Editorial
As the country struggles against various odds — the civil-military imbalance, the Pak-US tensions, the institutional infighting and an ailing president — the news that Pakistan is one of the four remaining polio-endemic countries is no less depressing. We are a priority country for the Global Polio Eradication Initiative for the simple reason that Pakistan is now reporting more cases than those of the other three endemic countries Nigeria, India and Afghanistan put together.  


immunisation
A crippling reality
Despite several efforts to re-strategise the fight against polio, the reported incidents continue to rise
By Aoun Sahi
With 174 registered cases of polio this year, Pakistan tops the list of nations that have failed to eradicate polio. This is the second consecutive year the country has displayed a dismal record in fighting the disease. Last year, too, Pakistan topped the list with 126 cases. 


Foreign hand

Removing misconceptions about the polio vaccine is a tougher challenge than acquiring access to the target children
By Shahzada Irfan Ahmed
The United Nations Children’s Fund (Unicef) warning that Pakistan is facing a serious risk of being the last polio reservoir in the world has put it on the global disease watch radar and media limelight. The extraordinarily high instance of new polio cases is, therefore, yet another wrong reason for Pakistan to be in the news.  


perspective
Bumpy drive to eradication

As the number of polio cases in Pakistan reaches 174 this year, there is an urgent need to re-identify the reasons and causes
By Waqar Gillani
Pakistan is one of the four remaining polio-endemic countries in the world, making ours a priority country for the Global Polio Eradication Initiative, according to the World Health Organization (WHO). The virus, which also led America’s Central Intelligence Agency to catch their biggest target of the decade — Osama bin Laden — this May near Islamabad through a fake polio campaign, is still on the rise and spreading.

Tales of woe
A poor villager in KP holds religious orthodoxy responsible for the miserable plight of his daughter
By Mushtaq Yusufzai
In Regi village in the suburbs of Peshawar, a cleric opposed to polio vaccination has constantly urged people to avoid administering polio drops to their infants, as in his view it is a conspiracy of the West to make their next generation impotent and decrease population of the Muslims.

Province of issues
Balochistan which has registered 68 out of a total 167 polio cases this year so far has emerged as the most problematic province in the fight against polio
By Muhammad Ejaz Khan
Eighteen months old Asad Khan from Kharotabad area of Quetta, was crippled because he had not been administered polio drops. His father’s voice drops as he speaks of Asad’s plight.

 


 

Editorial

As the country struggles against various odds — the civil-military imbalance, the Pak-US tensions, the institutional infighting and an ailing president — the news that Pakistan is one of the four remaining polio-endemic countries is no less depressing. We are a priority country for the Global Polio Eradication Initiative for the simple reason that Pakistan is now reporting more cases than those of the other three endemic countries Nigeria, India and Afghanistan put together.

That the worst statistics of polio came from the most troubled province of Balochistan was even sadder.

So why exactly are we lagging behind the rest of the world when it comes to polio eradication? We at TNS tried to look for the reasons and, unfortunately, like overpopulation, were fed a plateful — starting from war on terror in the tribal areas, cultural barriers and the conservative Pushtoon and Baloch cultures, undocumented cross-border as well as within the country movement of people, ineffective programme management.

Aoun Sahi writes that “Balochistan which has registered 68 out of a total of 167 polio cases this year so far has emerged as the most problematic province in the fight against polio in Pakistan in recent years — from 8 registered cases in 2005 the number has risen alarmingly to 66.” 

He finds out that cultural barriers and a shaky health infrastructure are the two main issues hampering polio eradication in the province. “Neither do they permit male team members to enter their homes nor do they allow their women to form female teams to do the needful… ”

This is both sad and criminal. Families that have polio patients now regret why they ignored the call for prevention. They must be brought on the national media and asked to narrate their stories.

But this not where it ends; the supply side or the outreach has a host of issues. The availability of the vaccine, its proper maintenance (it must be kept between 2 to 8 degrees Celsius) and administration is not ensured. People we spoke to have blamed it on the absence of local government system when there was “at least ownership of the campaign at the union council level”.

This is the crippling reality that we face on ground. The health of the nation is clearly not well.

 


immunisation
A crippling reality
Despite several efforts to re-strategise the fight against polio, the reported incidents continue to rise
By Aoun Sahi

With 174 registered cases of polio this year, Pakistan tops the list of nations that have failed to eradicate polio. This is the second consecutive year the country has displayed a dismal record in fighting the disease. Last year, too, Pakistan topped the list with 126 cases.

An overwhelming majority of polio cases in Pakistan are being registered in the volatile tribal areas, the adjoining districts of KP and three districts of Balochistan along southern Afghanistan, where perhaps the risk is becoming a threat — because vaccinators are unable to reach the children in the country for a number of reasons.

Experts believe several factors — war on terror in the tribal areas, conservative Pushtoon culture, undocumented cross-border as well as within the country movement of people and ineffective programme management — have stood in the way of complete eradication. They believe Pakistan needs to re-strategise its polio campaign to achieve the target of polio-free Pakistan by 2012. “We need to develop a sense of ownership among the vaccinators and other staff members involved in the campaign,” Dr Hanif Khelji, chief coordinator of the Rotary Club’s polio eradication programme in Balochistan tells TNS.

“We need to involve local NGOs, political parties and religious scholars in the campaign. Also, an effective system of accountability is required most urgently,” he adds.

Officials at National Institution of Health (NIH), Islamabad admit that the emergence of new polio cases every day in the country is a substantial proof of the poor performance of the polio programme. Simply, it is not delivering.

The experts reiterate the need to make radical changes in the polio campaign strategies in different parts of the country, especially the 14 high-risk districts and agencies. “A strong monitoring and accountability system is needed to evolve which really is lacking in the current campaign strategy,” stresses one NIH official.

Balochistan which has registered 68 out of a total 167 polio cases this year so far has emerged as the most problematic province in the fight against polio in Pakistan in recent years — from 8 registered cases in 2005 the number has risen alarmingly to 66.

In the Quetta block, comprising Quetta, Pashin and Qilla Abdullah districts, the strong Pakhtoon area, “cultural barriers and a shaky health infrastructure are the two main issues hampering polio eradication. Neither do they permit male team members to enter their homes nor do they allow their women to form female teams to do the needful,” says a senior official of health ministry in Quetta, talking to TNS.

He believes the Musharraf-introduced local government system worked better. “There was at least ownership of the campaign at the union council level. The polio cases have drastically increased after the local government system was abolished,” he says, adding that lack of continuity, political interference and no sense of ownership are the main factors responsible for the polio emergence in Balochistan.

“Federal government along with international organisations need to introduce a new strategy based on these factors,” he suggests.

Noorul Haq Baloch, the focal person for polio campaigns in the Balochistan health department does not hesitate to admit the shortcomings of the polio campaigns in the past. “We have completely re-strategised our planning for the upcoming campaign. Union councils will be our main focus. We are in the process of hiring medical doctors even at union council levels to monitor and evaluate the campaign. Paramedics will work under them,” he says.

Another problem that he points out is the free and unchecked human trafficking between Quetta block and southern Afghanistan. “We have set up transit teams to immune people in border areas. We are also in regular contact with our Afghan counterparts and planning to closely coordinate surveillance and supplementary immunisation activities (SIAs) on both sides of the border,” says Noorul Haq.

In the Peshin district alone there are more than 130,000 children under the age of five to target in the upcoming campaign but the elders simply refuse to get their young ones vaccinated. “We are planning to take religious scholars, local elders, political parties and teachers on board,” he says.

But essentially, reaching out to all the children is not the only issue. “We have to ensure the vaccine is not wasted before it goes into the child’s mouth. It must be kept between 2 to 8 degrees Celsius,” says Jalaluddin, programme manager Research and Development Foundation, a Peshawar-based NGO working in collaboration with the UNICEF on making polio campaigns more effective in KP and tribal areas of Pakistan.

“Earlier, children as young as 10-12 years of age were hired for the vaccination campaign. Surely, they are too young to handle a sensitive job as this. The government must train vaccinators and hire qualified people,” he urges.

Dr Jan Baz Afridi, Deputy Director, Expanded Programme for Immunisation (EPI), KP, asserts that the situation has improved compared to previous years: “We are ensuring a government official is made part of every mobile team and held accountable for the team’s activity.”

He adds that the prime minister announced major changes in the polio eradication effort on November 24. “He clearly underlined that activities and accountability needed to be tracked and monitored at the provincial, district and union council levels. We have already constituted committees on these levels for the first time and hope to achieve maximum in coming campaigns,” he says.

Tribal areas of Pakistan are another problem in Pakistan. In Khyber Agency alone, more than 200,000 children are out of the immunisation net since 2009. Polio vaccinators in the Agency tell TNS that there is not even a single female mobile team out of a total of 113 teams in the Agency.

“Male teams can only go to a certain gathering place in villages and request village men to bring their children out for vaccination,” says a vaccinator in Khyber Agency, “We have received no new instructions for the upcoming campaign and we believe a lot of children will go amiss.”

Dr Abdul Qadoos, in charge of health-related operation in Khyber Agency, says that there are more than 210,000 children under five in the Agency. “At least 76,000 of them are inaccessible. We have formed 13 transit teams to vaccinate children of those families who move from one place to other. We have already suggested to the government to introduce the more expensive injectable polio vaccine and some incentive to the target families for vaccinating their children”. He admits maintaining the recommended temperature for vaccine is a problem in tribal areas due to hours-long load shedding of electricity.

UN agencies working on polio eradications have also been working closely with the government of Pakistan to re-strategise the polio campaign in the country. World Health Organisation has been working on district-specific plans to maximise the impact of supplementary immunisation activities (SIAs). New approaches are being put in place to increase access to populations in conflict-affected areas by employing local access negotiators; implementing the new Short Interval Additional Dose (SIAD) strategy during windows of opportunity and continuously assessing the evolving security situation to help guide strategy and update district-specific plans.

“We have several approaches. First, to position vaccination teams at points of exit where people may be fleeing an area to ensure that those children are vaccinated. Then following up at the camps for the internally displaced people or among the communities where they have taken shelter, with vaccination campaigns”, Sona Bari of Global Polio Eradication Initiative, a public-private partnership led by national governments and spearheaded by WHO tells TNS via email. “Also, when there is a pause in conflict for whatever reason, we use a tactic known as Short Interval Additional Dose. Thanks to new vaccines, we can deliver doses of polio vaccine at shorter intervals than before. This advantage is used when an area is accessible for a short time. Teams will go in and vaccinate twice during a short period of time,” she says.

Due to large-scale population movements with neighbouring Afghanistan, the two countries will closely coordinate surveillance and SIA activities. “Technical support has been deployed to key border areas to improve immunisation activities, and temporary vaccination posts have been set up at key border crossings and gathering sites”, she says.

   

 

Foreign hand
Removing misconceptions about the polio vaccine is a tougher challenge than acquiring access to the target children
By Shahzada Irfan Ahmed

The United Nations Children’s Fund (Unicef) warning that Pakistan is facing a serious risk of being the last polio reservoir in the world has put it on the global disease watch radar and media limelight. The extraordinarily high instance of new polio cases is, therefore, yet another wrong reason for Pakistan to be in the news.

The challenge of eradicating this crippling disease has been accepted by the government and fully supported by organisations like Unicef and World Health Organisation (WHO).

Quite ironically, much is expected from these international organisations widely criticised by conspiracy theorists on various charges, such as the vaccine is used as a tool to control population by making the recipient child infertile or imams (prayer leaders) who term this vaccine haram (prohibited in Islam) alleging it contains lard. The fact they have no substantial evidence to prove their claim is however insignificant.

Such claims got some evidential support when it was confirmed that some individuals under the garb of vaccinators selected DNA samples of Osama bin Ladin’s family in Abbottabad.

Regardless, the role of international organisations in the fight against polio is integral. At times when finger-marking is still the main method of verification in the country, a more reliable system of monitoring is required.

TNS talked to representatives of global organisations and locals working for them to know their observations, experience, perspective and opinion on how to achieve the goal of polio eradication.

Farooq Hameed, who has worked with Unicef in Balochistan for almost 10 years, terms bad governance the major cause for spread of disease in the district. “The culture of patronisation is so strong in the area that District Health Officers (DHOs) are appointed on the behest of politicians. This promotes culture of corruption as these officials are protected by the politicians when they are in trouble,” he says.

Hameed says he has observed over the years that most of the health department professionals including Lady Health Workers (LHWs) sit at home and volunteers have to be depended upon. When the district management is corrupt, they will resort to activities like selling petrol, taking vaccinators to fewer places on official vehicles and wrongly reporting that children or families were not at home.

Vaccinators also wrongly use the excuse of children running fever, he adds.

Hameed laments one a dedicated and honest Balochistan Health Minister had to accept publicly that he failed to execute the immunisation campaign in the province. He simply failed to take the mafia head on.

Dr Elias Durry, senior coordinator for the WHO’s polio eradication effort in Pakistan, is also of the view that mismanagement in the main cause of spread of polio in Pakistan. Without going into details, he says, the fact that the highest risk areas are Quetta and Karachi — both provincial capitals — proves inaccessibility is not the major cause for spread of polio.

Durry says WHO provides technical and financial support to Pakistan to implement the National Emergency Action Plan. Right now it’s struggling hard to meet the target of vaccinating at least 95 per cent children. “I would say again what we mostly lack is proper and quality vaccinators,” he adds.

Dr Khalid Jameel, head of the Rehabilitation Department, Mayo Hospital, Lahore, tells Unicef that he urges international community to also focus on the rehabilitation of children affected by polio. Popularly known as Big Brother, Dr Jameel receives polio patients from all over Pakistan and evaluates their cases before referring their names for support.

Under an agreement reached upon by Punjab Chief Minister Shahbaz Sharif and Unicef, such affectees get financial support for education and sustenance and wheelchairs etc.

Dr Jameel says unfortunately polio is irreversible; international community does support immunisation drives at a large scale but very few go for rehabilitation.

Dr Seema Raza, a medical health professional, believes desired results cannot be achieved without addressing the root causes which sometime remain unnoticed by locals and foreigners fighting the disease. Explaining her point, she says, not less than 80 per cent childbirths take place at homes, mostly in far flung areas.

The newborns in these cases are not administered polio vaccine soon after their birth whereas in hospitals, whether government or private, it is mandatory to do so. Those who reach hospitals are advised to get further doses in time and they mostly follow the advice, she adds.

Dr Raza points out another problem in this regard — a child affected by polio virus has to be isolated immediately to save others. This is not possible in rural areas where awareness is negligible and so the space to accommodate family members in different rooms constricted.

   

 

perspective
Bumpy drive to eradication
As the number of polio cases in Pakistan reaches 174 this year, there is an urgent need to re-identify the reasons and causes
By Waqar Gillani

Pakistan is one of the four remaining polio-endemic countries in the world, making ours a priority country for the Global Polio Eradication Initiative, according to the World Health Organization (WHO). The virus, which also led America’s Central Intelligence Agency to catch their biggest target of the decade — Osama bin Laden — this May near Islamabad through a fake polio campaign, is still on the rise and spreading.

Of the four countries in the world that are not polio-free yet — Nigeria, Afghanistan, India and Pakistan — the last three fall in South Asia. The WHO reports say Pakistan is also the cause of a recent detection of a polio case in China as the said child carries the virus similar to the one in Pakistan. Correspondingly, the WHO has warned other countries of the world against the presence of the genetic link to the wild poliovirus type-1 detected in China’s Xinjiang province, bordering Pakistan, in the past few months.

Since the launch of the special polio vaccination campaign in 1994, the country has made substantial progress towards the eradication of the disease that cripples children. However, the conflict zones of the country — chiefly Balochistan and the tribal areas — are still under threat by the virus.

The latest number of polio cases in Pakistan (recorded early December) this year has reached 174, according to official reports. This number includes five cases in Punjab, 30 in Sindh, one in Gilgit-Baltistan, 19 in Khyber-Pakhtunkhwa, 51 in the Federally Administered Tribal Areas (FATA), the war-hit zone; and 68 in Balochistan, the most sparsely populated and the most poorly managed province.

In the early 1990s, the annual incidence of polio was estimated at more than 20,000 cases a year, but over the past few years an average of only 100 cases per year has been reported.

“Currently, Quetta zone and Fata are the most affected areas in Pakistan,” says a senior official in the polio eradication coordination department at federal level.

He says the major reasons are lack of strategy, quality of campaign, and accessibility. The vaccination teams are not achieving the required target. There are still 180,000 children in this area left to be vaccinated as compared to 300,000 a couple of years ago.

Pakistan is now reporting more cases than the cases of the other three endemic countries Nigeria, India, and Afghanistan put together.

After 23 years of commencing the WHO-led Global Polio Eradication initiative, billions of dollars in investment, mobilisation of 20 million health workers and a population wide intervention in 125 countries, vaccinating more than two billion children, there are only four countries in the world which continue to harbour the disease. Pakistan is the only country where cases have steadily increased since 2008, says the WHO report.

There are only five important districts for polio eradication in Balochistan — namely Quetta, Pishin and Kila Abdullah, making a triad and adjoining districts of Nasirabad and Jaffarabad. KP and Fata continue to be at risk. Several areas in these conflict regions have been inaccessible for vaccination, leaving too many children insufficiently protected against polio.

The Sindh programme has demonstrated its capacity to interrupt poliovirus transmission; however, the achievements could not been sustained. One type-3 polio case was reported in 2010. In 2009, Sindh reported 12 polio cases. Epidemiological data complemented by genetic analysis of polioviruses confirms the ongoing circulation of type-3 poliovirus in Karachi.

“One of the major reasons for non-eradication of polio in the province is people’s refusal to have their children vaccinated,” KP Health Secretary Asmatullah Kakar says.

Misinformed religious factions challenge the writ of the state and the campaign against polio widely, on the notion that vaccination is forbidden in the religion because it affects fertility.

Pakistan has run 118 anti-polio special campaigns since 1994, while it started its normal polio campaign in 1982, recalls Dr Azhar Bhatti, Additional Director, Expanded Programme for Immunisation (EPI), Punjab.

According to Bhatti, recent researches have shown that the potable water of Lahore, Multan, Faisalabad and Rawalpindi is contaminated with the polio virus. The government is working on eliminating the risk in collaboration with the WHO, he adds.

The tremendous progress towards the eradication of polio in Pakistan is threatened by stagnation due to managerial and implementation failures and a lack of accountability in these districts.

“One of the main reasons behind the persistent circulation remains the inconsistency of campaign quality at the sub-district level and continuing sub-optimal routine EPI coverage,” says an official report of Government of Pakistan.

“On the other hand, inaccessibility to children in security compromised areas such as KP and Fata and pockets where the people refused the vaccination have also contributed to the persistence of the disease’s circulation in KP and Fata. Additionally, the movement of over 400,000 internally displaced persons from active conflict areas of KP and Fata which have both non-immune and under-immune children because they are inaccessible or refusals resulted in a significant disturbance in the epidemiological situation and contributed to an upsurge in cases in KP and Fata, Islamabad and Punjab.”

Moreover, malpractices such as absenteeism in public facilities, ghost vaccination teams, well-institutionalised pilfering from the supply chain, crony managerial appointments, collusion in monitoring records and embezzlement at the field level are also cited as reasons for the failure of such campaigns.

The gaps in the governance of the Polio Eradication Programme are an impediment to an effective translation of the National Emergency Plan for Polio Eradication into concrete action on the ground and all the sensitisation, awareness creation and commitment mobilisation at the highest level, ultimately comes to a naught, according to an official report.

 

Global status of polio

Till Nov '11

 

Countries          Confirmed          Confirmed           Confirmed           Confirmed

          cases 2008   cases 2009   cases 2010   cases 2011

Afghanistan          31          38          24          47

India   559          762          44          01

Nigeria 798          388          18          42

Pakistan          117          89          144          174 (till now)

 

Reasons for non-eradication

- Inaccessibility

- Hard-to-reach areas

- Lack of political will

- Religious propaganda

- Lack of accountability

- Low quality campaign

- Lack of proper monitoring

- Negligence of staff and

    teams

- Lack of coordination

- Transfer of virus through

    travel

- Poor district level

    supervision

- Following the cold-chain 

    of vaccine

- Inconsistent quality of

    vaccination activities in a

    few key reservoir areas

- High population

    movement

- Injudicious distribution of

    vaccinators at union 

    council level

- Improper utilisation of

    resources in a few key

    districts and towns

- Selection of

    inappropriate/incompe-

    tent volunteers/vaccina-

    tion staff during the

    campaign

- Non-existence of regular

    outreach EPI activities

 

Tales of woe
A poor villager in KP holds religious orthodoxy responsible for the miserable plight of his daughter
By Mushtaq Yusufzai

In Regi village in the suburbs of Peshawar, a cleric opposed to polio vaccination has constantly urged people to avoid administering polio drops to their infants, as in his view it is a conspiracy of the West to make their next generation impotent and decrease population of the Muslims.

Interestingly, the cleric’s own son became victim to the poliovirus as a result of his refusal to vaccination campaigns. However, instead of showing any regrets, the cleric thought it was the Will of the Almighty and must not be meddled with.

A common villager, however, is having second thoughts. Khan saheb (real name changed), a resident of a small village in KP, is sad because listening to the fiery sermons of the cleric cost him his daughter Hafsa’s health.

Scared he might be picked on for “daring to differ,” Khan says ruefully how a number of medical workers visited his house to have his child vaccinated against poliovirus but he refused to all of them, saying it was “un-Islamic”.

Sadly, he learnt the lesson the hardest way. “My daughter has become paralysed for life and I feel guilty like anything,” he says. “I hold myself responsible for her plight.”

Khan is not loath to blame the orthodox thinking of the clerics who propagate against polio vaccination, rejecting any efforts on the part of the government to eradicate the virus from the face of the earth.

Apart from the tribal areas where militancy, military operations and malicious propaganda by certain clerics have contributed to the rising number of polio cases, the vaccinators are faced with similar challenges in Khyber-Pakhtunkhwa. KP recorded 19 cases this year, five of them in Peshawar, the provincial capital.

Senior health officials are of the view that besides reasons such as a lack of security for vaccinators in different areas, insufficient resources and corruption, propaganda against vaccination by clerics has made it difficult for them to convince parents to have their children administered with polio drops. In Peshawar areas where the literacy rate is low, parents continue to refuse vaccination to their kids.

With financial assistance and technical support from donor organisations, the provincial health department and the EPI organised several seminars and workshops with the aim to removing misconceptions attached to polio vaccination. Even the services of eminent religious scholars were utilised and they personally attended functions, issued religious decrees in support of the polio campaign and through sermons urged people to save lives of their children from being paralysed forever by administrating polio drops in time.

But all such efforts appear to have gone to waste since the virus has not been eradicated.

Senior officials of different donor agencies say over Rs 500 million are being spent on each of the nine anti-polio campaigns every year to administer Oral Polio Vaccine (OPV) to around five million children.

According to Dr Jan Baz Afridi, EPI chief in KP, refusal cases have been brought down from 26, 000 to 16000 during the past few months.

In North Waziristan, where even the Taliban led by Hafiz Gul Bahadur and influential religious clerics publicly announced their support to polio vaccination, it was the health department and people associated with polio education programme who failed to reach out to the children living beyond Miramshah and Mir Ali, the two major towns of the tribal region.

An official of health department in Miramshah tells TNS that due to a lack of checks and balances by the high-ups based in Peshawar and Islamabad, the vaccination campaign has never achieved its target in the region. Hence, polio teams supposed to visit each and every house just end up handing over vaccines to villagers in far-flung areas they meet at a bus terminal or markets in Miramshah.

The villagers are advised to take vaccines along and administer to kids in their villages. Since the vaccines require a standard temperature, therefore it has lost its efficacy by the time it reaches its target areas.

 

Province of issues
Balochistan which has registered 68 out of a total 167 polio cases this year so far has emerged as the most problematic province in the fight against polio
By Muhammad Ejaz Khan

Eighteen months old Asad Khan from Kharotabad area of Quetta, was crippled because he had not been administered polio drops. His father’s voice drops as he speaks of Asad’s plight.

This is not the first case of polio in Balochistan. The province has, in a short span of two months, seen as many as 27 polio cases registered in different districts of the province including Quetta, Qillah Abdullah, Jaffarabad, Khuzdar, Nushki, Pishin and Loralai. The current tally becomes 66.

One reason for the resurgence of the crippling disease in Balochistan is that the drinking water in most cities of the province is turbid and unhygienic. According to an EPI report, the number of polio cases in Balochistan during the current year has risen to 275 where the 138 cases have not been confirmed. Nevertheless, 66 cases were confirmed to be positive. The report of 24 cases is yet to come.

The efforts of the Balochistan government to save the children have mostly been aborted as the number of polio patients continues to grow.

Due to the non-administration of polio vaccination, the virus is rapidly spreading, says Asmatullah Khan Kakar, Provincial Secretary Health Department, talking to TNS.

The real causes of the spread of poliovirus in Balochistan are said to be poor literacy rate, propaganda against polio vaccination campaign and professional negligence on the part of the medical workers. For a three-day awareness campaign, each worker is only paid Rs 250 a day. As for the workers they are neither trained nor supplied with community maps of the field.

On the other hand, the residents in suburban areas hold the view that since the vaccines are manufactured in western countries, they will have harmful side effects on their kids.

Another health fallacy seen in interior Balochistan is that when sick a patient is carried to the local mullahs (religious/spiritual clerics) who either gives them a charm amulet or some sort of ‘spiritual’ treatment that not only wastes time but also aggravates the ailment.

Most polio cases in Balochistan have occurred in the Afghan-Pakistan border areas. According to the officials of provincial health department, the Afghan refugees who come into Pakistan bring with them the virus.

In the given situation, legislation is under consideration against all violators of polio vaccination, whereby those who refuse to get the vaccination will be arrested.

Since polio is a water-borne disease, most inhabitants of Balochistan and its suburbs people are vulnerable to it because they are generally not careful about potable water, especially with regard to miners. It is a pity that 85 percent population of Balochistan is simply deprived of clean drinking water despite all claims by the provincial government.

The allocation of annual health budget for the province goes to waste when the same is not properly implemented, coupled with the paucity of related health facilities and an absence of official medical practitioners from the district headquarter hospitals that aggravate the already dilapidated health situation in Balochistan.

 

 

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