News Flash 520: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Hermit crab (Dardanus Calidus)

News Flash 520

Weekly Snapshot of Public Health Challenges

World Federation of Public Health Associations: GLOBAL PUBLIC HEALTH WEEK

Experts call for action on the commercial determinants of health and health equity

Quadripartite call to action for One Health for a safer world

Pandemic Accord Talks Resume Soon With Call for More Attention to One Health, and Less Misinformation

Alumni Spotlight: Collaborating to support evidence-based health policies in Africa

RECORDING AHEAD WEBINAR ABOUT POLICY OPTIONS FOR EFFECTIVELY TACKLING MEDICAL DESERTS

DECLARATION ON THE HEALTH AND CARE WORKFORCE ADOPTED IN BUCHAREST

Neighbors on alert as Equatorial Guinea and Tanzania battle Marburg

Defunding prevention and climate change drive rebound of malaria in Peru

The Level of Awareness and Impact of Ebola Outbreak on Access, Use and Adherence to HIV Treatment and Preventive Care, Psychological and Socioeconomic Well-Being of Female Sex Workers in the Ebola High Risk Districts in Uganda by AWAC Uganda

SAGE updates COVID-19 vaccination guidance

No More COVID-19 Boosters for Healthy People, WHO Experts Recommend

EU medicines agency: COVID vaccine side effects still being monitored

The Covid-19 Pandemic as Tipping Point (Part 1) by Ted Schrecker

Do COVID’s Origins Matter?

Long COVID: Incidence, Impacts, And Implications

Access Denied: The role of trade secrets in preventing global equitable access to COVID-19 tools

Access Denied: The impact of Big Pharma influence on UK government decision-making in the COVID-19 pandemic

TDR Newsletter: World Tuberculosis Day Bulletin

MSF applauds Indian Patent Office’s rejection of J&J’s attempt to extend monopoly on lifesaving TB drug

IMF Lending Under the Resilience and Sustainability Trust: An Initial Assessment

MPP announces its Community Advisory Panel (CAP) to support the implementation of the organisation’s new strategy

Evidence of crimes against humanity in Libya, experts say

HRR 671: HISTORY AS IT WAS NEVER TOLD TO YOU

Male guardianship rules in north Yemen restrict women’s aid work

We Cannot Improve Maternal and Child Survival Without Improving Data Systems

Lack of water services leave women and girls vulnerable to ‘sextortion’

Australia Has Begun a Climate Charm Offensive to Land UN Summit

What the IPCC report means for global action on 1.5°C

Air Pollution and Mortality at the Intersection of Race and Social Class

Mini Rapid Assessment -Issues Brief on The Level of Awareness and Impact of Ebola Outbreak on Access, Use and Adherence to HIV Treatment and Preventive Care, Psychological and Socioeconomic Well-Being of Female Sex Workers in the Ebola High Risk Districts in Uganda

Find here a not yet anywhere published document by the Alliance of Women Advocating for Change (AWAC) partner organization. AWAC is an umbrella network of grass root female sex worker led organizations in cutting across the 6 regions of Uganda. It was established in 2015 by female sex workers (FSWs) to advance health rights, human rights, socio-economic rights and social protection for FSWs and other marginalized women and girls including their children in Uganda. Geographical focus areas encompass: slum areas, islands, landing sites, transit routes, mining, quarrying, plantations, road construction sites and border areas in Uganda

AWAC.jpg (342×457)

Mini Rapid Assessment -Issues Brief on The Level of Awareness and Impact of Ebola Outbreak on Access, Use and Adherence to HIV Treatment and Preventive Care, Psychological and Socioeconomic Well-Being of Female Sex Workers in the Ebola High Risk Districts in Uganda

Download the study here

https://awacuganda.org/download/mini-rapid-assessment-issues-brief-on-the-level-of-awareness-and-impact-of-ebola-outbreak-on-access-use-and-adherence-to-hiv-treatment-and-preventive-care-psychological-and-socioeconomic-well-being/

PEAH is pleased to publish a study titled “Mini Rapid Assessment -Issues Brief on The Level of Awareness and Impact of Ebola Outbreak on Access, Use and Adherence to HIV Treatment and Preventive Care, Psychological and Socioeconomic Well-Being of Female Sex Workers in the Ebola High Risk Districts in Uganda” as a not yet anywhere published work by AWAC-Uganda .

This report presents findings of the mini rapid assessment and issues brief conducted from 28th November 2022 to 15 th Dec 2022, to examine the level of awareness of Ebola and the impact of its associated restriction guidelines on the access and adherence to HIV treatment and preventive care, psychological and socioeconomic well-being of female sex workers in the Ebola High risk districts of Kassanda, Mubende, Masaka, Kampala, Mukono and Wakiso in Uganda. The assessment employed a survey through a cross-sectional design–with a strong focus on districts that have been affected by the Ebola epidemic using qualitative and quantitative approaches. This report is presented in sections: – introduction, purpose and objectives, methodology, findings and lessons learnt, challenges, conclusion and recommendations

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About AWAC

For the past seven years since its inception in 2015, as an umbrella network of grass-root female sexworker (FSW) led-organizations/ groups in Uganda, AWAC has advocated for gender justice and implemented programs in quest for an inclusive Policy and Social environment where the rights of FSWs including FSWs with intersecting vulnerabilities are recognized, promoted and protected to enable them live healthy and productive lives. AWAC also works to promote the voices, fight stigma, discrimination and criminalization of all forms and champion access to integrated qualityHIV/SRHR/GBV and mental health services. AWAC has empowered grassroots FSWs to: organize, understand their rights and responsibilities; lobby for meaningful involvement; seek and demand for equitable access to health, legal, social and economic services; hold leaders accountable and as well challenge oppressive, stigmatizing and discriminatory practices, policies and laws.

The Covid-19 Pandemic as Tipping Point (Part 1)

PEAH is pleased to publish the first half of a two-part blog post with remarkable insights by professor Theodore Schrecker as a renowned political scientist specializing in the political economy of health and health inequalities. Click here to see all relevant reflections by him published on PEAH over recent years

By Ted Schrecker

Emeritus Professor of Global Health Policy, Newcastle University

The Covid-19 Pandemic as Tipping Point (Part 1)

I began a (pessimistic) 2022 book chapter on the prospects for ‘building back better’ after the Covid-19 pandemic by quoting the first sentences of J.G. Ballard’s magnificent dystopian novel High-Rise:

Later, as he sat on his balcony eating the dog, Dr Robert Laing reflected on the unusual events that had taken place within this huge apartment building during the previous three months. Now that everything had returned to normal, he was surprised that there had been no obvious beginning, no point beyond which their lives had moved into a clearly more sinister dimension.

The giveaway word here is “normal,” and the new normal to which Laing’s world has returned is one in which a deadly class war between the affluent and even more affluent residents of a 40-story tower block has completely destroyed the interior of the building and most of its vital systems, and survivors are reduced to killing and eating the pets of their less fortunate neighbours. In a scene near the end of the novel, surviving children play with human bones in the tower block’s rooftop sculpture garden.

This rather dramatic introduction was designed not to suggest that post-pandemic societies will literally regress to that extent, although that could happen in some contexts, but rather that conditions of life that come to be regarded as normal in the post-pandemic world will probably look very, very different from those of late 2019, and for most of us more insecure and threatening. I am more convinced of this now than I was when I wrote the chapter.

In a recent conference paper, I argued that the pandemic should be understood as a tipping point, initiating processes that magnify and accelerate existing trends, in particular those involving rising inequality and its direct and indirect effects on health. The concept of a tipping point is used in several, slightly different ways depending on context, but it is now most familiar from research on climate change. Leading climate researcher Timothy Lenton explains: tipping points “occur when there is strongly self-amplifying (mathematically positive) feedback within a system such that a small perturbation can trigger a large response from the system, sending it into a qualitatively different future state.” Stated more colloquially, “sometimes little things can make a big difference,” or at least a disproportionate difference, “to the state and/or fate of a system.”

Figure 1. Schematic representation of cascading effects in the vegetation–rainfall system

(a) Vegetation–atmosphere system in equilibrium. (b) Initial forest loss triggered by decreasing oceanic moisture inflow. This reduces local evapotranspiration and the resulting downwind moisture transport. (c) As a result, the rainfall regime is altered in another location, leading to further forest loss and reduced moisture transport.  Reproduced without change from Zemp, D. C., Schleussner, C. F., Barbosa, H. M. J., Hirota, M., Montade, V., Sampaio, G. et al. (2017). Self-amplified Amazon forest loss due to vegetation-atmosphere feedbacks. Nature Communications, 8, 14681 under a Creative Commons Attribution 4.0 International Licence.

An especially striking example is provided by deforestation in large tropical rain forests (Figure 1). As much as half of the precipitation that falls on such forests originates from evapotranspiration within the forest itself. The concern is that deforestation resulting from human activity (forest clearance) will combine with reduced oceanic moisture inflows to lead to a tipping point in which reduced rainfall accelerates forest dieback, and the rain forest transitions to savannah or steppe. This will itself accelerate climate change, as the forest no longer provides a carbon sink. Researchers write that findings about multiple processes of this kind “imply that shifts in Earth ecosystems occur over ‘human’ timescales of years and decades, meaning the collapse of large vulnerable ecosystems, such as the Amazon rainforest and Caribbean coral reefs, may take only a few decades once triggered.” This is a long time in the context of such phenomena as election cycles, but an eyeblink in geological time. Whatever the time scale, once a tipping point has been reached, the pace of changes that were already under way accelerates rapidly, and entirely new changes may begin.

My pre-retirement colleague Clare Bambra and colleagues have provided an especially compelling account of how distribution of health outcomes during the pandemic reflected and magnified economic inequalities (open access, and essential reading). Looking ahead, here are a few of the patterns (far from an exhaustive list) that suggest the value of considering the pandemic as tipping point:

Concentration of wealth at the very top of national and global economic distributions: The number of US dollar millionaires worldwide increased from 46.8 million in mid-2019, the last pre-pandemic year, to 62.5 million in 2021. This growth was fuelled by rising share prices, but also by
Soaring property prices in much of the world. US homeowners saw their wealth increase by more than US$6 trillion between the start of the pandemic and the third quarter of 2022; average house prices across Canada’s 15 major metropolitan areas rose by as much as 45 percent between 2019 and 2021, depending on distance from the city centre. The ‘flip side’ of this pattern, which began before the pandemic but was accelerated by it and is repeated in many European centres, is
A growing pattern of unaffordable housing and semi-permanent housing insecurity, underpinned by the financialization of housing, which also predates the pandemic and led one group of Australian researchers to conclude that: “sustained inflation of property values … has fundamentally shifted the social class structure, from a logic that was structured around employment towards one that is organized around participation in asset ownership and appreciation.”
Housing prices are an important part of a larger cost-of-living crisis, originating in supply chain disruptions associated with the pandemic and worsened by Russia’s invasion of Ukraine and its weaponization of energy exports. Interest rate increases – a conventional central bank inflation-fighting tactic – cannot address these impacts because they have no effect on supply, and in fact are likely to magnify inequality, as they raise the cost of consumer debt and are passed through to consumers by producer firms.
In a global frame of reference, countries differed in the fiscal capacity they were able to deploy in initial responses to the pandemic, which will probably lead to increased inter-country inequality. Further issues arise from what could be
An impending sovereign debt crisis for many countries; before the pandemic the sovereign debt load of countries in sub-Saharan Africa, the world’s poorest region, was more than twice its nominal value in 2009, the year after the financial crisis. In early 2023 the American Public Health Association called on the International Monetary Fund, World Bank and G20 “to eliminate debt for the poorest countries and expand fiscal space for public financing of health services and public health programs.”
Finally, of course, there are the effects of climate change on various social determinants of health, including food security.

The World Economic Forum’s 2023 Global Risks Report devoted an entire chapter to the concept of “‘polycrisis’ – a cluster of related global risks with compounding effects, such that the overall impact exceeds the sum of each part.” This is a useful way of capturing the interactions discussed here, yet at the same time we must acknowledge that many trends in question will present as crises for many, and opportunities for others. (Housing price escalation is a case in point.)

Perhaps my view of the future is excessively bleak. After all, high-income countries were able to buffer many of the pandemic’s economic effects, and the US improbably experienced a substantial, if temporary, drop in poverty. The situation outside the high-income world was, and is, considerably more grim, like the “vaccine apartheid” that has now largely faded from public consciousness reflecting the multiple dimensions of global inequality and the relative invisibility of the global majority. Numerous blueprints, some quite detailed, exist for ‘building back better’. The second part of this posting will direct readers to a few of these; assess some of the formidable political obstacles to their realization against the background of rising inequality; and offer a few conjectures about health in the post-pandemic new normal.

News Flash 519: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Flying Gurnard (Dactylopterus Volitans)

News Flash 519

Weekly Snapshot of Public Health Challenges

World Literacy Summit: April 2-4 2023, Oxford University, Oxford, UK

Cross-country analysis of health worker mobility across the European Union and neighbouring countries (2010 – 2022): Highlights

55 countries face a health worker crunch linked to COVID-19: WHO

Protecting Public Health through Technology Transfer: The Unfulfilled Promise of the TRIPS Agreement

Is There a Case for “Common but Differentiated Responsibility” in Global Health?

Over 6.5 million South Africans could be affected by long COVID

Audio Interview: The Future of Covid-19 Research

From concept to scale Celebrating 10 years of seasonal malaria chemoprevention

WHO clears combination malaria nets to dodge resistance

World Tuberculosis Day 24 March 2023

WHO steps up the Director-General’s flagship initiative to combat tuberculosis

Urgent need to improve access to TB testing to support rollout of better, safer, shorter treatment for drug-resistant TB

The quality of antiretroviral medicines: an uncertain problem

SEE WHAT MATTERS: Combating Stigma to End HIV/AIDS in Eastern Europe and Central Asia (EECA) by Olga Shelevakho

Burundi declares public health emergency amid first polio cases in 30 years

People’s Health Dispatch Bulletin #46: Health workers demand change

March 2023 TDR Newsletter

The messy business of sanitation and toilets

Our lifetime opportunity to enable water, sanitation and hygiene for all

THE STATE OF WOMEN AND LEADERSHIP IN GLOBAL HEALTH

Surge in executions of drug offenders in 2022, more on death row

Uganda passes a law making it a crime to identify as LGBTQ

HRR 670: OUR CRITICAL SENSE HAS SHARPENED, OUR DEMANDS HAVE GROWN, BUT WE HAVE NOT YET SUFFICIENTLY FOUGHT AGAINST THE PROGRESSIVE ATOMIZATION THAT DISSOCIATES US INTO TINY GROUPS AND DISABLES US FOR EFFECTIVE COLLECTIVE ACTION

Consumer protection: enabling sustainable choices and ending greenwashing

Protecting and Managing the High Seas

Global fresh water demand will outstrip supply by 40% by 2030, say experts

Number of city dwellers lacking safe water to double by 2050

National Geographic Society and Utrecht University Launch World Water Map

MIND THE WATERGAP Mapping the world’s water shortages

Next Decade Will Determine if We Can Stop Global Warming at 1.5ºC, Says IPCC

EU climate chief calls for higher ambition at COP28 after IPCC report

Climate deaths ’15 times higher’ for most vulnerable

‘See What Matters’ Campaign

PEAH is pleased to publish a piece by AFEW partner organization. AFEW is dedicated to improving the health of key populations in society. With a focus on Eastern Europe and Central Asia, AFEW strives to promote health and increase access to prevention, treatment and care for major public health concerns including - though not limited to - HIV, TB, viral hepatitis, and sexual and reproductive health

By Olga Shelevakho

Communications Officer, AFEW International

‘See What Matters’ Campaign

Combating Stigma to End HIV/AIDS in Eastern Europe and Central Asia (EECA)

AFEW Partnership has launched a social impact campaign «See What Matters» as a part of the project “Combating stigma to end HIV/AIDS in Eastern Europe and Central Asia (EECA)”.

Background

Stigma and discrimination against people living with HIV continue to exist and affect various areas of human life, thereby creating barriers and obstacles to HIV prevention and treatment and seriously reducing the overall quality of life of those affected.

Self-stigma of PLHIV remains the most pressing issue for EECA countries. Findings from studies conducted in Kazakhstan, Kyrgyzstan, Russia and Ukraine showed a high level of self stigma among people living with HIV: 81.3%-91.2% of PLHIV surveyed conceal their HIV-positive status from others, half of respondents feel guilt and shame about their HIV status.

HIV infection is still associated with “inappropriate sexual behavior” and belonging to marginalized populations. Women are the most susceptible to HIV-related stigma. HIV stigma in women is associated with rejection by family and friends, society, feelings of insecurity and loss, low self-esteem, fear, anxiety, depression, suicidal thoughts and even suicide attempts

To reduce the self-stigma of women living with HIV and affected by HIV and to change societal attitudes towards them through reducing social stigma, AFEW Partnership developed the project “Combating stigma to end HIV/AIDS in Eastern Europe and Central Asia (EECA)”.

Media campaign

In 2022, we conducted a survey among women living with HIV, most vulnerable to HIV and affected by HIV (including the mothers of children with HIV), showing the challenges they face in their daily lives. Based on these responses, we created a media campaign in the “animadoc” style, which allowed us to combine artistic elements with realistic ones. Here we use direct quotes of the women involved, photographs of their eyes, and their real voices in national languages as a voiceover.

The campaign materials are freely available in English/Russian, as well as Kazakh, Kyrgyz, Uzbek, and Ukrainian languages, and include videos and other materials that can be used for online and offline promotion. You can find them on the official website of the campaign.

The “See What Matters” campaign was developed in the scope of the project “Combatting stigma to end HIV/AIDS in EECA”, implemented by the AFEW Partnership with financial support from Gilead. We would like to thank local organisations and communities of women living with HIV in the region for our collaboration – “Positive Women” in Ukraine, Public fund “Country Network of Women Affected by HIV” in Kyrgyzstan and “ISHONCH VA HAYOT” in Uzbekistan.

Official website of the campaign WWW.STOPSTIGMA.HIV

The report “Results of assessing the level of stigma and discrimination of women living with HIV in the EECA Region” - https://drive.google.com/file/d/1gyY-BqMeUxkkrrAXVVFnBbTUVEhxdz8B/view

Links for the videos - https://youtu.be/fNHzhdq30N4

https://youtu.be/JIwSWf_qgdo

Official news item - https://afew.org/see-what-matters/

News Flash 518: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Spiny fan-mussel (Pinna Rudis)

News Flash 518

Weekly Snapshot of Public Health Challenges

WEMOS is hiring: SENIOR GLOBAL HEALTH ADVOCATE on ACCESS TO MEDICINES (24-36 HOURS/WEEK): From April 2023 to April 2024. Submit on 19 March 2023 at the latest

Pillars of Health Survey: we are looking for health workers who migrated in EU and neighbouring countrie

Call for inputs: Policy Brief Universal Health Coverage Office of the High Commissioner for Human Rights OHCHR. DEADLINE 03 April 2023

UNITAID: Call for Proposals: Mitigating antimalarial drug resistance in Africa deadline 11 AUGUST 2023

Pandemic Accord Text Falls Short of Expectations

Three Years of the COVID-19 Pandemic: ‘A Failure of Multilateralism and Solidarity’

For Post-pandemic Recovery, Should Countries Focus on Protecting Incomes or Jobs?

The world’s first mRNA vaccine for deadly bacteria

BioNTech Mobile MRNA Vaccine Labs Reach Rwanda

Why Eli Lilly’s Insulin Price Cap Announcement Matters

News Update: EU-India FTA negotiations could have negative impact on access to medicines

Technology transfer obligations in legislation proposed in the United States (in the 117th Congress)

Petition adds pressure on FDA to finally enforce clinical trial reporting law

The well-being economy: a remedy for social fractures

Shifting to well-being economies, the time for action is now!

WHO Raises Alarm Over Increased Healthcare Worker Migration to Rich Countries Post Pandemic

The UK government lays out its new development objectives

Solar Powered Freezer Improving Immunization Coverage in Hard-to-Reach Rural Villages

Balochistan Primary Healthcare: What Has Been Done and What Needs to Improve? by Muhammad Noman

Surviving among the rubble: Syria and Türkiye one month on

Data and analysis on the economic, political, and social changes impacting Africa

Africa pays the price as China and Russia muscle in

HRR 669 THE STRUGGLE FOR HEALTH: AN EMANCIPATORY APPROACH IN THE ERA OF NEOLIBERAL GLOBALIZATION

People’s Health Dispatch: Women’s right to health: International Working Women’s Day Special

Obesity prevention: changing perspectives

Trading Cars for Bikes: 1 Way Cities Are Improving Health

Climate vulnerable countries welcome new ‘loss and damage’ plan

Concessional Finance for Addressing Climate Change: A System Ripe for Reform

Q&A: ‘It is still possible to conserve the Amazon’

The Climate Gap and the Color Line — Racial Health Inequities and Climate Change

Some 90% of Countries Exceed WHO Air Pollution Guidelines; Report Includes “Citizen Science” Data from Low-Cost Monitors

Balochistan Primary Healthcare: What Has Been Done and What Needs to Improve?

Balochistan, one of the four provinces of Pakistan, faces numerous challenges in terms of its primary healthcare system, including issues related to service delivery, quality, accessibility, and financing. This paper presents an overview of the primary healthcare system in Balochistan, highlights the achievements and challenges of the system, and suggests potential policy interventions that can improve the health outcomes of the population

By Muhammad Noman

Healthcare System, CHIP Training and Consulting

Quetta, Balochistan Pakistan

Balochistan Primary Healthcare

What Has Been Done and What Needs to Improve?

Introduction

Background and Context

Balochistan, the largest province of Pakistan, is home to approximately 13 million people, many of whom live in rural and remote areas with limited access to healthcare services.

Balochistan map - Google credit

The primary healthcare system in the province faces multiple challenges, such as inadequate infrastructure, inadequate human resources, lack of essential medicines, low funding, and poor quality of care. These challenges have contributed to a high burden of communicable and non-communicable diseases, poor maternal and child health outcomes, and low life expectancy.

Research Problem and Question

The primary healthcare system in Balochistan is in dire need of improvement. The research problem is to identify the factors that have contributed to the poor performance of the system and to suggest policy interventions that can enhance its effectiveness. The research question is: What has been done to improve the primary healthcare system in Balochistan, and what needs to be done to make it more responsive, efficient, and equitable?

Significance and Purpose of the Study

The study is significant because it provides a critical analysis of the primary healthcare system in Balochistan, which is essential for understanding the health needs and priorities of the population. The purpose of the study is to identify the strengths and weaknesses of the primary healthcare system in Balochistan and recommend policy interventions that can address the existing gaps and challenges.

Objectives and Hypothesis

The objectives of the study are to: (1) Review the existing primary healthcare system in Balochistan, (2) Identify the strengths and weaknesses of the system, (3) Analyze the factors that have contributed to the poor performance of the system, and (4) Recommend policy interventions that can improve the health outcomes of the population. The hypothesis is that policy interventions, such as strengthening the health system governance, enhancing primary healthcare services delivery, ensuring quality and accessible primary healthcare, addressing the financing gap, and promoting public-private partnerships, can improve the performance of the primary healthcare system in Balochistan.

Literature Review

Overview of Primary Healthcare in Balochistan

The primary healthcare system in Balochistan is characterized by a three-tiered structure, consisting of Basic Health Units (BHUs), Rural Health Centers (RHCs), and Tehsil Headquarter Hospitals (THQs). BHUs are the first point of contact for patients and provide a range of services, including maternal and child health, immunization, family planning, and basic laboratory tests. RHCs and THQs provide more specialized services, such as surgery, diagnostic tests, and inpatient care. The primary healthcare system in Balochistan is funded by the provincial government, the federal government, and development partners.

Achievements of the Primary Healthcare System

The primary healthcare system in Balochistan has achieved some significant milestones over the years. For example, the Government of Balochistan has established a network of basic health units (BHUs), rural health centers (RHCs), and maternal and child health centers (MCHs) across the province, which have significantly increased access to healthcare services, particularly in remote and rural areas.

Balochistan has increased the number of BHUs from 649 in 2011 to 1,135 in 2019, and the number of RHCs from 153 in 2011 to 299 in 2019. The province has also made progress in reducing the prevalence of communicable diseases, such as tuberculosis, malaria, and polio, through targeted vaccination campaigns and disease surveillance. Moreover, the introduction of community-based programs, such as Lady Health Workers (LHWs) and Community Health Workers (CHWs), has improved access to basic healthcare services, particularly in hard-to-reach areas.

Challenges of the Primary Healthcare System

Despite the achievements, the primary healthcare system in Balochistan faces numerous challenges that impede its effectiveness. First, the system suffers from inadequate infrastructure, including dilapidated health facilities, insufficient equipment and supplies, and a shortage of safe water and sanitation facilities. Second, the system lacks sufficient human resources, including doctors, nurses, and other health professionals, especially in rural and remote areas. Third, the system is plagued by a shortage of essential medicines, medical supplies, and diagnostic tools, which hampers the delivery of quality care. Fourth, the financing of the primary healthcare system is inadequate and unstable, with limited resources allocated for preventive and primary care services. Fifth, the quality of care in the primary healthcare system is low, with inadequate supervision and monitoring of health workers, poor management of health facilities, and weak health information systems. Finally, the primary healthcare system in Balochistan is characterized by limited accessibility, with many people unable to access basic healthcare services due to geographical, financial, cultural, and social barriers.

Some of the specific achievements of the primary healthcare system in Balochistan include:

Improved access to healthcare services: The establishment of BHUs and RHCs has significantly increased the accessibility of healthcare services in Balochistan, particularly in remote and rural areas. This has enabled more people, particularly women and children, to access basic healthcare services.

Maternal and child health: The primary healthcare system has contributed to improving maternal and child health indicators in Balochistan. The establishment of MCHs has helped reduce maternal and infant mortality rates, while immunization programs have helped increase vaccination coverage among children.

Control of communicable diseases: The primary healthcare system has played a crucial role in controlling communicable diseases in Balochistan. Through the implementation of disease control programs, such as the tuberculosis control program and the malaria control program, the prevalence of these diseases has been significantly reduced.

Health education and promotion: The primary healthcare system has facilitated health education and promotion activities in Balochistan. Health workers at BHUs and RHCs have conducted awareness campaigns and health education sessions, promoting healthy lifestyles and disease prevention.

Human resource development: The primary healthcare system has contributed to the development of human resources in the healthcare sector in Balochistan. The training and capacity-building of healthcare workers, particularly those working in BHUs and RHCs, has improved the quality of healthcare services in the province.

Methodology

Study Design

This study uses a qualitative research design, based on a review of the existing literature on the primary healthcare system in Balochistan, including government reports, academic articles, and international health organization publications. The study also draws on secondary data from national and provincial health surveys, such as the Pakistan Demographic and Health Survey and the Balochistan Health Survey.

Data Collection and Analysis

The data collection for this study involves a comprehensive review of the literature on the primary healthcare system in Balochistan, focusing on the period from 2010 to 2020. The data are analyzed using a thematic approach, which involves identifying common themes and patterns across the literature, and summarizing the findings in a narrative format. The analysis is guided by the objectives and research question of the study.

Results and Discussion

Strengths and Weaknesses of the Primary Healthcare System

The review of the literature indicates that the primary healthcare system in Balochistan has several strengths, including the expansion of the BHUs and RHCs, the introduction of community-based programs, and the reduction of communicable diseases. However, the system also has several weaknesses, including inadequate infrastructure, insufficient human resources, inadequate financing, poor quality of care, and limited accessibility.

Policy Interventions to Improve the Primary Healthcare System

Based on the strengths and weaknesses identified in the literature review, the study recommends several policy interventions that can improve the performance of the primary healthcare system in Balochistan. These interventions include: (1) Strengthening the health system governance by improving policy and planning, promoting inter-sectoral collaboration, and enhancing accountability; (2) Enhancing primary healthcare services delivery by improving the quality of care, introducing innovative service delivery models, and expanding the scope of services; (3) Ensuring quality and accessible primary healthcare by strengthening the health information system, promoting patient-centered care, and addressing social determinants of health; (4) Addressing the financing gap by increasing the budget allocation for primary healthcare, exploring alternative financing mechanisms, and enhancing resource mobilization; and (5) Addressing human resource gaps by improving recruitment and retention, enhancing training and capacity-building, and promoting community engagement.

Implications for Practice and Policy

The findings of this study have several implications for practice and policy in Balochistan. First, the study highlights the need for a more comprehensive and integrated approach to primary healthcare, which includes the promotion of preventive and curative services, as well as the management of non-communicable diseases. Second, the study emphasizes the importance of community engagement and empowerment in improving access to and utilization of primary healthcare services. Third, the study underscores the need for a more sustained and stable financing mechanism for the primary healthcare system, which includes both public and private sources. Finally, the study emphasizes the importance of evidence-based policymaking, which takes into account the local context and the needs of the population.

Conclusion

The primary healthcare system in Balochistan has made progress in expanding access to basic healthcare services, reducing communicable diseases, and introducing community-based programs. However, the system still faces numerous challenges, including inadequate infrastructure, insufficient human resources, inadequate financing, poor quality of care, and limited accessibility. To address these challenges, the study recommends several policy interventions that can improve the performance of the primary healthcare system, including strengthening health system governance, enhancing primary healthcare service delivery, ensuring quality and accessible primary healthcare, addressing the financing gap, and addressing human resource gaps. These interventions have several implications for practice and policy, including the need for a more comprehensive and integrated approach to primary healthcare, the importance of community engagement and empowerment, the need for sustained and stable financing, and evidence-based policymaking.

References

Ahmad K, Jafri W, Ali A, et al. Health status of the people of Balochistan, Pakistan: an overview. Journal of Ayub Medical College Abbottabad. 2012;24(3-4):4-9.
Balochistan Health Department. Annual Development Program (ADP) 2021-22. Accessed on February 22, 2023. http://www.balochistan.gov.pk/departments/health
Bhutta ZA, Hafeez A, Rizvi A, Ali N, Khan A. Health systems in Pakistan: challenges and opportunities. The Lancet. 2013;381(9885):1193-1207.
Government of Pakistan. Pakistan National Health Vision 2016–2025. Ministry of National Health Services, Regulations and Coordination; 2016.
Jafri W, Bhatti N. Healthcare system in Pakistan: a critical review. Journal of Rawalpindi Medical College (JRMC). 2015;19(1):91-94.
National Institute of Population Studies (NIPS) [Pakistan] and ICF International. Pakistan Demographic and Health Survey 2017-18. Islamabad, Pakistan, and Rockville, Maryland, USA: NIPS and ICF; 2019.
World Health Organization. Health Systems Strengthening Glossary. World Health Organization; 2011.
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Decision Makers’ Perception of the Performance and Salary of UC Polio Officers in Pakistan

Union Council (UC) polio officers are responsible for implementing and monitoring polio vaccination campaigns at the grassroots level in Pakistan. Semi-structured interviews were conducted with policymakers, program managers, and other relevant stakeholders at the federal and provincial levels to explore their perception of the performance and salary of UC polio officers. Several themes related to their perception were identified, including the importance of the role of UC polio officers in the program's success and the low salary as a major factor in their motivation and retention

By Muhammad Noman

Healthcare System, CHIP Training and Consulting

Quetta, Balochistan Pakistan

Decision Makers’ Perception of the Performance and Salary of UC Polio Officers in Pakistan

Introduction

Pakistan is one of the two remaining countries in the world where polio is still endemic, and the government has been running a polio eradication program with the support of international organizations, including the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO). The program employs thousands of workers, including Union Council (UC) polio officers, who are responsible for implementing and monitoring polio vaccination campaigns at the grassroots level. However, the program has faced many challenges, including security threats, vaccine refusals, Gray houses, un registered children, low routine immunisation and social mobilization issues. In this study, we aim to explore the decision-makers’ perception of the performance and salary of UC polio officers in Pakistan.

Literature Review

Previous research on the polio eradication program in Pakistan has identified several challenges, including security threats, vaccine refusals, Gray houses, unregistered children, low routine immunisation social mobilization, and monitoring and evaluation issues. Some studies have also highlighted the importance of the role of polio workers, including UC polio officers, in the success of the program. For example, a study conducted in 2017 found that the performance of UC polio officers was positively associated with the vaccination coverage in their respective areas. Another study conducted in 2019 found that the salary and working conditions of polio workers, including UC polio officers, were important factors in their motivation and retention.

Methodology

To explore the decision-makers’ perception of the performance and salary of UC polio officers in Pakistan, we conducted semi-structured interviews with policymakers, program managers, and other relevant stakeholders at the federal and provincial levels. We used purposive sampling to select participants with different levels of authority and experience in the polio eradication program. We conducted 20 interviews between June and August 2022, and the interviews were audio-recorded and transcribed verbatim.

Results

Our analysis of the interview data identified several themes related to the decision-makers’ perception of the performance and salary of UC polio officers. One theme was the importance of the UC polio officers’ role in the program’s success, and many participants acknowledged their hard work and dedication. However, several participants also expressed concerns about the quality of their work, including issues related to supervision and monitoring. Another theme was the low salary of UC polio officers, which was identified as a major factor in their motivation and retention. Many participants suggested that increasing their salary could improve their performance and retention.

Conclusion

The decision-makers’ perception of the performance and salary of UC polio officers in Pakistan is crucial for the success of the polio eradication program. Our study identified several themes related to their perception, including the importance of their role in the program’s success and the low salary as a major factor in their motivation and retention. These findings have important implications for policy and programmatic interventions aimed at improving the performance and retention of UC polio officers in Pakistan.

The study suggests that the low salary of UC polio officers is a significant factor in their motivation and retention. The decision-makers interviewed for the study acknowledged that the salary of UC polio officers was not sufficient to meet their basic needs and that it was an issue that needed to be addressed.

The study recommends that the relevant stakeholders should consider increasing the salary of UC polio officers to improve their motivation and retention, which in turn, can help improve the performance and success of the polio eradication program in Pakistan.

References

Azizullah, A., Khattak, M. N. K., & Ahmad, S. (2017). Performance of polio workers and their perceptions about the reasons for missed children during polio campaigns in Peshawar, Pakistan. Journal of epidemiology and global health, 7(1), 27-34.
Janjua, N. Z., Razaq, M., Chandir, S., Rozi, S., Mahmood, B., & Mullen, S. (2019). Exploring the reasons for low polio vaccination coverage in Karachi, Pakistan. BMC public health, 19(1), 174.
Pakistan Polio Eradication Program (2021). Retrieved from https://www.endpolio.com.pk/
United Nations Children’s Fund (UNICEF). (2021). Pakistan. Retrieved from https://www.unicef.org/pakistan/
World Health Organization (WHO). (2021). Poliomyelitis. Retrieved from https://www.who.int/health-topics/poliomyelitis#tab=tab_1
Khan, M. U., Ahmad, A., Ur-Rehman, N., & Alkhathami, M. A. (2020). Challenges and solutions to eradication of polio from Pakistan. International journal of environmental research and public health, 17(13), 4876.
Khan, M. U., Ahmad, A., & Khan, A. U. (2018). Polio eradication in Pakistan: the challenges and the way forward. Journal of epidemiology and global health, 8(1-2), 1-3.
Shaukat, S., Riaz, A., Alam, M. M., Khurshid, A., Sharif, S., Rana, M. S., … & Zaidi, S. S. Z. (2019). Environmental surveillance of poliovirus in sewage samples from selected sites in Pakistan. Journal of clinical microbiology

By the same Author on PEAH

Polio Eradication Programme in Pakistan: Critical Analysis from 1999 to 2023

News Flash 516: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings