ISLAMABAD: The rapid and uncontrolled spread of polio through Pakistan has the whole world on edge. Nearly all international observers have admitted that the polio crisis in Pakistan has reached disastrous proportions and immediate steps are necessary to stem the spread of the “Pakistan poliovirus” which has already caused deaths and paralysis in Pakistan, Afghanistan, the Middle East and parts of Africa.

But the provinces – who are responsible for the all-important portfolio of health – seem unwilling to let go of the polio lucrative programme that their governments have all but driven into the ground.

A meeting of the inter-provincial steering committee, chaired by National Health Services (NHS) Minister Saira Afzal Tarar, was convened on Wednesday to discuss whether the National Disaster Management Authority (NDMA) should be given the job of combating polio in the country.

The case for the NDMA had been made by the recently published report of the Global Polio Eradication Initiative’s Independent Monitoring Board (IMB), which describes the NDMA as “bringing can-do to can’t do”. The report is highly critical of the Pakistan government’s unwillingness to innovate in the search for solutions to the spiraling polio crisis. It holds up the example of Nigeria, which introduced health camps and empowered an Emergency Operations Centre (EOC) which it is still using to contain the threat of Ebola inside its borders.

Health officials call IMB report ‘unrealistic’, say NDMA has no mandate to work on polio

But provincial representatives overwhelmingly opposed the recommendation, calling it unrealistic and saying that the NDMA does not have the mandate or the capacity to conduct health campaigns.

Held at the PM’s Polio Cell and attended by the PM’s Focal Person on Polio MNA Ayesha Raza Farooq, Punjab Health Adviser Khawaja Salman Rafique, Sindh Polio Oversight Committee Chairperson Dr Azra Fazal Pechuho and provincial health secretaries, the meeting dismissed the IMB report for being disconnected with ground realities in Pakistan.

Mr Rafique expressed reservations over parallels being drawn with Nigeria, saying that Pakistan had lost over 73,000 to terrorism and polio workers were being target-killed across the country. “There can be no parallel for Pakistan’s situation with any other country,” he said.

The NDMA, Mr Rafique said, was only activated during disasters and was not equipped to undertake a nationwide campaign of this magnitude. He chose, instead, to trumpet the ‘achievements’ of his province, boasting that the Punjab chief minister would hold review meetings on a monthly basis, whereas his advisers were meeting every fortnight.

Khyber Pakhtunkhwa Health Secretary Akbar Khan also said that it was not the NDMA’s job to conduct health campaigns. He said the KP health department was committed to eradicating the disease and a comprehensive strategy had been evolved, in consultation with all stakeholders, including international partner agencies, to counter the menace of polio in the province.

Representing the Sindh Government, Dr Pechuho said that the NDMA only worked in times of disaster, while polio campaigns were a continuous process. The health department works better in tandem with the district management, she said. She also contended that in 2012, Karachi had been rid of polio, but a major impediment to its eradication was the transfer of the virus to the city through people coming from the tribal areas.

These views were also echoed by the representatives of Balochistan, Fata, Gilgit-Baltistan and Azad Jammu and Kashmir.

NHS Secretary Mohammad Ayub Shaikh told the meeting that the infrastructure at the district level that was available to the NDMA was the same as the one working on the polio programme and argued that any change in the management structure at this point would have serious consequences.

But even as NDMA spokesperson Ahmad Kamal conceded that they did not currently have the mandate to implement polio campaigns in the country, another official from the disaster management body told Dawn that this was exactly why the IMB had called on the government to empower the disaster management body to cope with the crisis.

“After the 2010 floods, the National Health Emergency Preparedness and Response Network (NHEPRN) was established. Although NHEPRN was working under the health ministry, it provided anti-snake venom and other health facilities in emergency conditions,” he said, suggesting that NDMA would be able to adapt to any situation it was faced with.

“The army’s medical corps can also facilitate the NDMA or the polio programme,” he said.

The most telling reaction was that of an NHS ministry official, who wondered aloud why the health departments of the various provinces were so insistent on resisting the handing over of the polio programme to NDMA.

“If the provincial machinery could have delivered on polio eradication, we would not have been in the situation that we currently face,” he said.

The key thing to remember, he said, is that such programmes are worth millions of dollars.

“In addition, the IMB has asked the prime minister and his cabinet to decide. How can those who have already failed to deliver reject the IMB’s request,” he asked.

Published in Dawn, October 30th , 2014