ISLAMABAD: In a major policy move, the caretaker government has reversed a decision of the PDM government regarding a $1.785 billion worth of foreign-funded programme to allow the World Health Organisation (WHO) and UN’s International Children’s Emergency Fund (Unicef) to operate the project, instead of the provinces, for eradication of polio in the country.

The decision of the PDM government taken on July 11 was reversed on the request of the secretary national health services, regulations & coordination at a maiden meeting of the Executive Committee of the National Economic Council (Ecnec) the day it was reconstituted with Caretaker Finance Minister Dr Shahshad Akhtar as chairperson.

This is very rare that a key policy decision of an elected government has been reversed by a caretaker setup. In fact, this is for the first time that forums like Ecnec and Central Development Working Party (CDWP) have been created in a caretaker arrangement to make important policy decisions on public sector development.

“The Ecnec considered and approved (a) project of Ministry of National Health Services, Regulations & Coordination titled “Emergency Plan for Polio Eradication (3rd revised)” at a cost of $1.784 billion including a grant from GPEI partners of $1.197bn, Islamic Development Bank loan of $552 million and AFD loan of $35m”, said an official statement. “The project will supply polio eradication vaccines all over Pakistan and will be executed by WHO and UNICEF”, the announcement said, adding the meeting after discussion also “extended the duration of umbrella PC-1 of the project to three years with authorisation to EAD to enter into loan agreements to finance the project on behalf of Government of Pakistan to achieve the objectives of eradication of polio and make polio-free Pakistan”.

Earlier, Ecnec had approved on July 11 the $1.785bn (about Rs535bn at current exchange rate) with the condition that provinces would take over the responsibility of polio eradication and be held accountable for which the provinces should prepare PC-1 (planning code 1 for project implementation) within one year. The decision of the PDM government, according to the secretary NHS “placed the entire programme in a state of uncertainty” putting at stake “the lives of 44 million children who rely on these critical polio vaccines”. He implored that “if polio activities are forced to halt from October onwards, it could lead to catastrophic consequences for these innocent lives. The implications extend beyond our borders, as the risk of increased global isolation due to travel restrictions loom, which could further exacerbate the crisis”. It was not immediately clear if the secretary of health had raised these concerns before the then Ecnec meeting.

The meeting was informed that recognizing the urgency of the matter, a post-Ecnec meeting at the planning commission on August 23 concluded that the federal cabinet or the prime minister should revise the Ecnec’s July 11 decision to extend the umbrella PC-1 to three years instead of one year and “assigning the responsibility back to Unicef and WHO for support in the implementation of the project interventions instead of the provinces”. Caretaker Prime Minister Anwaarul Haq consented and allowed the Ministry of National Health Services to present the issue before the Ecnec for a reevaluation of the earlier decision.

The meeting was informed that Ministry of Planning, Development and Special Initiatives presented the “Emergency Plan for Polio Eradication (3rd Revised) to the Ecnec which approved on July 11 Para 20 of the Summary of the project with total cost of $1.784bn (all foreign aid) subject to compliance of CDWP’s directions that “Provinces shall prepare their PC-1 within one year so that further ownership of the programme implementation may be shifted to the provinces with their responsibility to acquire loan and liability to pay back directly; and the provincial PC-Is will explicitly depict share of a loan of each of the province which shall be relented to the provinces from the very outset of the implementation of the PC-Is.”

The Ecnec decision of July 11 also required that “For achieving the objective of polio eradication and Polio Free Pakistan, there is a need to review and revise the implementation strategy whereby the provincial and sub-provincial health departments, instead of UNICEF and WHO, are made optimally inclusive in implementation of project interventions and consequently the provinces are made more accountable. This also necessitates the formulation of provincial PC-1 by the respective health departments.

Meanwhile, during the interim, the Umbrella Federal PC-I may continue for a period of one year to avoid interruption of services.

The Ecnec meeting on Monday also asked the Planning Commission and Ministry of National Health Services, Regulations and Coordination to provide project/programme evaluation of Polio Eradication programme and integrated lesson learnt in implementation of Phase –III.

It also directed that a committee co-chaired by the Secretary of Finance and Secretary EAD examine the re-lending arrangements with provinces for funding of project of similar nature with clear recommendations to ensure proper implementation of the projects.

Published in Dawn, September 5th, 2023