“SOMETIMES people get very angry and tell us to leave; especially if they are busy with household chores and we are disturbing them. If we insist they begin using abusive language and there have been times when they have shut the door in our face.” These experiences were shared by the Lady Health Workers (LHWs) of Ittehad Town in Baldia, Karachi, who were deputed to administer oral polio vaccine drops to children.

Like all their colleagues in the struggle against polio, the LHWs know just how high the stakes are. The success of the global effort to eradicate this paralysing disease rests on the shoulders of these front-line healthcare staff working in high-risk zones like the one mentioned above.

Inaugurating the first nationwide polio campaign of 2023 recently, Prime Minister Shehbaz Sharif pressed upon parents and caregivers to open their doors for polio workers and urged them to bring their children forward to receive the vaccine.

Aiming to vaccinate slightly over 44 million under-five children against possible disability, this is the first nationwide five-day campaign after the catastrophic floods inundated one-third of the country. So far, some 75 per cent, or 33m, of the targeted children have been vaccinated.

The PM’s praise for polio workers rings hollow.

The drive, which began on Jan 16, involves approximately 265,000 polio workers. However, in the districts of Hyderabad and Karachi Division, the campaign has been rescheduled to start tomorrow, Jan 23, and run until Jan 27, due to the recently conducted local government elections.

On the first day of the campaign, LHWs boycotted the vaccination drive, insisting that their demands be met. The Grand Health Alliance (GHA), representing different bodies of healthcare providers (including LHW unions), has been protesting against the discontinuation of the risk allowance of Rs17,000 per month that was given to them during the Covid-19 pandemic. Withdrawn some six months ago, the health workers feel it is impossible to make ends meet, given the current surge in food prices, after a substantial amount has been deducted from their pay.

With the pandemic no longer raging, the GHA is saying if it cannot restore the health risk allowance, the government can, at least, raise their monthly salary of Rs35,000 to bring it at par with the income of their counterparts in other provinces. This demand is totally justified.

Unfortunately, given the boycotts in other districts, the matter has not been resolved as Karachi and Hyderabad get ready to start the drive.

According to the Polio Eradication Programme, the health ministry and Expanded Programme on Immunisation (EPI) are still in ‘negotiations’ with leaders of the GHA. However, GHA representatives say they have failed to reassure them that their concerns and demands will be addressed. In fact, the prime minister’s words lauding the efforts of the front-line workers and thanking them for their hard work and sacrifices, saying the nation was indebted to them, ring hollow under the circumstances.

Working in security-compromised areas in other provinces too, their lives are continuously at risk which sometimes makes it impossible for them to perform their duties. Communities feel that those against the vaccine particularly target women because when the latter are killed the fear factor increases and acts as a deterrent for families that are reluctant to admit the workers into their homes. Still these women continue their work, despite the perils they face.

There is also no denying the importance of this cohort of female health workers in the eradication of polio as known and trusted community members; along with administering polio drops, they carry out multiple other tasks, including advising on nutrition, sanitation and family planning.

Not meeting their demands will be hugely demotivating at a time when the programme faces the biggest challenge of polio workers who feel burnt out and unable to cope in these expensive times.

On Jan 28, 2022, Pakistan had not reported a single case of a child afflicted with polio in the past one year. In fact, the last polio case had been reported on Jan 27, 2021, from Balochistan. Later unfortunately, the country slipped and 2022 saw 20 reported cases of polio. But there has not been any case since Sept 22 last year.

Eradicating polio is a priority and there is no room for complacency. Polio is a gateway to many other diseases. If routine immunisation (EPI) is pushed through, it will offer a long-term solution which could see education and sanitation efforts implemented as well as a polio-free Pakistan. Getting rid of polio in Pakistan (and Afghanistan) would mean the second infectious disease would have been eradicated from the world after smallpox.

The writer is a journalist.

Published in Dawn, January 22nd, 2023