AFTER emerging from 2010 as the country with the highest number of polio cases - 140 - with nearly 70 per cent from Fata (72) and Khyber Pakhtunkhwa (24), the provincial health authorities are pursuing a 'composite plan' to free the province and its adjoining tribal areas from polio by the end of this year, with technical and financial support of international agencies.

The Polio Eradication Plan (PEP) 2011, unveiled by the provincial Health Department early this month, is different from previous initiatives. While the provincial Health Department and Fata had been running their anti-polio programmes separately in the past, now for the first time a unified campaign, which will be monitored from the top, will be run in both the settled and tribal areas with active involvement of the civil administration.

Not only is the rise in the number of polio cases in 2010 alarming, the fact that 72 confirmed cases were reported from Fata and 24 in Khyber Pakhtunkhwa out of the total 140 cases in the country, clearly indicates where the fault line lies, says Dr Janbaz, director of the Expanded Programme on Immunisation.

The major reasons for the rise in polio cases are insecurity in Fata resulting in the inaccessibility of polio teams to a number of areas and disrupted health services in the flood-affected areas.

Other factors for the failure of earlier interventions, Dr Janbaz says, include frequent movement of population between Fata and the settled districts, non-accountability of those responsible for implementation of the programme, poor supervision at the grassroots level and lack of awareness among the people.

Unlike previous polio eradication programmes, PEP-2011 will be executed under the supervision of a Task Force headed by the chief secretary, Khyber Pakhtunkhwa, who has approved the work plan for the year. The execution mechanism involves divisional commissioners, district coordination officers and political agents, as heads of their respective areas of jurisdiction. The executive district officer (EDO) health of each district will be accountable before these authorities in case of any negligence in commissioning of the programme, explains Dr Janbaz,

Under PEP-2011 three different province-wide polio-vaccination campaigns have been planned, including a Sub-National Immunisation Day (SNID) to be observed on January 31 in 10 high risk districts of the province and the entire tribal areas.

Similarly, two separate National Immunisation Days (NIDs), which will be observed in March and May, are also part of the plan, says Dr Janbaz.

Officials in the health department, wishing to remain anonymous, tells Dawn that the international donors and health agencies who have been supporting the polio eradication plan since 1988 had been harbouring serious concerns over the lack of political will on the part of the incumbent government.

“WHO, Unicef and the Bill and Melinda Gates Foundation, the three major financiers of the polio plan, had expressed their reservations to the government at different forums and even warned of terminating their support, if the government did not address those concerns,” an official tells Dawn .

Meanwhile, Inayatullah Khan, who served as health minister in the previous MMA government, is not too optimistic about the outcome of the government's new polio eradication plan because he believes the level of political will in the current dispensation is not sufficient to make the plan work.

Security may be a problem, he says, but it can be overcome, as it has been in Afghanistan, which registered only 24 cases of polio in 2010. He recommends that the government engage with the militants and convince them to let the polio teams work in their areas, as it was done in Afghanistan.

Khan also lamented about the poor monitoring and supervision of the polio campaigns. “I myself had been the minister for health, but twice my house in Peshawar was bypassed by the polio teams and I had to call them to get my kids vaccinated,” says Mr Khan.

Dr Janbaz concedes that there might have been problems or lack of interest at the highest level in the past, however, the current government is serious in eradicating this menace from the province.

The political will to do this, he adds, was first exhibited on October 4 last year when the governor and chief minister, the top executive and constitutional heads of the province, jointly held an important meeting to chalk out PEP-2011. They agreed to hold meetings on a quarterly basis to monitor progress towards the targets envisaged under PEP-2011.

At the national level, President Asif Ali Zardari last week launched the National Emergency Plan for polio-eradication to demonstrate the government's seriousness, says Dr Janbaz. “This was the reason that the government garnered international support with more enthusiasm.”

Last week too, the Bill and Melinda Gates Foundation announced the donation of $17 million for Pakistan's anti-polio drive. Dr Janbaz believes “the major portion of these and other support from WHO and Unicef will come to Khyber Pakhtunkhwa and Fata”.

The office of the chief secretary of Khyber Pakhtunkhwa, he further explains, has been made the focal point for the implementation of the entire programme, which in itself demonstrates the will on the part of the civil administration.

A large number of children in Fata had remained un-immunised in 2010 due to insecurity: more than 300,000 children could not be assessed. To ensure access of the polio vaccination teams this time and ensure children in security compromised areas are vaccinated, Dr Janbaz says, it has been planned that the law enforcement agencies will facilitate access to areas which are under military control.

Moreover, as per the plan, all new positions created during the implementation of 2011 will be reviewed jointly by the donor partner organisations and the respective deputy directors to ensure transparency in the process, Dr Janbaz assures.