Integrating Routine Immunisation in all phases of the programme cycle and creating a meaningful synergy between the two could prove a win-win. It is imperative to establish “provincial hubs for Innovation and research” in each province. The provincial EOCs, hitherto, disempowered, are empowered to the extent to decide the operational routine issues at the minimum. To engage and buy sustained “good Will” of Media and social media, the media house owners, editors, and top anchors are effectively engaged in selling the “Neo-Polio model”. A national round table on Polio Eradication- participated by all mainstream political parties- could be another right step forward. This forum would develop a “National Polio Narrative” so the big scheme of things can be modified. In the back backdrop of all this, there is a dire need for “a programme rethink” that can ensure leading and managing the programme successfully even if out of the comfort zone of “the Lords of polio” In the 1st place, the government should create a broad-based forum of “Neutral experts” from Public health, the development sector, media and academia to work as a “Strategic advisory Committee”. This is by far the bigger reason for failure than trivialities. The lack of injecting ample motivation into the FLWs has been off the programme radar. The environment for the FLWs (Front Level Workers) for various reasons is no doubt harsh and unconducive. “One size fits all strategies” and stereotyping raise questions on programme lesson learning capacity. Demand-based refusals keep erupting and organised community boycotts are used as a bargaining chip but the programme is visibly devoid of a long-term strategic solution. The contextualisation and specialisation required to win the minds and hearts are found missing. Despite some serious efforts, there is still a disproportion between Ops and Comms components. Routine Immunisation has remained stagnant in high-risk areas like North Waziristan and Southern KP. The programme risk analysis system seems to have missed some existing “blind spots” the situation now has proved this right. The absence of a strategic balance between the leadership, management and technical domains is doomed to keep us on our toes. The private sector which could plug some vital gaps hasn’t been adequately tapped. A just and equitable accountability system is largely missing from the programme architecture, only the poor lot face the music. The structure remained an “inverted pyramid”, a top-heavy one, in terms of decisions making and incentives, contrary to the need of the programme of this scale. The programme management structure doesn’t seem to fit this multi-stakeholder and multi-million dollar programme. The real problem is not small hiccups on the ground but the absence of vision and strategic depth at the higher level, unfortunately, this is for reasons put under the carpet. Worrying is the absence of a realisation in the high offices that Polio is rather intertwined in social, anthropological, cultural and humanitarian fabrics. The community refusal in a way itself is a manifestation of an existing deep-seated strategic and programmatic gap. Despite the tantrum of the “New Communication strategy” there is visible unchartered territory that the programme needs to navigate. This scribe has pushed limits to advocate for curbing this but the programme then in self-proclaimed confidence turned a deaf ear to the advice. when the teams- for lack of motivation- and the community – for lack of conviction- collude on finger marking the children but not vaccinating this is the programme faux paux. Of the many, the key reason that has surfaced – of very late though- is the hidden refusals i.e. One can engineer any logic, any self-assurance but the case surge’s mirror shows serious flaws in the big scheme of things. with poorer health indicators, and dysfunctional health and governance systems could eradicate Polio but Pakistan despite being well ahead in all domains, is still struggling? Something is surely not working? The programme’s simplistic view is when children are missed for any reason the virus circulation is established and cases are all but a natural outcome. It is still a perplexing conundrum how countries like Somalia, South Sudan, Sierra Leone, DRC etc. A Polio case anywhere is a case everywhere, the virus doesn’t respect borders. The resurgence of cases in Malawi, Mozambique, the UK and now the US, which has been declared polio-free a decade ago, should raise alarm bells in the global polio eradication teams’ cosy rooms. The euphoria in the Polio programme turned out to be pretty ephemeral with the resurgence of Polio cases in North Waziristan, which now stands at 12 from the same district in Khyber Pakhtunkhwa province, against one case in Afghanistan, the only second endemic country.
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