KARACHI, April 15: The Sindh health department may go for a review of the polio eradication activities in the province, seeking an effective role on the implementation side.A source said that the authorities were highly perturbed over the implementation of the polio eradication initiatives at the district level, and wanted to ensure that issues like ghost vaccinators, inaccessible areas, insincere supervisors and an inadequate check-and-balance system and a loose command over the related field staff should be addressed soon.

“Without improving the quality of anti-polio drops administration in the children up to five years in Sindh, the goal of a Pakistan without polio can hardly be achieved,” said the source, adding that the detection of three cases of polio during the first three months of 2008 had given a bad name to the province and that was why the administrative high-ups wanted that all partners, including the federal and provincial governments and international agencies concerned, try to renew their efforts to identify the pitfalls.

This year, Sindh has reported three polio cases -- one each in Nawabshah, Hyderabad and Shikarpur. Two of the victims are under two years of age, while the other one is of 72 months. One of the victims had had no routine immunization.

According to an analysis of polio vaccination related data of 2007 in the province, there were 115 union councils which fell in the high-risk category areas for various reasons, including low routine immunization, highly mobile population, seasonal migrants, low socio-economic status, low literacy rate, environmental issues and poor sanitary conditions, managerial issues and unwilling workers, including vaccinators and women health workers, at the district and UC levels.

The source said that at a meeting of the technical advisory group on poliomyelitis eradication in Afghanistan and Pakistan, which was held in Cairo in the first week of February and attended, among others, by the Sindh health secretary, the immunization activities made in Sindh were also discussed and it was felt that still there was a lot to be done.

According to a report on the Cairo meeting, more than 20 per cent of the union councils in many districts, especially in the transmission zones and high-risk zones, had a coverage rate of less than 95 per cent during the last many consecutive rounds.

It is believed that some areas are being missed regularly not only in routine immunization but also during the national and sub-national immunization days, said another source in the provincial health department and underlined the need for an even planning and improved supervision management quality and special immunization activities monitoring results, largely in the high-risk areas of Karachi, a couple of southern districts and the entire northern part of the province.

When contacted for his comments, the provincial secretary for health, Malik Asrar Hussain, told Dawn that there was a need to ensure effective supervision, vaccinator selection and improvement in the monitoring of the polio rounds.“We need to reach and immunize every deserving child in every district of the province during every round of immunization, which is possible only through a well-planned and carefully implemented operation,” the secretary said, adding that the present conditions showed a loose command structure.

Talking of the role of his department in polio eradication, he said that in the existing working frame, though the Sindh health department, along with the federal government, was a major stakeholder, it had been unable to make the staff belonging to the district governments answerable to it as far as anti-polio activities were concerned.

He said if the polio programme was to be run with real success, an enhanced and effective role of the Sindh health department should also be ensured. Districts were not performing well as there was not a well-knit check-and-balance system, he said, adding that health department officials had very little to do as far as deployment of vaccinators and other health officers in the polio immunization campaigns were concerned.He said the anti-polio operations were based on commitment and coordination of various stakeholders, but he personally felt that in the given situation the district officials could make the decisive contribution by involving the right vaccinators and creating a fascinating environment both for parents and children in and before the days of immunization.

He said he would hold a meeting of all stakeholders and members of civil society and the media before the launch of another national immunization campaign in May, with the aim of increasing the participation of the community, religious leaders, teachers and parents in the campaigns. He also stressed a third party evaluation on the effectiveness of immunization activities.