Safety not guaranteed: ‘Incentivise workers to gain ground in fight against polio’

While security comes first, Dr Sania Nishtar believes higher pays, life insurance can also motivate.

ISLAMABAD: “There is no substitute for security,” says Dr Sania Nishtar, former federal health minister, about motivating polio workers in the wake of several fatal attacks. The cardiologist believes in order to keep up with the fight against polio, health workers need to be motivated through greater institutional support.

Nishtar, who also founded health think tank Heartfile, finds such support can come by way of life insurance and better wages, and will bolster immunisation efforts at large.

While security might be the biggest, most immediate challenge faced by anti-polio drives, the devil lies in the detail which often goes unnoticed.



The need for electricity which helps maintain the cold chain needed for proper immunisation is often sidelined, leading to wasted vaccination endeavours, points out Nishtar.

According to Samant et al (2007), the oral polio vaccine (OPV) “may lose 4% to 13% of its potency per day at 25°C, 11% to 21% per day at 31°C, and 26% to 34% per day at 37°C.”

The paper, published in the journal Public Health Reports, goes on to illustrate how failing to maintain the cold chain can possibly correlate to polio incidence spikes in high-temperature months in India. “The cold chain plays a central role in the polio eradication initiative in rural areas, given frequent power failures and high summer temperatures.”

A majority of polio cases in Pakistan in 2013 were reported between May and September.

The doctor-turned-health advocate goes on to explain how other oft-missed elements can help in anti-polio campaigns, such as clean water and sanitation. The need to monitor basic health units (BHU) is vital to the motivation of health workers, stresses Nishtar. Better BHUs can also help avoid ‘ghost vaccines.’

“A ghost vaccine is when workers collect salaries without carrying out vaccinations,” explains Nishar. A lack of consistency and monitoring at BHUs allows such workers to slip through the cracks.

Although awareness would help towards lobbying the government to regulate BHUs, Sania Nishtar feels awareness itself takes lift from general improvement in per capita income.

Even as problems of accessibility and religious opposition prevail, Nishtar is confident incentivisation of workers can serve to invigorate the drive to eliminate the crippling disease. “The new government has a historic opportunity to eradicate polio, provided these challenges are surmounted.”

However, Nishtar believes the balance between the centre and provinces is yet to be struck in terms of monitoring and accountability.

The federal Ministry of Health was disbanded in 2010, leaving the infrastructure split in nine divisions across various ministries including the Prime Minister’s Polio Cell.

Attacks on polio teams

December 18, 2012

Five polio workers were shot dead in coordinated attacks in Karachi and Peshawar. The incident caused WHO to halt vaccination activities for a second time in 2012

December 19, 2012

Hilal, a polio team member, was shot in Daudzai, Peshawar.  Zakai and her driver Ayaz, members of a team, were shot dead in Trakha, Charsadda

January 28, 2013

A policeman escorting polio workers was shot dead by unidentified people in Swabi district

February 26, 2013

A policeman escorting a team was shot by unidentified men in Ghala Dher, Mardan

April 10,  2013

Two policemen escorting a polio team were shot by unidentified gunmen in Mardan district

May 28,   2013

Two polio workers died as result of firing  by unidentified men in Badhaber, Peshawar

May 29, 2013 

A mob lobbed stones at polio workers in Thal, Hangu, injuring one

June 16, 2013 

Two health workers were shot dead in Padini, Swabi by unidentified assailants on a motorbike

July 7, 2013 

A health worker was assaulted by two men for visiting their house to administer vaccines in Chichawatni, Multan

October 7, 2013 

A blast in Garhi Mali Khel, Peshawar, targeting polio teams, killed a sub-inspector and two Suleman Khel peace committee members

October 10, 2013 

Three khasadars  from Khyber Agency protecting polio teams were killed in a blast near Achini

Published in The Express Tribune, October 24^th, 2013.