June 10, 2008	Tuesday	Jamadi-us-Sani 05, 1429

KARACHI, June 9: Polio eradication campaigners in the province called for true accountability in the process of administration and supportive ownership of the related activities at all levels as the authorities are all set to launch another round of special immunization campaign across the province from June 10.

The sub-national campaign against polio is supposed to benefit more than 6.529 million children in the province. About 19,431 mobile, transient and fixed teams comprising about 35,000 vaccinators have been constituted to administer Oral Polio Vaccines (OPV-I) to children.

Sources privy to the anti-polio activities said the authorities and the stakeholders were highly disturbed after the detection of some new polio cases in the province and desired to see improvement in the performance of field staffers and their supervisors.

The fresh challenge before the senior immunization programme officials is to achieve quality vaccination results by administrating drops to every deserving child in the province, said an official, adding that there was a need to ensure that individuals were best placed and a sense of belonging and honesty prevailed at every stage – right from the selection of vaccinators to their training, supervision, retention and payment.

About the latest victim of the polio virus, the manager of the National Expanded Programme on Immunization said that the seven-month-old boy, who lived in Site Town, had received neither any routine immunization dose nor the supplementary OPV drops at any stage, which was a matter of concern.

With the second confirmed polio case in Karachi this year, the city shares 22.22 per cent cases reported in the province since January. Of 11 cases reported across the country, nine were detected in Sindh. It is feared that if stringent measures are not taken to improve immunity among children against the virus on a war-footing basis, it would be difficult to avert emergence of more cases during the coming peak virus transmission months in the province.

This year’s first case was reported in Nawabshah on January 1, followed by one in Hyderabad on the 25th, Shikarpur on February 25, Karachi on April 1, Mirpurkhas on the 5th, Naushehro Feroze on the 6th, Jacobabad on the 9th, Dadu on the 23rd and the latest case was detected last month in Karachi.

6,081 teams for Karachi

About 2,245,243 children will be administered oral polio vaccine in Karachi, which is being considered as a reservoir of polio virus after the detection of two confirmed polio cases during the first month of this year. For a three-day immunization campaign, commencing today, a total of 6,081 teams have been formed for Karachi, followed by 1,016 teams for Khairpur, 924 teams for Ghotki, 825 for Dadu, 741 for Hyderabad and hundreds of teams for other districts.

An official said that only a high quality vaccination drive was the only way to interrupt the virus circulation, which surely needed well-trained and dedicated vaccinators who enjoyed support and supervision of their seniors in the government. Most of the vaccinators, who were paid the honorarium for their polio-field work from the World Health Organization through the EDOs or THOs concerned, could not be held accountable for their failure to deliver since their high-ups lacked the will to achieve better results, said another source.

A majority of the polio vaccinators or volunteers, who are engaged for polio eradication activities, belonged to district governments and as such the Sindh immunization programme manager finds no reason to charge them for slackness or inadequate coverage.

The manager, who is mainly responsible for the supply of OPV to the field-workers for an anti-polio drive, however, can pass on any adverse comments or recommend disciplinary action against any vaccinator or area in-charge to the provincial health secretary if he receives some reports from the WHO officers concerned.

An insider revealed that the WHO, which looked at the technical and surveillance sides of the polio campaigns as well, rarely came up with adverse remarks against any vaccinators or supervisors in black and white.

Political appointments

The problem of lacking ownership and accountability has its consequence in the process of eradication of polio in the province. The situation is aggravated largely when one had to handle the workers coming with political background. That was why the immunization executers needed the political commitment very much, said the source, adding that there was no fool-proof arrangement even to ensure the exact utilization of teams, vehicles and other logistics for a particular campaign, against the relevant micro-plan prepared by the respective EDO or THOs.

In the case of Karachi and a couple of other districts it was learnt that volunteers or vaccinators were hired for the polio campaigns not only from the local government’s health sector but also from the private sector, including women and teenagers, with political connections and as such any statement or complaint regarding the availability of field forces and the task they accomplished could hardly be rechecked or authenticated in time.

For the last some months, there have been reliable reports that a marked difference existed between the coverage of the deserving population during a campaign and ink-marking of the fingers of children in question. The survey of finger-marks after a campaign normally showed lower coverage in many areas of the province, said a source.

EDOs on board

When asked for comments, Sindh EPI Manager Dr Mazhar Khamesani and the WHO polio eradication team leader in Sindh, Dr Yehia Mostafa, said that efforts were being made to increase the access of vaccinators and surveillance staff to children under five in various areas.

“We have now decided to take the EDOs (health) on board as well so that any deficiency on the part of district staffers could be adequately addressed in time,” the EPI manager said, adding that dedicated and honest vaccinators and supervisors were a must for the success of the polio eradication campaign at all levels and the decision to attach importance to the EDOs as well would surely help ensure a system of rewards, incentives and punishment.

Dr Mostafa said actions were taken against personnel related to consultation, surveillance and monitoring for any discrepancy without sparing time, while on the other hand efforts were also being made to enhance ownership of the respective governments and community at all levels in the process of OPV administration.