Home / Pakistan / Lifesaving drops for a crippled nation: Challenges in project management of Polio Eradication Program

Lifesaving drops for a crippled nation: Challenges in project management of Polio Eradication Program

Fatima Khalid
Khalidfatima886@gmail.com

Introduction:
Striving to survive in 2020, amid the crisis of novel global pandemic, Covid-19, one should not forget the ancient, crippling virus, Polio, having its homage in our beloved country. Corona which has taken more than 1.5 lac lives and have infected millions, it pains me to pen down that more than 350,000 have lost their healthy lives to another virus. Today, only three countries are attached to this ominous disease which includes Pakistan, to some extent Nigeria and Afghanistan. Pakistan was hit by this disease 26 years ago in 1994. Polio is highly infectious, consisting of serotypes 1, 2, and 3. transmission contributing to majority of the cases especially in regions with poor hygiene and sanitation. The successful eradication of wild poliovirus therefore rests on Pakistan’s immunisation programme and strategy.

Pakistan still has 147 cases in 2019 and 39 in 2020 which shows that there’s some lack in effectiveness and efficiency of the program as it is facing various challenges due to its situational, financial, cultural, religious and other perspectives. There has been a decline in Polio Cases from 20,000 every year in 1990’s to only eight cases in 2018. But the issue lies in the fact that, if the virus is circulating even in one child, no child is safe from this crippling virus.

Discussion:
Polio Eradication program is basically a public-private led partnership by The Government of Pakistan, headed by partners including World Health Organization, United Nations Children’s Fund (UNICEF), Bill and Melinda Gates Foundation, Rotary International and the US Centres for Disease Control and Prevention (CDC).

“Polio is one of the few diseases we can eradicate in the world in the next few years. This is a priority of the United Nations and I am extremely happy to see it is a clear priority for the Government of Pakistan,” said Mr. Guterres.

Mr. Guterres issues a very praising and motivational comment for Pakistan’s Polio program. But, let’s throw a light on current progress of the program. Pakistan’s Expanded Programme on Immunisations (EPI) was formally initiated in 1978 after the WHO launched its Expanded Programme on Immunisation in 1974 . National EPI policy is regulated by the guidance of the National Immunisation Technical Advisory Group (NITAG), which makes evidence-based recommendations to improve the programme. Program’s objective is to optimize immunization of OPVs to children under 5 years by procuring OPVs and providing services necessary for polio campaigns, therefore contributing to the eradication of Polio in Pakistan. Annually the target for vaccinating children under age 5 is around 39 Million. OPV and GPEI budget brings the overall cost to of strategy to US $5.1 billion.

The Polio eradication program which is at its last stages that is end game strategy 2019-2023 has sorted out three challenges majorly including inaccessibility, insecurity, conflict, weak or fragile health systems, Operational, management and resource risks but after critically analyzing the program, more challenges can be sorted out in the way of program completion towards its closeout phase i.e. zero policy. Closely looking at Pakistan’s challenges a consistent problem that is arising is safety and security concerns. Till now over 100 polio workers have been killed due to various reasons. With life threats of polio frontline workers, the program seems unable to achieve its target in the time frame. Even after spending billions of rupees in awareness campaigns, there’s still awful parental perception. Parents refuse to get their children immunized as observed in Karachi in the last two latest SIAs. Pashtuns from low as well as high income group refuse to get their children vaccinated. In, Islamic Republic of Pakistan, with strong religious influence, sardars and Mullahs makes the Pashtuns avoid or refuse vaccinating their children. Keeping the geography and culture of Pakistan we can deduce that there is strong correlation between low immunization completion and negative socioeconomic factors adding poverty and illiteracy.

The icing on the top is its geographical challenges whether it is the Himalayan Range and glaciers of the north to harsh terrain of Baluchistan in the south with poor health safety. Cultural differences, densely populated areas, poor management and operational deficits adds to it. Another important perspective to this is concerns regarding OPV efficacy. Frequent power outages and the scarcity of equipment in Pakistan have made it difficult to maintain the cold chain necessary for OPV efficacy and has contributed to the alarming rise of cVDPVs as well as wild poliovirus-induced poliomyelitis among vaccinated children. Families lack access to basic services and children receive little or no protection against disease.

Poor immunization services, combined with high rates of malnutrition and a lack of safe water and sanitation, create conditions that allow the virus to thrive and paralyse vulnerable children with low immunity. Mobility and mass migration between Afghanistan and Pakistan makes several children inaccessible for polio workers. Weak and Fragile healthcare infrastructure in Pakistan that has been evident in Covid Pandemic as well. Technical Challenges arise when vaccines become ineffective in areas with poor sanitation and high-density population. Lack of efficient and reliable laboratory network is also seen.

For every challenge a project should have multiple strategies to deal with it. Pakistan has devised National Emergency Action Plan for polio eradication program 2018-2019 outlining the planning and strategies to handle polio vaccination and spreading of this virus. Pakistan Programme revisited its strategy and put forward the Extension of the National Emergency Action Plan 2018-2019. This program has been in constant control under the stakeholders. It has completed its three stages of initiation, planning and is working more effectively on execution and control. For this to happen they have collaborated with EPI and ISD with interventions that can improve lives and perception regarding polio Programme.

Furthermore, there is revised modalities in campaign, to reduce community fatigue and have better campaigns quality including community engagement and social mobilization strategies. They are incorporating new case response to ensure timely decisions in affected areas. As, we have entered polio endgame strategy, whose strategy can be explained in three words, eradication, integration, certification and containment. Afghanistan Pakistan hub is being created with collaboration of both countries only polio can be eradicated. Expanded partnership with WASH and other programs can generate better results.

Conclusion:

However, one cannot completely negate the fact that Pakistan has climbed some steps up and have lowered its numbers. Pakistan has made important progress towards stopping poliovirus transmission in the country. Case numbers are the lowest they have ever been, while immunity gaps among children continue to decline. An array of approaches and tools are implemented to help Pakistan reach the finish line of zero polio cases. Better project can add Pakistan to Polio free country as well. Hopefully!

Footnotes:

[1] Conflict and Health Research Group, King’s Centre for Global Health, King’s College London, Suite 2.13 Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK

[2] Owais A, Khowaja AR, Ali SA, Zaidi AK. Pakistan’s expanded programme on immunization: An overview in the context of polio eradication and strategies for improving coverage. Vaccine. 2013;31(33):3313–9.

References:
1. Ghafoor, S., & Sheikh, N. (2016). Eradication and Current Status of Poliomyelitis in Pakistan: Ground Realities. Journal of Immunology Research, 2016, 1–6. doi: 10.1155/2016/6837824
2. Hussain, S. F., Boyle, P., Patel, P., & Sullivan, R. (2016). Eradicating polio in Pakistan: an analysis of the challenges and solutions to this security and health issue. Globalization and health, 12(1), 63. https://doi.org/10.1186/s12992-016-0195-3
3. Weekly Epidemiological Record . Polio vaccines: WHO position paper, January 2014. Geneva: World Health Organization; 2014.
4. Aylward B, Tangermann R. The global polio eradication initiative: lessons learned and prospects for success. Vaccine. 2011;29:D80–5. doi: 10.1016/j.vaccine.2011.10.005
5. Garon JR, Orenstein WA. Overcoming barriers to polio eradication in conflict areas. Lancet Infect Dis. 2015;15(10):1122–4. doi: 10.1016/S1473-3099(15)00008-0
6. Pakistan. (2020, March 21). Retrieved from https://www.who.int/countries/pak/en/
7. Polio eradication a UN priority, says Guterres in Pakistan visit | UN News. (n.d.). Retrieved from https://news.un.org/en/story/2020/02/105764
8. Polio. (n.d.). Retrieved from https://www.unicef.org/pakistan/polio
9. Pakistan. (n.d.). Retrieved from http://polioeradication.org/where-we-work/pakistan/
10. User, S. (n.d.). Eradication Strategy. Retrieved from https://www.endpolio.com.pk/polioin-pakistan/eradication-strategy
11. Rehman, A. U., Sahir, I., Yaqoob, I., & Zulfiqar, S. (2020, January 7). Factor Affecting Polio Eradication Program in Pakistan. Retrieved from https://www.hilarispublisher.com/abstract/factor-affecting-polio-eradication-program-in-pakistan-21200.html
12. Polio Eradication and Endgame Strategic Plan 2013–2018. (n.d.).
13. Andrade, G. E., & Hussain, A. (2018, October 27). Polio in Pakistan: Political, Sociological, and Epidemiological Factors. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6318131
14. Kanwal, S., Hussain, A., Mannan, S., & Perveen, S. (2016, March). Regression in polio eradication in Pakistan: A national tragedy. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26968287
15. Shah, S. Z., Saad, M., Rahman Khattak, M. H., Rizwan, M., Haidari, A., & Idrees, F. (2016). “Why we could not eradicate polio from pakistan and how can we?”. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28718581
16. Larson, N. (2014, May 5). WHO declares polio ‘public health emergency’ (Update).
17. Hyland, R., Doan, M., & O’Leary, A. (n.d.). Pakistan’s Rise to Zero

Comment Using Facebook

Check Also

Facts behind ‘confusion’ arose after HEC chairman statement regarding talks with FAPUASA

HEC makes and improves policies on basis of evidence: Chairman Dr. Tariq Banuri There is …

6,063 comments

  1. I like the helpful info you provide in your articles.
    I’ll bookmark your weblog and check again here regularly.
    I’m quite sure I’ll learn many new stuff right here!
    Good luck for the next!

  2. I’m not sure exactly why but this web site is
    loading extremely slow for me. Is anyone else having this problem
    or is it a problem on my end? I’ll check back later and see if the problem still exists.

  3. After I initially commented I seem to have clicked the -Notify me when new comments are added- checkbox and now whenever a
    comment is added I get 4 emails with the same comment.
    Perhaps there is an easy method you can remove me from that service?
    Thank you!

  4. Great info. Lucky me I came across your blog by chance (stumbleupon).

    I’ve bookmarked it for later!

  5. hello!,I like your writing so so much! share we keep in touch extra approximately your post on AOL?
    I require a specialist on this house to solve my problem.
    Maybe that is you! Taking a look forward to see you.

  6. Do you have a spam problem on this blog; I also am a blogger, and I was
    curious about your situation; we have developed some nice practices and we are looking to
    exchange methods with others, please shoot me an email if interested.
    해외선물대여계좌업체추천.

  7. When some one searches for his required thing, thus he/she needs to be available that in detail, therefore that thing is maintained over here.

  8. After I originally commented I seem to have clicked the -Notify me when new comments are added- checkbox and from now on every
    time a comment is added I recieve four emails with the same comment.
    There has to be an easy method you can remove me from that service?
    Appreciate it!

  9. What’s up every one, here every one is sharing such familiarity,
    so it’s fastidious to read this weblog, and I used to visit
    this webpage every day.

  10. Fabulous, what a webpage it is! This webpage provides useful
    facts to us, keep it up.

  11. Hi there! Would you mind if I share your blog with my myspace group?
    There’s a lot of people that I think would really appreciate your content.
    Please let me know. Thank you

  12. I just like the helpful innformation youu provide on your articles.
    I’ll bookmark your bog and check onc more right here regularly.
    I amm moderately certain Iwill be informed a lot
    of new stuff right here! Good luk for the next!

  13. Link exchange is nothing else except it is just placing the other person’s web site link on your page at suitable place and other person will also do same for you.

  14. Hi my loved one! I wish to say that this article is awesome, nice written and come with approximately all vital infos.
    I would like to peer extra posts like this .

  15. Howdy! Would you mind if I share your blog with my myspace group?

    There’s a lot of folks that I think would really appreciate your content.
    Please let me know. Thank you

  16. I’m really enjoying the design and layout of your site.
    It’s a very easy on the eyes which makes it much more pleasant
    for me to come here and visit more often. Did you hire out a designer to create your theme?
    Fantastic work!

  17. This is really interesting, You’re a very skilled blogger.
    I’ve joined your feed and look forward to seeking more
    of your great post. Also, I’ve shared your site in my social networks!

  18. It’s really a cool and helpful piece of information. I’m glad that
    you shared this helpful information with us.
    Please stay us informed like this. Thanks for sharing.

  19. I go to see every day a few sites and websites to read content, however this weblog offers feature based posts.

  20. I really like reading an article that can make men and women think.
    Also, many thanks for allowing me to comment!

  21. Just a smiling visitant here to share the love (:, btw outstanding layout.

  22. Nice read, I just passed this onto a friend who was doing some research on that. And he actually bought me lunch because I found it for him smile So let me rephrase that: Thanks for lunch! “Without friends no one would choose to live, though he had all other goods.” by Aristotle.

  23. Incredible points. Sound arguments. Keep up the amazing effort.

  24. Wow that was strange. I just wrote an incredibly long comment but after I clicked submit my commkent didn’t show up.
    Grrrr… well I’m noot writing alll that over again. Anyhow, just
    wantedd to say great blog!

  25. Its like you read my mind! You seem to know so much about this, like you wrote the
    book in it or something. I think that you could do with some pics to drive the message home a little
    bit, but other than that, this is fantastic blog.

    A fantastic read. I will definitely be back.

  26. Thanks , I have recently been searching for information about this topic for a while and yours is the greatest I have
    found out so far. However, what in regards to the bottom line?

    Are you positive about the source?

  27. This is a topic which is near to my heart… Cheers!
    Exactly where are your contact details though?

  28. Do you mind if I quote a few of your posts as long as I provide credit and sources back to your webpage?

    My blog site is in the exact same area of interest as yours and my visitors would certainly benefit from a lot of the information you present here.
    Please let me know if this alright with you. Appreciate it!

  29. Keep on writing, great job!

  30. Hello there! This post couldn’t be written much better!
    Going through this article reminds me of my previous roommate!
    He always kept talking about this. I’ll forward this post to him.
    Pretty sure he’ll have a very good read. Many thanks for sharing!

  31. Piece of writing writing is also a excitement,
    if you be familiar with after that you can write if not it is difficult to
    write.

  32. This post is truly a fastidious one it helps new net people, who are
    wishing for blogging.

  33. hello!,I really like your writing very a lot!
    share we be in contact more approximately your
    article on AOL? I require an expert in this area to unravel
    my problem. May be that’s you! Having a look forward
    to peer you.

  34. I loved as much as you will receive carried out right here.
    The sketch is tasteful, your authored material stylish.
    nonetheless, you command get got an shakiness over that you wish be delivering
    the following. unwell unquestionably come more formerly again as exactly the
    same nearly very often inside case you shield this increase.

  35. It is perfect time to make a few plans for the long run and it’s time
    to be happy. I have read this submit and if I could I
    wish to counsel you few attention-grabbing issues or advice.

    Maybe you can write next articles referring to this article.

    I wish to read even more things approximately it!

  36. My brother suggested I might like this web site.
    He was entirely right. This post actually made my day. You cann’t imagine simply
    how much time I had spent for this info! Thanks!

  37. I want to convey my affection for your generosity in support of men and women that have the need for guidance on this one topic. Your very own dedication to passing the message all-around became wonderfully functional and have surely made employees much like me to reach their dreams. This informative publication denotes a whole lot to me and even more to my mates. With thanks; from each one of us.

  38. I enjoy you because of your own effort on this web site. Ellie take interest in going through investigations and it’s simple to grasp why. Most people hear all about the powerful tactic you present both interesting and useful tips and tricks by means of this website and as well welcome participation from other individuals on the idea while my child has been understanding a whole lot. Have fun with the rest of the year. Your conducting a splendid job.

  39. I must get across my love for your generosity giving support to men and women who have the need for help with this situation. Your very own dedication to getting the message up and down turned out to be unbelievably invaluable and has regularly encouraged those like me to attain their goals. Your interesting information entails so much a person like me and still more to my mates. Thank you; from everyone of us.

  40. I am writing to make you know of the beneficial discovery my wife’s daughter found checking your web site. She mastered such a lot of pieces, with the inclusion of what it is like to possess a marvelous coaching mood to have many more with ease understand specified very confusing topics. You truly surpassed my expectations. Thank you for presenting these precious, healthy, educational and in addition easy tips about your topic to Jane.

  41. There is definately a great deal to learn about this issue.
    I like all the points you made.

  42. Thanks for one’s marvelous posting! I definitely enjoyed reading it, you could be a
    great author.I will make sure to bookmark your blog and will come back sometime soon. I want to
    encourage you to ultimately continue your great job, have a nice
    weekend!

  43. My partner and I stumbled over here from a different website and thought I may as
    well check things out. I like what I see so i am just following you.
    Look forward to looking at your web page again.

  44. Hello, Neat post. There’s a problem along with your site in web explorer, might check this?
    IE nonetheless is the market leader and a large
    section of folks will leave out your excellent writing because of this problem.

  45. hello!,I like your writing so a lot! share we keep in touch extra approximately your article on AOL?
    I require a specialist in this space to resolve my problem.
    Maybe that is you! Taking a look forward to peer you.

  46. whoah this weblog is wonderful i like studying your posts.
    Stay uup the ggreat work! You realize, a lot oof people are looking around ffor this information, you could help them greatly.

  47. Hi there, just wanted to say, I enjoyed this blog post.

    It was helpful. Keep on posting!

  48. Hi, Neat post. There’s a problem together with your web sitge in internet explorer,
    could test this? IE nonetheless iis the mareket leader
    andd a big portion of other folks wiol miss your fantastic writing because
    of this problem.

  49. If some one desires expert view about boogging and site-building then i propose him/her to visit this blog, Keep
    up the nice job.

  50. Its not my first time to pay a quick visit this site, i am browsing
    this web page dailly and get fastidious data from here daily.

Leave a Reply

Your email address will not be published.