State of child health in Pakistan is among core national issues which call for immediate and serious attention.
Representatives of various international health organisations, who have over the years played a key role in assisting Pakistan to control outbreaks in the country, believe that the gap between reported and assessed cases, disintegrated and unreliable monitoring and observation systems have massively contributed to the outbreaks in Pakistan over the past five years.
Head of the polio eradication at the World Health Organisation in Pakistan Dr Elias Durry, while talking to The Express Tribune, said that there are three major causes explaining why hundreds of thousands of children are missed during immunisation drives each year. He cited poor health service delivery at the grass root level to be a major cause adding that the inability to keep a proper check and balance over it only made things worse.Parents who refuse to get their children immunised also contribute to the number of rising cases. One of the other causes which work as a major contributor to the hike in numbers is the inaccessibility to children of areas mostly under militant threats.
In regard to outbreaks he said, “As large number of children remain unimmunised for a long period of time, you are playing the virus’s game and not the eradication or control game… which is the sole reason children face outbreaks like measles and polio.”
He went on to say that while the outbreak of measles was due to the aforesaid reasons lack of accountability only added to the soaring numbers. For polio, he added that areas like Fata should be made accessible for vaccinators if Pakistan is to head off major outbreaks.
However, another UN official sternly criticised Pakistan’s evaluation systems aimed at surveillance of immunisation drives terming them insufficient to curb outbreaks.
Speaking on condition of anonymity he added, “Pakistan is among those developing nations that have yet to do much for the welfare of the general public. But the lack of social demand for immunisation, discrepancies, corruption, underperforming officials and militancy are factors that push Pakistan back to the starting point”.
Immunisation drives
Expanded Programme on Immunisation (EPI) Pakistan provides vaccination against tuberculosis, poliomyelitis, diphtheria, pertussis, tetanus, hepatitis B, haemophilus influenza type B and measles.
According to the Findings of Global Alliance for Vaccines Initiative’s paper on EPI, the programme, over the last two decades has failed to reach its expected reduction in the number of diseases preventable by vaccines.
One reason cited for the poor performance was the reduced focus on EPI (funding and technical assistance) in relation to other specific campaigns (for example, polio).
In addition, reduced attention to capacity building of available human resources on local-level planning, management, logistics, and monitoring, evaluation and surveillance have resulted in poor EPI performance. Further, the management of the programme has further deteriorated due to the increased political interference over the last decade.
With the implementation of 18th Amendment, that lead to the devolution of powers to provincial governments, has resulted in stock-outs, poor quality vaccines, and overall negative effects on the outcomes.
The EPI is under-resourced to achieve expected results. EPI is too underfinanced to provide a comprehensive immunisation service to the community. Additional resources are needed for vaccines, logistics, recurrent expenses, human resource expansion, capacity building, training, and social mobilisation.
Immunisation is believed to be a proven tool for controlling and eliminating life-threatening infectious diseases and is estimated to avert between 2 and 3 million deaths each year. It is one of the most cost-effective health investments, with proven strategies that make it accessible to even the most hard-to-reach and vulnerable populations.
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