LAHORE: The province-wide drive to fight polio through a large-scale immunisation programme may suffer a blow as Chief Minister Road Map Project Manager Dr Emma Hannay and officials of the health department, WHO and Unicef have developed “serious differences” over the proposal of replacement of doctors with non-medics.

Dr Emma has come up with a proposal to replace the union council medical officers (UCMOs) with non-doctors including school health nutrition supervisors/lady health supervisors/dispensers during the campaign days in Punjab. She says the patients have to suffer as doctors remain busy in anti-polio drives all over the province.

Technical experts and officials of the health department, WHO and Unicef have joined hands to thwart the proposal which, they say, is a specious idea that will jeopardise fight against polio. They say withdrawal of doctors will have far-reaching implications on the drive against polio and endanger the progress of the last few years, the documents pertaining to the meetings held on this particular issue said. (A copy of the documents is available with Dawn).

The experts further warn that at this stage Pakistan doesn’t afford experimentation with its only successful model, asking who will bear the responsibility in case of an outbreak. “An outbreak will reverse Pakistan’s progress of the last few years,” they stress.

Both sides met twice to discuss the issue but the meetings remained inconclusive. During the recent meeting held last week, the debate on the matter got heated to the extent that they exchanged a word and refused to entertain each other’s views. The documents say the officials met to review the proposal of the Chief Minister Road Map team to spare doctors of the BHUs from polio campaigns.

Dr Emma presented data analysis on the presence of medical officers at the BHUs in normal days and during supplementary immunisation activities (SIAs), emphasising that less than 50pc of the visiting patients are able to approach the MOs during campaign days.

Supporting alternates like nutrition supervisors/LHS/support staff to replace doctors at the BHUs, she stressed that the patients must not suffer due to an MO’s absence. She also said the cumulative number of days of National Immunisation Days (NIDs), SNIDs and SIADs affected MOs presence data, according to the documents.

Punjab Expanded Programme on Immunisation Director Dr Munir Ahmad and partners (WHO and Unicef) insisted that Pakistan could not afford experimentation as only a doctor provides technical and professional leadership to frontline workers (vaccinators/LHW/LHS/support staff).

“The UCMOs’ position is of pivotal importance and the onus of ownership and responsibility in local structures lies on it,” Dr Munir said. He said a doctor as UCMO provided technical and professional leadership to a team of vaccinators/LHWs/paramedics/support staff during campaign days.

“Punjab’s progress will be jeopardised if makeshift arrangements are made on a key position like UCMO,” Dr Munir further warned. The National Emergency Action Plan (NEAP), prepared by a group of experts, also put the responsibility of leadership on doctors, he said.

The WHO representatives including provincial team leader Dr Salah Haithami and Dr Asif Chaudhry said the quality of human resource for SIAs (vaccinators/LHWs/paramedics/support staff) was poor.

The Unicef representatives are of the view that in the final cost-benefit analysis, a doctor’s presence in the campaign outweighs his absence by quite a margin. Withdrawing a doctor from the SIAs would mean big chunk of support staff attached with doctor also will remain at the BHU, away from the campaign. This will force induction of more volunteers than professionals, ruining the quality of campaigns, they said.

The EDO health said separating doctors from the campaigns would have a disruptive effect. “A UCMO has to be a doctor, or else the campaigns will suffer,” he warned.

Published in Dawn, April 17th, 2015

On a mobile phone? Get the Dawn Mobile App: Apple Store | Google Play