KARACHI: While formulating anti- polio strategy to face the challenges, Caretaker Sindh Chief Minister Fazul-ur-Rehman has called a task force meeting on July 2.
“No polio case has been detected in Sindh in the last one year, however, Karachi and Qambar-Shahdadkot districts have been rated as high risk areas,” this was revealed in a meeting held here at the CM House on Monday under the chairmanship of the CM to review performance of polio programme.
The meeting was attended by Provincial Coordinator POCC Shahnaz Wazir Ali, Principal Secretary to CM Sohail Rajput, Secretary Health Fazal Pechuho, Provincial Coordinator Emergency Operation Center (EOC) Fayaz Jatoi and Aziz Memon of International Polio plus Committee Rotary International.
The chief minister was told that all polio activities were guided by the National Emergency Action Plan (NEAP). Globally, Pakistan and Afghanistan were the only remaining countries with polio. In 2018 to date, Pakistan reported three cases (all from district Dukki of Balocistan), and Afghanistan eight cases. In Sindh, all six districts of Karachi are still classified as ’Tier 1’ core reservoir, means districts of highest risk.
Epidemiology
No Polio case has been detected in Sindh as compared to last year when two polio cases were reported and both were from Karachi, Gulshan-e-Iqbal and Gadap. The virus isolated from environmental sites (taken from sewage system), indicating ongoing virus transmission.
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In Karachi, samples are taken from 11 sites every month. In May only, Machhar Colony, Gadap, came positive. In Northern Sindh, samples were taken from six sites and Kamber turned out to be positive. On this the chief minister said that the situation could not be termed as normal. All the stake holders, partners and civil society had to work together to make Pakistan polio free zone.
Structure of polio program
The chief minister was told that the three tiers structure provides oversight and direction to the polio programme. The Provincial Task Force led by the chief minister and/or chief secretary meets quarterly and has membership of secretaries, Health and Education, all commissioners, LEAs, and provincial heads of partner agencies.
Divisional Task Forces led by commissioners operate in all six divisions with membership of the DCs, DHOs/THOs and their district teams.
District Polio Eradication Committees (DPECs) have been formed in all 29 districts, led by deputy commissioner. DPECs are supported by the District Polio Control Rooms (DPCRs) which are responsible for the day-to-day running of all polio-related activities in the districts. Most DPCRs function throughout the month.
The provincial Emergency Operations Centre (EOC) is the technical lead at the provincial level and coordinates all activities between government, partners and the federal level (National EOC).
Assessment
The epidemiological situation in Karachi has improved. Virus from environmental site has restricted to only Gadap. The campaign quality has further improved, eradication levels are still not consistently achieved due to high number of missed children due to refusals.
After the outbreak in lower Sindh (Badin, Thatta, Sujawal) between September -December 2016, these districts received significant inputs (human resources, monitoring, supervision, accountability) with a subsequent improvement in performance quality. This improvement has been sustained. In Northern Sindh, all polio eradication activities are well managed by DPCRs under joint leadership of DC/DHO.
Routine immunization in Sindh remains weak and still leaves too many young children without immunity against polio. Large efforts have been made together with the EPI programme to improve the situation, progress remains to be guarded. Currently, a large- scale measles campaign is being jointly conducted in Karachi (and later also in other districts of Sindh) by EOC and EPI.
Fayaz Jatoi highlighting the challenges said that stopping virus transmission in Karachi required sustained polio activities of highest quality in selected high-risk areas of the city.
“We need to minimize the number of still missed children soon after every campaign and special strategy may be formulated for permanently missed children focusing on refusal conversion,” he said.
He said that the energy and morale of the workforce was in a precarious balance — back-to-back activities for many months, high expectations, constant pressure, punitive measures, inadequate support etc have taken a toll on front line workers and led to high staff turnover.
Further accountability measures were required for both good and bad performances. Human resource issues remained a key obstacle, including the ability to fill vacancies with motivated, well-performing staff— both in government and with partners, he said.
Highest-quality surveillance becomes critically important as ever fewer polio cases are reported now. Surveillance must be able to detect and quickly investigate each weakness case to be sure that zero means zero.
The chief minister directed the principal secretary to call a meeting of provincial task force on May 2, 2018 so that strategy could be evolved to face the challenges.
