate the polio teams and to resolve the OPV refusal cases.

The most important duty is to constitute Health Committees at UC level in FATA. There are 50 Agency Councilors and a powerless “Health Committee” at the Agency level in Mohmand Agency. The Agency Councilors can effectively communicate the tribal community regarding Polio eradication and other health related programs.

  • RELIGIOUS SCHOOLS (MADRASSAS):

Most of the tribal community is religious and follows the teachings of the religious teachers of Islamic Schools. There must be workshops about Polio eradication for religious teachers and students of Islamic Schools. In the context of current political environment, the role of religious teachers and students of Islamic Madrassas in FATA is the key of success in the war against Polio.

The close contact of the Health Department with the religious teachers and students of Islamic Schools will resolve the religious refusal cases in Polio NIDs and other health related programs, e.g. Family Planning.

  • BASIC HEALTH UNITS (BHUs) / RURAL HEALTH CENTERS (RHCs):

The staff of the BHUs / RHCs can perform the following roles in the communication for polio eradication and AFP Surveillance.
a)  LHVs (Lady Health Visitors):
These health professionals should convince the women during their routine visits for antenatal and postnatal care in the catchment areas of BHUs/RHCs.
Most of the ill child cases are due to the refuse of their mothers. The LHVs should contact these women to resolve the ill child refusal cases.
b)  TBAs (Traditional Birth Attendants):
The TBAs should perform the same job as the LHVs do in the catchment areas of BHUs/RHCs.
c)   Medical Technicians (MTs)/Dispensers:
The MTs and Dispensers should involve themselves in the community and social meetings. Through this method, no one in the population will refuse to vaccinate their children against Polio.
d)  EPI Technicians:
These officials have the potential to eradicate Polio in one year in FATA, if they are properly managed, equipped and encouraged. Routine immunization and the outreach EPI [Extended Program on Immunization] program is the "gold standard" technique for a strong communication network for polio eradication and active AFP Surveillance at FATA.

  • THE SUBJECT OF PUBLIC HEALTH IN THE EDUCATION CURRICULUM:

It is a most effective methodology for Polio eradication to include the subject of Public Health in the curriculum of school class level 5 to level 12 in the schools and colleges of FATA, Pakistan. It will develop the knowledge of the students and teachers about polio and other communicable diseases.

The Non-Governmental Organisation (NGO) and Polio Eradication Initiative (PEI):
There are several NGOs/welfare organisations that can substantially play their due role in PEI. For Example: PRCS (Pakistan Red Crescent Society), Media Workers Organization (MWO), Médecins Sans Frontières (MSF), OXFAM, etc. These NGOs should launch awareness campaigns about polio eradication in FATA.

  • THE PREACHERS OF ISLAM (TABLEEGHE JUMAT):

Nowadays, 97 percent of the educated and illiterate population of FATA/Pakistan have great respect for the Preachers of Islam. The WHO, along with the Government of Pakistan, should contact and convince the central leadership of Tableghee Jumat to include the Polio Eradication Initiative in their curriculum; this could be the 99 percent guarantee / assurance that their communication will eradicate polio in FATA at UC level within a very limited course of time.

  • HBV/TT/MEASLES or ORS (Oral Rehydration Solution) STRATEGY:

It is the personal observation of the author of this article that the administration of HBV/typhoid tetanus (TT)/measles to the women and children in Polio NIDs has been greatly appreciated by the tribal community. In order to reduce the OPV refusal cases, there must be some incentives for the tribal women and children in Polio NIDs in the form of HBV/TT/Measles and ORS.

  • The ANTI-POLIO CAMPAIGNS by PHARMACEUTICAL &   TELECOMMUNICATIONS COMPANIES:

The public relation departments of pharmaceutical companies should launch anti-polio campaigns at the UC level in FATA. Nowadays, mobile phones have become a fashion and a necessary piece of equipment in communication for most of the people. The telecommunication companies should send text and voice messages in local languages.

Text Message:

  1. Please vaccinate your children against polio.
  2. Two drops of Polio Vaccine can save the life of your child.

Voice Message:

Polio team will come to your house, please make sure of the vaccination of your under-five -years children.

The mobile companies in the market are Mobilink, Telenor, Warid, Ufone, and Zong, etc.

By Syed Feroz Shah