‘Outsourcing polio vaccination campaigns to NGOs a bad idea’

The routine immunisation coverage of Sindh’s children against different vaccine-preventable diseases is currently restricted to 56 percent, provincial Health Minister Dr Saghir Ahmed said on Thursday.
“This is due to the bifurcation in the primary and secondary healthcare services offered to the masses in the province,” he said at a press briefing on the “Polio Eradication Initiative – Routine Immunisation”.
“The Health Department is presently responsible for managing secondary and tertiary healthcare programmes only,” he added.
“Routine immunisation, an essential component of primary healthcare, is no more in the domain of the provincial Health Department.”
Health Secretary Hashima Raza, World Health Organisation Representative Dr Jameel Yousuf, UNICEF Communication Officer Rabia Amjad, Expanded Programme on Immunisation (EPI) Manager for Sindh Dr Mazhar Khamisani and Health Director General Dr Hafizul Haq Memon were also present at the press briefing.
Ahmed said there is an urgency to strengthen the routine immunisation programme in the province with due provision to evaluate the performance of the People’s Primary Healthcare Initiative (PPHI) that has been assigned the responsibility of primary healthcare.
Earlier, Health Secretary Hashima Raza said the PPHI is working in the province under a memorandum of understanding signed between it and the district governments of the province.
“The memorandum of understanding is coming to an end this year and would perhaps be reviewed for extension or carried on under a separate arrangement,” he added.
The health minister on the occasion also took strong exception to the proposals to outsource the polio eradication campaigns to nongovernmental organisations (NGOs) and extensively spoke about how Health Department officials strictly comply with the micro-managerial plans developed according to the recommendations of the WHO and UNICEF.
“The town health officers in Karachi have managed to attain more than 97 percent coverage rates in the province and yet receiving cases of children crippled with polio,” he said.
“The situation compels us to think of other reasons that may not be liked by those contemplating to outsource the immunisation campaigns,” he added. “It would have been better if the approach had been adopted two to three years ago.”
Replying to a question, the minister said that once routine immunisation is reassigned as a responsibility to the Health Department, only can the department be held answerable for any sluggish performance.
“In case of new cases of polio or outbreak of diseases covered under the EPI, the department would have ensured evaluation and accountability,” he added.
The minister acknowledged that the province is facing a difficult situation as it was exposed to natural calamities for two consecutive years.
“Yet, the Health Department turned them [natural calamities] into an opportunity and vaccinated children and women, brought to hundreds of flood relief camps, against a series of ailments,” he added.
Earlier, Health Director General Dr Hafizul Haq Memon said 70 percent of vaccination teams had no female health workers, who could have facilitated easy accessibility to homes.
“We have now revised our micro-planning at every level and replaced zonal officers with union council supervisors, who necessarily have to be medical officers,” he said.
He said the sub-national immunisation that will begin from December 19 will cover all under-five children in 12 districts and children in high risk towns and talukas of six districts, including seven towns in Karachi alone.
EPI Manager for Sindh Dr Mazhar Khamisani in his detailed report about the performance of his programme spoke about the reasons for children not being immunised against polio.
“The highest number of polio-affected children did not receive vaccines as no team visited their home,” he said.
“There were also several cases where children were found unavailable as their parents refused to get them vaccinated,” he added.
WHO representative Jameel Yousuf said the number of polio cases has increased in Pakistan including Sindh, which contributed 18 percent (30 cases) of all 173 reported in the country.
“The national emergency plan for the eradication of polio in the country, launched this year in January, is presently being reviewed,” he added. “It has been registered that while the plan is perfect, there exist deficiencies in its implementation. It is not difficult to eradicate polio as even countries like Sudan and Somalia, with virtually no infrastructure, be it sanitary system or healthcare, have managed to eliminate the virus from their environment.”
The WHO representative said there is no guarantee that an immunised child will not be inflicted with the virus.
“We are, however, being provided with an opportunity to achieve the goal as three polio vaccination campaigns to be conducted next week, followed by two others till March 12, will be during the low polio virus transmission period,” he added.
Rabia Amjad of the UNICEF said donors are focused on funding only those union councils that are 100 percent prepared for vaccination campaigns and these preparations would be adequately verified.