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

  1. 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.
  2. 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.
  3. Pakistan Polio Eradication Program (2021). Retrieved from https://www.endpolio.com.pk/
  4. United Nations Children’s Fund (UNICEF). (2021). Pakistan. Retrieved from https://www.unicef.org/pakistan/
  5. World Health Organization (WHO). (2021). Poliomyelitis. Retrieved from https://www.who.int/health-topics/poliomyelitis#tab=tab_1
  6. 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.
  7. 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.
  8. 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

 

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A Renewed International Cooperation/Partnership Framework in the XXIst Century

This reflection piece calls for a debate to discuss whether the present trend of “business-based” partnerships (from former solidarity based cooperation) is pertinent with the evolving global challenges and coherent with the ethical principles inherent to the human and environmental global agreements related to global wellbeing in sustainable (CO2 emissions below 1,8 mT per person and year –ppy-) equity (international and subnational inequality GINI [i] < 0,2). It concludes that in order to progress to lower global inequities and achieve a carbon neutral world by the mid of the century and so prevent a climate disaster for the next generation, a greater focus is required on rural vs local, collaboration vs. competition, justice vs. market access to right-based universal social services and a shift from military spending to exhaust all peace agreements and fund a meaningful collaboration according to capacities and needs

By Juan Garay

Professor of Global Health Equity in Chiapas, Mexico, ELAN and UCLV, Cuba and National School of Health, Spain

A Renewed International Cooperation/Partnership Framework in the XXIst Century

 

Development co-operation (let us define it as a relation of mutual benefit) has been the Cinderella of international relations, and it seems now to be “lost in translation”

Historically, interactions between larger groups, tribes or countries, translated in benefiting those with greater power by poaching minerals, crops and/or slaves. It often came with taking over the governance through colonization in different shapes and in the name of “civilization” or “conversion”. Europe was most often in that power side throughout history.

Other relations aimed at counter-balancing those power relations and focus on the benefit those in the “losing side”. Those intentions were often related to religious groups and came with other interests, as evangelization, and a “vertical” approach (from those knowing better or having more than those in the receiving end) under different shapes of “charity”.

After the world wars in the XXth century, the cry for peace led to the foundation of the United Nations and the adoption of the Universal Declaration of Human Rights. Such new spirit, together with the impact of the war in the colonial powers, led to the wave of independence of most of the African, Caribbean and Pacific countries, while the European Union (EU) was born. Soon after, the former EU colonial and colonized countries gathered in the Youndee, Lome, Cotonou Agreement. As the Breton Woods institutions progressed with the post war reconstruction of Europe, they started to offer finance to lower income countries in return for opening up their economies to investments of former metropolia and introduce “adjustment programmes” which often meant lower government spending (especially for public services), a move called by some as neo-colonization.

Development cooperation bid to respect national priorities and governance, which led in 2000, in parallel to the Millennium Development Goals (MDGs), to the Paris principles on Aid Effectiveness (meant to respect country’s priorities and sovereign processes). Ten years later, and aware and alarmed by the threat of global warming and the responsibility of the “developed” countries, the world agreed in Busan 2011 on a more horizontal approach where all countries shared challenges and all could learn from each other. In Addis Ababa 2015, as total Overseas Development Assistance (ODA) was less than 0,2% of the world’s Gross Domestic Product /GDP- (0,4% in the EU), the global consensus on financing for development called to increase aid and domestic revenues, remittances and foreign investment towards sustainable development.

Limited ODA, appropriation and weak links with additional financing for development undermined compliance with the MDG targets which were swiftly replaced by the Sustainable Development Goals (SDG) 2030 agenda relevant to all countries and called on enhanced global collaboration beyond former vertical north-south dynamics.

Soon after, in 2020, just after Brexit, the Covid pandemic hit the world and greed to hoard vaccines ruled over solidarity. When the pandemic seemed to vanish, Russia’s invasion of Ukraine further confronted the countries with greater military power (members of the United Nations’ Security Council) and the world increased spending in arms and in burning coal. The EU embraced more clearly than ever security under United States of America (USA)-led North Atlantic Treaty Organization, sided -without the cracks of the Iraq war- with the USA and confronted Russia’s military invasion and China’s leading world trade. So it was that the EU remained allied with the biggest army while confronting as enemies its main energy (Russia) and manufactured import sources (China).

The EU’s (claimed) leading roles on peace, human rights, equity and ecology were blurred by providing arms, rejecting refugees, eroding its social model, burning coal and dismissing the imports’ factor in carbon emissions.

The world’s leading economies gradually shifted the focus of international cooperation to Foreign Direct Investment, eight-times higher than annual ODA, some 1,6% of the world’s GDP, which, if adjusted to SDG needs, could meet the estimated SDG gap in ten years.

In reaction to China’s 2013 Belt and Road Initiative (BRI) one-trillion initiative signed with 151 countries, the USA launched with G7 in 2021 the B3W (build back better world) as a “values-driven, high-standard, and transparent infrastructure partnership led by major democracies” aimed to narrow the $40 trillion (Tn) world estimated (by McKinsey) investment gap  (60% by emerging economies) infrastructure ( power, roads, telecom, water, rail, airports, ports) required by 2035[ii]. As part of it and claiming its own leading role as still the world’s main investing, trading and ODA partner in the world, the EU launched its Global Gateway (GG) aimed to mobilize €300 billion (Bn) in investments focused on quality and transparent connectivity as the way of “showing political presence and ambition”[iii]. However, the financial muscle of EU’s GG is a third of China’s BRI and 0,7% of the G7 B3W gap.

Besides the limited funds in relation to the estimated gap, the EU’s GG is uncertain as it is engineered to attract or direct EU investments towards development, a call that has frequently fallen short to expectations in the last decades. Besides, offering public subsidies, often to profitable multinationals (and dropping past principles as untied aid) may echo the recent public uproar at governments rescuing banks after the 2008 crisis.

While China, the US and the EU and other G7 members add up 70% of the world’s GDP what is their legitimacy to promote “Sustainable Equity”?

In terms of sustainability, the EU’s carbon footprint per capita is 6 metric Tonnes (mT), four times above the ethical threshold (above which we’re bound to catastrophic global warming) compared to 7.6 of China and 14.6 of the USA. They together mean 80% green-house emissions, close to 90% if carbon emissions of imports were factored in. Their production-trade-consumption pattern are unsustainable. Despite many waves of global strategies as the MDG and SDG agendas and the recurrent G7 and Chinese initiatives in the name of development inequities have widened and CO2 emissions have increased or remained far from the ethical threshold mentioned above. The world’s growing inequity means 16 million excess (from feasible levels for all) deaths per year[iv] (one in four of all deaths) and the progress towards the 1.5° warming (“point of no return”[v]) predicted over 200 million excess deaths in the remains of the century[vi], the worst-ever intergenerational legacy in human history.

With such a record of low legitimacy in terms of their own carbon emissions, it is unclear how China, the USA and the EU will bring about the change the world needs towards sustainable equity. As per the EU’s GG, it is unclear its added value on digital connectivity (most chips are produced in Taiwan and the majority of communication satellites are from the US), clean transport (green hydrogen will still be a high-cost fuel and e China controls most key minerals for energy storage) or renewable energy sources (with China’s lead in solar panels scale production and decreasing prices).

Is the present EU cooperation framework, under the GG investment lead, coherent with the challenge of a carbon neutral EU and the strength of promoting its social model?

Many studies question how FDI to developing countries may make them more reliant on the depletion of natural resources to keep their economies running[vii]. The link between ODA subsidizing private FDI and the impact on wellbeing in sustainable equity in lower income countries, embeds the following uncertainties: 1) will the level of ODA, still a very low share of global GDP and FDI, attract higher flows to low-income countries? 2) If so, will that flow be clearly linked to sustainable equity, often meaning lower profits (equities, the “s” meaning often the opposite)? 3) If flows increase and increase sustainable equity, will they increase countries’ debts and dependency? And, 4) if FDI, as often aims, boosts EU trade,
will it increase our already unsustainable and harmful ecological and carbon footprint and undermine the wellbeing of coming generations?

So, is it the right direction for the EU to bet, with unclear global lead, on connectivity, under the shadow of the US-led B3W, through the uncertain and questionable leverage on the private sector and aimed at gaining political ambition?

What is the primary responsibility of the EU in the context of global challenges?

The EU has reduced (21% lower) more than any other region of the world its carbon emissions since 1990. However, it needs to further reduce them by three fourths (and other green-house emissions and ecological footprint) by changing its production-trade-consumption patterns, a sine-qua-non which is, more often than not, ignored. Its contribution to excess mortality through excess emissions may be 15% of the global projected burden of mortality due to climate change during the XXIst, that is, over 30 million deaths.

In contrast, the EU’s positive impact in the world is uncertain through 65 years of EU ODA and through the questionable link of innovation improving global wellbeing given the evidence of market failures of the potential public goods as Covid vaccines have recently shown.

So, the first challenge of the EU to be good for the rest of Humanity, as the “primum non nocere” (first, do no harm) medical oath states, is to reduce carbon emissions including through imports.

The EU commitment to a carbon neutral economy by 2050 meets the ethical challenge but it may come too late and insufficient especially if such commitment does not include the carbon emissions attributed to others, mainly China, whose exports are consumed in the EU. A reduction by three-fourths of the EU emissions means less production, less trade (as with China) and less consumption. The innovation, technology and scale of investments required to shift completely to energy based on renewable energies and fuels (as green hydrogen), will not come in time to meet the ethical goal without changing, urgently, our unsustainable lifestyles.

Which is then the main singularity of the EU to contribute to a better world in sustainable equity based on universal rights and as the solid base for global peace and prosperity?

While the EU reduces the harm imposed on others through excess carbon emissions, mainly the less polluting tropical countries, the EU should preserve at home and promote globally its social model regulating the market towards equity by a strong social contract between institutions -duty bearers- and citizens -right holders- enabling fiscal space and universal right-based social services as health, education, justice and social protection of those in greater need.

The EU’s main difference with China and the USA is its rights-based social model, with the most advanced and equitable regulation and taxation (with a tax-to-GDP revenue rate of 41% compared to 26% in the USA and 12% in China) of the market so as to reduce inequalities (EU’s GINI stands at 0.3 vs China’s and USA around 0.4) and provide universal social protection. The EU social model translates in the highest regional average life expectancy (80 years vs. 78 in China and 77 in the USA). The other main global lead in equitable wellbeing is Japan, with GINI of 0,32 (yet with a tax revenue rate of only 13% of GDP) and world’s highest life expectancy at 84 years. Equity dynamics call for a GINI <0,2 which may limit inequalities to a fair distribution between dignity and excess thresholds[viii].

A global strategy to effectively progress towards human wellbeing in sustainable equity

If ODA did not reach the necessary scale and impact, and private FDI has many uncertainties to translate in global sustainable equity, where could the EU and global cooperation head to?

One approach to be considered, on which we have based upcoming EU cooperation in Cuba is to focus at the local rural level. This is based on two main reasons: on the one side, ecologically basic needs need to be met with local means if we really commit to a carbon neutral world by 2050 and escape the 1,5° point of no return. On the other side, it is by recovering local and rural dimensions, blurred by national and global dynamics, how we can increase empathy with the communities we live with and the nature which supports our lives.

Hence, local sustainable development should aim at sovereignty (self-sufficient based on local means and capacities) of basic living needs, that is, food through sustainable agriculture, clean energy through renewable sources, both linked to sustainable water supply and circular economy and collaborative innovation (including 3D manufacturing) of housing and basic “wellbeing technology”.

The regional level links local communities under a shared geographic, cultural or national or sub-national administration, where cooperation may promote fiscal and territorial cohesion strategies aimed at socioeconomic equity and universal coverage of rights-based services of education, health, justice and social protection, where the EU has a strong record and potential lead.

Cooperation should also aim at promoting global collaboration towards public goods, shifting from the present focus on global competitiveness for market-driven inequitable access to raw materials, manufactures and services, including global public goods as recently revealed with the Covid pandemic.

The above mentioned approach requires sharing information online (as travels for work, and less for tourism are most often non-essential and unsustainable in terms of carbon emissions) and contributing with means meant to reach every person as a public good, according to added values in each country and region of the world.

The main local basic needs include basic food, energy, water, housing, key appliances, local transport and access to internet needs -FEWHATI- . They require global investments in solar panels (1kw pc costing in China 220$/kw), basic agroecology technology at some 2000$/Ha (feeding 10p), basic water supply and sanitation networks (solar pumps for 1500$/kw pumping from 150 feet depth and serving 100 person needs), basic comfort appliances (clima, fridge, kitchen appliances, screen) at some 800$/4p, shared electric light vehicle (1000$/4p) –yet with the challenge of short-lived batteries- and access to internet (smart phone and modem 400$/4p), all around $1000/p, with circular economy dynamics linked to building materials and decent housing. Some 3Bn people in the world lack those basic sustainable needs, which means, besides the workforce, transport and some machinery as drilling and trillion-3Tn investment for the next decade. That may seem close to the 3,3 Tn annual investment estimates by McKinsey[ix] for G7[x] which led to the B3W gap estimate by 2035. But while the basic local needs’ investment aims al sustainable wellbeing, the McKinsey and G7 B3W is based on keeping up the present destructive model of growth, transport and trade (including estimates to upscale airports and roads’ capacities in high income countries…).

The mentioned 3Tn basic needs funds are 3,3% of global GDP, close to the world’s military spending and some 10% of the redundant GDP n high income countries[xi]. It could help prevent 16 million annual deaths and reduce some 3-5 Bn CO2 ton emissions per year.

Collaboration between education and research centres should promote open software, and additive manufacture capacities so as to promote local knowledge sovereignty, repairs, adjustments and progressive local design and production.

If ODA meets the (though arbitrary[xii]) 0.7% in high income countries, the cost of such basic local needs for almost half the planet would mean 10 years of global ODA void of unnecessary flights, hotels and experts’ fees now accounting to 40-50% of ODA. Such minimal economic redistribution, 20 times lower than the equitable tax rate of the top 10% in the EU, could be uploaded by financial markets so as to reduce carbon emissions and prevent excess mortality due to global inequity.

Such 3Tn gap aims at the basic needs which in Maslow’s scheme[xiii] is the base but should be complemented by protection (health and justice services), opportunities and sense of belonging (education and culture). While fiscal equiy and territorial cohesion should fund such human rights-based social services, the global competition for what-should-be global public goods (eg. essential vaccines and medicines) and for basic-services’ civil servants’ salaries (as health, education and justice professionals), means that the inequity (unfair distribution) of global salaries fuels brain drain and undermines access to those essential protection and belonging needs. The estimates of the basic salaries that would prevent such migration flows are in the range of another 1000 per person and year ppy which could be provided by a sort “universal social protection fund” to operationalize the International Covenant on economic, social and cultural rights. That would be part of the empirical evidence of minimum $4000 ppy CV –dignity threshold[xiv]– (in contrast with insufficient world bank set poverty thresholds) below which no country in 60 years has been able to achieve the best feasible and sustainable levels of wellbeing (by proxy of life expectancy). Such reality calls, after the local needs’ investment, for a gradual shift of the ODA present insufficient (from 0.7%) and vertical (from “aid”) flows to required levels (some 7% of global GDP towards equity of < 0,2 GINI cross and sub-national) and framework (international fund, as with the national social insurance schemes), if the world truly commits to universal rights as it did, though in a non/committal way- 74 years ago.

The above described approach guides global dynamics to rural vs. urban, local sovereignty vs. global trade, universal vs market driven right-based social services, global collaboration vs. competition to advance on global public goods and a renewed cooperation framework based on fair redistribution of global resources rather than profit oriented investments, as the current trend (China’s B&R, US B3W and EU’s GGI) reflects.

Such global collaboration should strengthen multilateralism, a renewed global and binding commitment to the Universal declaration of Human Rights and question international oligarchic structures as the Security Council, the G7, G20 and other restrictive groups, through a truly democratic UN governance promoting the mentioned strategy towards sustainable equity.

The EU’s main added value is to champion equitable wellbeing, siding with Japan as global leads, collaborate with China’s lead in solar cells and other key global goods while reducing import high carbon dependency, with Taiwan’s semiconductors, with the USA’s innovative capacities, promote tireless peace talks with Russia and promote, with like-minded regions especially in the global South, a new deal based on universal right based framework and services towards sustainable equity led by a democratic renewed UN system.

There is an urgent need to change direction and avoid climatic tragedy and transform the present global lack of trust in institutions driven by market forces rather than by active participation and ethical principles on sustainable equity. In EU and the USA public trust across generations has declined from over 70% in the 60s to less than 30% presently. Such trend is similar to wider surveys in both “developed” and “developing” countries[xv]. A new global deal should promote collaborating to global justice through hope, rather than competing for power or privileges through fear.

This debate needs to reach schools and universities, workers and scholars, mass media and social networks and local, national and global politics. The future of our children is at stake as never before and Humanity needs courage and wisdom to change the present state of unethical inequities and direction towards apocalyptic disaster.

 

Endnotes

[i] The Gini index measures the extent to which the distribution of income or consumption among individuals or households within an economy deviates from a perfectly equal distribution.

[ii] https://www.mckinsey.com/capabilities/operations/our-insights/bridging-global-infrastructure-gaps

[iii] https://www.euractiv.com/section/global-europe/interview/eu-must-offer-alternative-to-russia-and-china-borrell-says/

[iv] https://doi.org/10.1093/acrefore/9780190632366.013.62

[v] https://www.ipcc.ch/sr15/chapter/spm/

[vi] http://www.peah.it/2018/07/5498/

[vii] https://environment-review.yale.edu/foreign-direct-investment-developing-countries-blessing-or-curse

[viii] http://www.peah.it/2021/04/9658/

[ix] McKinsey & Company is a global management consulting firm that serves leading businesses (e.g., Fortune 1,000 companies like Coca-Cola and Microsoft), investors (e.g., Private Equity firms like KKR), governments (e.g., US Dept. of Energy) and nonprofits (e.g., Bill and Melinda Gates Foundation).

[x] https://infrastructure.aecom.com/infrastructure-funding

[xi] http://www.peah.it/2021/04/9658/

[xii] https://www.oecd.org/dac/financing-sustainable-development/development-finance-standards/the07odagnitarget-ahistory.htm

[xiii] https://www.simplypsychology.org/maslow.html

[xiv] http://www.peah.it/2021/04/9658/

[xv] https://www.un.org/development/desa/dspd/2021/07/trust-public-institutions/

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

An article here on the progress and changes in the Polio Eradication Programme in Pakistan from 1999 to 2023. The Author provides a comprehensive overview of the systematic changes made to the Programme over the past two decades, and highlights the impact these changes have had on reducing the burden of polio in the country

By Muhammad Noman

Healthcare System, CHIP Training and Consulting

Quetta, Balochistan Pakistan

The Polio Eradication Programme in Pakistan 

Systematic Critical Analysis from 1999 to 2023

                                         

This article turns the spotlight on the Polio Eradication Programme in Pakistan, whereby the various strategies and approaches used to address the complex challenges of polio eradication in the country are highlighted, including the engagement of community health workers, the use of new communication and vaccination strategies, and the strengthening of surveillance and laboratory capacity. The Programme also underscores the importance of sustained commitment and collaboration among all stakeholders in achieving the goal of a polio-free Pakistan.

Given the complexity of the global strategy, a comprehensive overview of the systematic changes made to the Programme over the past two decades could be of interest. In this connection, a bulleted list is provided as follows:

  1. Establishment of a National Immunization Coordination Committee (NICC) to oversee polio eradication efforts.
  2. Development of a National Emergency Action Plan (NEAP) to guide polio eradication activities and adapt to changing circumstances.
  3. Creation of a Polio Eradication Cell within the Ministry of Health to coordinate polio eradication efforts at the national level.
  4. Introduction of new technologies, including geographic information systems (GIS) and mobile data collection tools, to improve surveillance and monitoring.
  5. Implementation of a national Polio Eradication and Endgame Strategic Plan (PEESP) to guide the final stages of polio eradication.
  6. Strengthening of the routine immunization system to increase overall vaccination coverage and provide a platform for delivering polio vaccines.
  7. Establishment of a network of social mobilizers and community-based organizations to promote vaccine uptake and address vaccine hesitancy.
  8. Engagement of religious leaders and scholars to promote vaccine acceptance within communities.
  9. Development of an e-registry system to improve the monitoring and evaluation of vaccination activities.
  10. Deployment of mobile vaccination teams to reach children in hard-to-reach areas, including nomadic populations and those affected by conflict.
  11. Introduction of the bivalent oral polio vaccine (bOPV) to improve vaccine efficacy and reduce the risk of vaccine-derived polio.
  12. Collaboration with neighbouring countries, including Afghanistan and Iran, to strengthen cross-border surveillance and vaccination activities.
  13. Strengthening of the cold chain system to ensure the safe storage and transportation of vaccines.
  14. Expansion of the use of environmental surveillance to detect the presence of poliovirus in sewage samples.
  15. Development of a national Emergency Operations Centre (EOC) to coordinate polio eradication activities during outbreaks and other emergencies.
  16. Introduction of the inactivated polio vaccine (IPV) to provide additional protection against polio and reduce the risk of vaccine-derived polio.
  17. Strengthening of partnerships with the private sector to improve vaccine access and delivery.
  18. Implementation of a national Independent Monitoring Board (IMB) to provide oversight and accountability for polio eradication efforts.
  19. Development of a Polio Eradication and Endgame Strategy for the Post-Polio Certification Era (2023-2030) to guide the final stages of polio eradication and prevent re-emergence.
  20. Integration of polio eradication activities with other health programs, including routine immunization, maternal and child health, and disease surveillance.
  21. Strengthening of laboratory capacity to improve the quality and speed of poliovirus testing.
  22. Introduction of new communication strategies, including social media and digital campaigns, to increase awareness and acceptance of polio vaccination.
  23. Expansion of the role of community health workers in delivering polio vaccines and promoting vaccine acceptance.
  24. Introduction of new training programs for health workers and volunteers to improve their skills and knowledge related to polio eradication.
  25. Development of a national surveillance system to detect and respond to outbreaks of vaccine-preventable diseases, including polio.
  26. Strengthening of partnerships with civil society organizations and other stakeholders to promote community engagement and ownership of polio eradication efforts.
  27. Introduction of new approaches to monitor and address vaccine hesitancy and refusal, including community engagement and social marketing.
  28. Implementation of targeted vaccination campaigns in high-risk areas and populations to maximize the impact of vaccination efforts.
  29. Introduction of new approaches to monitor vaccine coverage and identify underserved populations, including the use of mobile phone-based surveys and satellite mapping.
  30. Establishment of a polio certification commission to verify the absence of wild poliovirus in Pakistan and other countries in the region.
  31. Increased focus on the involvement of women in polio eradication efforts, including as health workers and community mobilizers.
  32. Expansion of the role of local government officials in supporting polio eradication efforts at the community level.
  33. Implementation of a national communication strategy to counter misinformation and rumours about polio vaccination.
  34. Introduction of new approaches to reach children in urban areas, including through mobile vaccination teams and school-based vaccination campaigns.
  35. Expansion of the use of social franchising models to improve the quality and availability of health services, including polio vaccination.
  36. Introduction of new approaches to monitor vaccine safety and detect adverse events following vaccination.
  37. Strengthening of the supply chain system to ensure the timely and efficient delivery of vaccines and other supplies.
  38. Implementation of a national emergency response plan to respond quickly to outbreaks of vaccine-preventable diseases, including polio.
  39. Integration of polio eradication activities with broader efforts to strengthen the health system and improve overall health outcomes.
  40. Continued engagement with international partners, including the World Health Organization and the Global Polio Eradication Initiative, to leverage technical and financial resources to support polio eradication efforts in Pakistan.
  41. Implementation of a national polio eradication emergency action plan to accelerate progress towards eradication.
  42. Development and implementation of new tools and technologies to improve polio vaccination and monitoring, including the use of mobile phone-based data collection and analysis.
  43. Strengthening of cross-border coordination and collaboration to prevent the importation of poliovirus from neighbouring countries.
  44. Expansion of the role of civil society organizations in promoting polio vaccination and community engagement.
  45. Introduction of new approaches to address the challenges of reaching populations living in conflict-affected and hard-to-reach areas.
  46. Establishment of a national laboratory network to improve the capacity for poliovirus testing and surveillance.
  47. Expansion of the role of private sector actors, including pharmaceutical companies and corporate foundations, in supporting polio eradication efforts.
  48. Introduction of new approaches to address the challenges of vaccine access and distribution, including the use of innovative cold chain technologies.
  49. Development of a national vaccine waste management strategy to reduce the wastage of polio vaccines and other vaccines.
  50. Strengthening of the national immunization program to ensure the sustainability of polio eradication efforts and the delivery of other vaccines and health services.

 

Overall, the systematic changes made to the Polio Eradication Initiative in Pakistan over the past two decades have been extensive and multifaceted, involving a broad range of stakeholders and approaches. While there have been challenges and setbacks along the way, the initiative has made significant progress in reducing the burden of polio and improving the overall health system in the country. The continued commitment and engagement of all stakeholders will be critical to achieving the goal of a polio-free Pakistan.

 

News Flash 514: 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

Red starfish (Echinaster Sepositus)

News Flash 514

Weekly Snapshot of Public Health Challenges

 

Webinar registration: Make Way website launch: Learn about intersectional SRHR lobby and advocacy February 21st, 2023

Webinar registration: AMEF report webinar Feb 22, 2023 02:00 PM in Amsterdam

Meeting registration: Unpacking the Summit of the Future Feb 27, 2023 02:30 PM Feb 28, 2023 02:30 PM Time shows in Amsterdam

Apply by 17 March 2023: Google.org is commiting $25M to fund solutions that accelerate progress towards the Global Goals

Leading and Coordinating Global Health: Strengthening the World Health Organization

Last call: Have your say about the European Citizens’ Initiative before 28/2

Health Taxes: Policy and Practice

THREATENED SCHOLARS INITIATIVE Afghan Challenge Fund Call for Proposals Deadline: March 15, 2023

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Outlook for 2023: Children in ‘Polycrisis’

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UNMET HEALTHCARE  by Kirubel Workiye Gebretsadik

How Pakistan’s community health workers use telemedicine for women’s health 

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European Green Deal: Commission proposes 2030 zero-emissions target for new city buses and 90% emissions reductions for new trucks by 2040

Climate crisis and health: a call for papers

 

 

 

 

 

 

 

 

 

 

 

UNMET HEALTHCARE

A short reflection here on the impact of unmet healthcare in Africa and on the radical change of direction governments should embrace to ensure healthy lives for all

By Kirubel Workiye Gebretsadik

Medical Doctor, Ras Desta Damtew Memorial Hospital

Addis Ababa, Ethiopia  

UNMET HEALTHCARE 

 

According to recent report from Africa Health Agenda International Conference (AHAIC), only 52% of Africans, or 615 million people, have access to the healthcare they require, the quality of the continent’s health services is often subpar, and only 50% of the continent’s women and girls have access to the family planning services they require. 8.2% of the people on the continent, or 97 million people, experience “catastrophic healthcare costs” every year, mainly in Sierra Leone, Egypt, and Morocco. Due to these out-of-pocket expenses, 15 million individuals would be forced into poverty every year.

World Health Organization defines, access to health care as the timely use of personal health services to achieve the best possible health outcomes. The health care need is considered unmet if individuals could not receive required treatment that was believed to improve their health condition. People may face financial and non-financial barriers to receiving needed health care. Delays or failure to receive necessary care can lead to poorer health outcomes. Medicine, diagnostic tests, medical supplies, inpatient care, outpatient care, and dental care are just a few examples of the necessary cares.

Unmet healthcare demands are determined by a variety of factors, including service quality, geographic accessibility, availability, financial accessibility, and acceptability of services. People from low and middle-income nations are continually at a disadvantage in each of the access dimensions, despite the fact that this is a complex, multifaceted global problem.

There are ways to improve healthcare or lessen the unmet medical need in poor countries. The most important aspect is long-term economic growth, which is measured by variables like life expectancy, the newborn mortality rate, the death rate, and the prevalence of a certain disease. The second option is a biomedical intervention that includes a widespread immunization campaign. Additionally, it entails improving diets, women’s rights, maternal health, political solutions (ending conflict and corruption), and providing more inexpensive drugs. Access to effective healthcare by those in need improves health, prolongs life and prevents suffering, improves population health and drives greater labor force participation, economic growth and higher productivity.

 

 By the same Author on PEAH

 Malaria Eradication and Prevention through Innovation

 ONE HEALTH ONE WORLD

  Social Innovation in Healthcare

 

Effective Communication in Pandemics: Lessons Learned from Covid 19

Covid deniers and anti-vaccine groups will continue to spread false messaging. Continuous science-based evidence must be propagated and such elements can only be countered with hard evidence. 

Health agencies must track misinformation associated with the COVID-19 in real time, and engage local communities and government stakeholders to debunk misinformation. 

The scientific community members involved in advising their governments must deliver public health risk communication clearly and transparently. Research has shown that where public health messages were clear and simple, better compliance was observed. 

The government leaders must lead by the example

By Nighat Khan

Visiting Professor

Barret Hodgson University, Pakistan 

Effective Communication in Pandemics

Lessons Learned from Covid 19

 

Coronavirus Disease 2019, caused by an infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) emerged as one of the largest outbreaks globally in recent years. To this date 663,640,386 confirmed cases have been reported with 6,713093 deaths across the globe (1).  It posed one of the biggest challenges for health systems in both the developed and developing world. As the cases spread rapidly and disease severity was observed, the World Health Organization declared it as global health emergency on January 30, 2020 (2).

To prevent SARS-CoV-2 from spreading, various steps such as quarantining the infected patients and their close contacts, school and workplace closure and social distancing were taken. Despite these efforts transmissions could not be contained worldwide. The WHO finally on March 11, 2020 declared it as pandemic (3) almost over 12 weeks since it was initially reported leading to massive case numbers and fatalities across all the continents.

While weeks were lost in realizing impact of Covid-19 on global health by the health organizations like WHO, governments and  health ministries, the scientific community came together to collaborate and collate the data and to ramp up the efforts to find treatments and to make the production and availability of effective vaccines a possibility in a record times.

However the scientists and health workers were at the mercy of their governments to combat several challenges in effective communication. This space was claimed by several conspiracy theorists.

As the WHO was contemplating on how to communicate the very little clinical information available to its member states, a wave of misinformation and disinformation spread across the globe (4). Internet was rife with all sorts of conflicting advices and hear say. Unscientific claims like Covid being a hoax and even role of technologies like 5G in spreading this viral infection. Genuine scientists and health workers who were trying to disseminate correct scientific information faced abuse and trolling over various social media platforms. These waves of false information caused erroneous appraisals of the threat as well as maladaptive coping responses leading to fatal consequences (5, 6, 7). One of the biggest challenges during this pandemic was sifting the relevant scientific information from false distortion of facts. Such pervasive, unsolicited and dubious misinformation and disinformation was available on social media platforms globally. The Centre for Disease Control (CDC) has hence defined and differentiated between misinformation and disinformation.Misinformation is false information shared by people who do not intend to mislead others, whereas disinformation is false information deliberately created and disseminated with malicious intent (8).

Besides the WHO the member state government responses were not up to a scientific standard. This was partly due to lack of sufficient scientific data as well as marginal involvement of scientific community by the governments. In many instances these scientists were sidelined.

While the South eastern nations like Singapore, Taiwan, South Korea, which had experiences with respiratory viruses and had well designed response protocols, performed exceptionally well in containing the virus spread, enforcing facial masks and saved lives of their citizens; in contrast many countries failed to realize the gravity of situation and delivered mixed messages and were slow to respond leading to high morbidity and mortality (9).

Lack of effective communication by some member state governments even up to denial about the seriousness of epidemic made people less careful about daily practices like hand washing, social distancing and most importantly wearing a face mask. This caused havoc in some countries like Brazil and certain states in USA (10).

Another difficulty faced was false remedies. Social media forums were rife with unscientific remedies. Although certain foods like ginger, garlic and lemon have beneficial effects on human digestive system, to report them as remedies against Covid-19 virus infection lead to many susceptible people falling prey to the viral infection (11).

Realization came late with the scientists and officials working for the WHO. Various briefs and guidelines were issued regarding disinformation and social behaviors of masses. In fact lack of clarity and varying standards of communications lead to release of an important document ‘Risk-communication and community engagement (RCCE)’ by the WHO in March 2020 (12). This document quantifies the risk management and communication during Covid-19 like challenges and sets up goals.

There were some interesting observations in effective communication by the countries. In the United Kingdom, the nations such as Scotland, Wales and Ireland were quick to grasp the gravity of the situation and their ministers were at the forefront of press briefings and communicating policy statements, whereas, England lagged clarity in communication, cases rose rapidly (13). Similar discrepancies in risk communication were observed in the United States where devolved health systems with each State health policy saw clear differences in Covid-19 led morbidities and mortalities.

The WHO has ever since been engaged in holding briefs and seminars on infodemiology (14) and several updates have been made available on the WHO website.

Extensive global health community of scientists collaborated henceforth for the development of vaccines and by end 2020 a variety of vaccines were available. Here again all the wonderful work by infectious diseases workers was tainted by Covid deniers and the disinformation about vaccine side effects once again proved to be a challenge. While a vast majority of people were relieved to have various vaccines availability, a group emerged questioning the authenticity of vaccine effectiveness data. Just as misinformation emerged early on in pandemic, additional conspiracy theories emerged about Covid-19 vaccines such as mRNA component of vaccine is used as microchip by Bill Gates to control and or carry out global population surveillance, and that it causes side effects or even sudden death.

Research has shown that such false notions are extremely difficult to change. It appears that some people are more susceptible to misinformation. Marginalized communities such as ethnic minorities and immigrants fall prey to these rumours more easily than others. This is partly due to poor efforts to approach these communities or language barriers leading to vaccine hesitancy. In a research carried out by Dube et al (16), six factors contributed to an individual’s decision making process and falling prey to misinformation. These factors are knowledge information, past experiences, perceived importance of vaccination, risk perception and trust, subjective norms and religious and moral conviction. Although vaccine hesitancy is a multifaceted phenomenon affected by social, cultural and political contexts, surprisingly vaccine-hesitant people were a heterogeneous group. Hornsey et al (17), based on research conducted in 24 countries, reported it to be higher in those in conspiratorial thinking, in people with high reactance or higher levels of discomfort towards needles and or blood and strong hierarchical worldviews.

Multiple websites encouraging conspiracy theories were at the forefront of spreading fake news such as large pharmaceutical industries exaggerate the benefits of vaccines and hide the dangerous data of side effects. These sites encouraged anti-science rumours. Islam et al (18) followed and examined online platforms such as fact-checking agency websites, Facebook, Twitter and online newspapers for their impact on public health. While carrying out the content analysis they reported 2311 reports of rumours, stigma and conspiracy theories in 25 languages from 87 countries. 82% of such claims were erroneous and were related to Covid-19 illness, transmission and mortality, control measures, treatment, origin of disease and even violence. These claims had serious implications on individuals and communities.

As it appears from above discussion, various factors came to play in increasing devastating spread of Covid-19 and each contributing factor needs to be researched and framework of action designed accordingly.

  • Although panic is counterproductive, health organizations and governments need to take each infectious outbreak with concern. The importance of investment in public health measures cannot be overemphasized. Countries such as Singapore, Taiwan and South Korea where effective public health surveillance systems were in place did fairly better than high income countries where public health systems were underfunded and ignored.
  • The scientific community members involved in advising their governments must deliver public health risk communication clearly and transparently. Research has shown that where public health messages were clear and simple, better compliance was observed.
  • The government leaders must lead by the example. Public trust regarding messages like social distancing and wearing masks were met with skepticism where leaders like Boris Johnson and Donald Trump were seen blatantly violating these messages.
  • Covid-19 vaccines were developed in record amount of time due to concerted global cooperation and such collaborative efforts lead to favorable outcomes.
  • Covid deniers and anti-vaccine groups will continue to spread false messaging. Continuous science-based evidence must be propagated and such elements can only be countered with hard evidence.
  • The WHO document about risk-communication and community engagement provides a useful document for the researchers and government both as a foundation stone for future course of action.
  • Health agencies must track misinformation associated with the COVID-19 in real time, and engage local communities and government stakeholders to debunk misinformation (18).
  • Further research is imperative to study the trends and prevalence of health misinformation on various social media forums and how such information is shared to devise interventions.

 

References

  1. https://www.who.int/emergencies/diseases/novel-coronavirus-2019?adgroupsurvey={adgroupsurvey}&gclid=EAIaIQobChMIi5uzsraA_QIVi9Z3Ch1SCAFWEAAYASAAEgJ67fD_BwE
  2. https://www.who.int/news/item/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)
  3. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-covid-19-mass-gatherings
  4. https://www.who.int/health-topics/infodemic#tab=tab_1
  5. Lee, S.K., Sun, J., Jang, S. et al.Misinformation of COVID-19 vaccines and vaccine hesitancy. Sci Rep 12, 13681 (2022). https://doi.org/10.1038/s41598-022-17430-6
  6. Lurie, P., Adams, J., Lynas, M., Stockert, K., Carlyle, R.C., Pisani, A. and Evanega, S.D., 2022. COVID-19 vaccine misinformation in English-language news media: retrospective cohort study. BMJ open12(6), p.e058956.
  7. Cinelli, M., Quattrociocchi, W., Galeazzi, A., Valensise, C.M., Brugnoli, E., Schmidt, A.L., Zola, P., Zollo, F. and Scala, A., 2020. The COVID-19 social media infodemic. Scientific reports10(1), pp.1-10.
  8. https://www.cdc.gov/vaccines/covid-19/health-departments/addressing-vaccine-misinformation.html
  9. Kim J, Moon J, Jung TY, Kim W, Yoo HC. Why Have the Republic of Korea, Taiwan, and Singapore Coped Well with COVID-19 and What Are the Lessons Learned from Their Experiences? Yonsei Med J. 2022 Mar; 63(3):296-303. doi: 10.3349/ymj.2022.63.3.296. PMID: 35184433; PMCID: PMC8860936.
  10. https://www.hsph.harvard.edu/news/hsph-in-the-news/what-the-u-s-did-wrong-with-covid-19/
  11. https://news.northwestern.edu/stories/2020/09/social-media-contributes-to-misinformation-about-covid-19/
  12. https://apps.who.int/iris/bitstream/handle/10665/331513/WHO-2019-nCoV-RCCE-2020.2-eng.pdf
  13. Cameron-Blake, E., Tatlow, H., Wood, A., Hale, T., Kira, B., Petherick, A. and Phillips, T., 2020. Variation in the response to COVID-19 across the four nations of the United Kingdom. Blavatnik School of Government, University of Oxford.
  14. https://covid19.who.int/region/amro/country/us
  15. https://www.who.int/teams/epi-win/infodemic-management/3rd-virtual-global-who-infodemic-management-conference
  16. Dubé, E. and MacDonald, N.E., 2022. COVID-19 vaccine hesitancy. Nature Reviews Nephrology18(7), pp.409-410.
  17. Hornsey, M.J., Chapman, C.M., Alvarez, B., Bentley, S., Salvador Casara, B.G., Crimston, C.R., Ionescu, O., Krug, H., Preya Selvanathan, H., Steffens, N.K. and Jetten, J., 2021. To what extent are conspiracy theorists concerned for self versus others? A COVID‐19 test case. European Journal of Social Psychology51(2), pp.285-293.
  18. Islam MS, Sarkar T, Khan SH, Mostofa Kamal AH, Hasan SMM, Kabir A, Yeasmin D, Islam MA, Amin Chowdhury KI, Anwar KS, Chughtai AA, Seale H. COVID-19-Related Infodemic and Its Impact on Public Health: A Global Social Media Analysis. Am J Trop Med Hyg. 2020 Oct; 103(4):1621-1629. doi: 10.4269/ajtmh.20-0812. PMID: 32783794; PMCID: PMC7543839.

 

———

By the same Author on PEAH

Ethical Challenges in Big Data in The Developing World

Challenges in Universal Health Coverage in Pakistan

 

 

 

 

 

 

 

News Flash 513: 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

Loggerhead sea turtle (Caretta Caretta)

News Flash 513

Weekly Snapshot of Public Health Challenges

 

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Want to Contribute an Article to PEAH?

PEAH-Policies for Equitable Access to Health aims to tackle ALL health priority challenges relevant to -though not limited to- climate safeguarding, fair access to care, medicines and food, disadvantaged/discriminated people and cultural diversity protection from a view encompassing the policies, strategies and practices of all involved actors.

Inherently, PEAH focus encompasses the best options for use of trade and government rules, the effects of current international agreements and intellectual property standards, the opportunities offered by new financing mechanisms and innovation models, and the ways for better coherence, coordination and collaboration among stakeholders supposed to streamline access to health priorities

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A platform maintained by Daniele Dionisio*, PEAH – Policies for Equitable Access to Health serves as an internationally oriented blog backed by academics and stakeholders from a number of organisations worldwide.

Not an indexed journal, PEAH runs without any monetary grant/funding/support. Nonetheless, it benefits from world scale audience actively coming to the website, while relying to date on around ten thousand regular followers whose numbers are on the rise on daily basis.

People from leading centres and institutions continue writing articles for PEAH, as shown by our Featuring section (see also links to 2023 2022  2021 and 2020  external contributions).

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Spontaneous submissions in the form of articles, editorials and blogs are welcome. Pieces dealing with the priorities and challenges first and foremost in the resource-limited countries, including for fair access to high-quality health treatments and care, food, and for climate safeguarding would be to the point.

PEAH aims to face, indeed, ALL health priority challenges relevant to -though not limited to- climate safeguarding, fair access to care, medicines and food, disadvantaged/discriminated people and cultural diversity protection from a view encompassing the policies, strategies and practices of all involved actors.

Inherently, PEAH focus encompasses the best options for use of trade and government rules, the effects of current international agreements and intellectual property standards, the opportunities offered by new financing mechanisms and innovation models, and the ways for better coherence, coordination and collaboration among stakeholders supposed to streamline access to health priorities.

No editorial requirements nor limits as regards the length and structure of your contribution, and you are invited to incorporate references as hyperlinks directly in the text.

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* Daniele Dionisio is a member of the European Parliament Working Group on Innovation, Access to Medicines and Poverty-Related Diseases. Former director of the Infectious Disease Division at the Pistoia City Hospital (Italy), Dionisio is Head of the research project PEAH - Policies for Equitable Access to Health

** PEAH network includes, among others, the EU Parliament Group on “Innovation, Access to Medicines and Poverty-Related Diseases”, representatives at the Italian Ministry of Foreign Affairs' Directorate General for Development Cooperation in Rome, leaders from academia worldwide, managers from emerging economies' drug industries and executives from UN agencies, Medecins Sans Frontieres and international NGOs, the Global Fund, Knowledge Ecology International, Indian Council of Medical Research, Quamed, Oxfam, SciDev.net, Devex, Health Property Watch, I-MAK, AFEW, Wemos, DNDi, the Italian National Institutes of Health,...