Centrally located sectors conspicuous for poor results
Just because Islamabad has been polio-free for the last four years does not mean that children residing in this city are safe from the threat of polio. According to the World Health Organization’s Post Campaign Monitoring (PCM) results for the July 2012 campaign, children living in such centrally located sectors as F-7, G-5, G-9 and I-8 have not been reached with polio drops.
Exclusive PCM data available with ‘The News’ shows that the Directorate of Health Services of the Capital Development Authority (CDA) has failed to achieve satisfactory results in all the three indicators utilised for conducting the PCM namely, Finger Marking Coverage (FMC), Lot Quality Assurance Sampling (LQAS) and Market Survey (MS). Ironically, the problem lies not in slum areas but in sectors located in the heart of Islamabad, which allows no room for officials to seek shelter behind excuses such as problems of access or compromised security situation.
“Twenty-nine per cent of the areas within Islamabad have recorded sub-optimal results and have missed the target,” confirmed a reliable source working for WHO. “Of the 14 UCs that were checked, four (F-7, G-5, G-9 and I-8) were conspicuous for sub-optimal results,” he said, requesting anonymity. Asked to elaborate the grading system of the PCM methodology, he explained that coverage below 95% is considered sub-optimal and unacceptable. “It is not about grading performance; either you achieve above 95% coverage or you are considered below optimal levels,” he categorically stated.
Similarly, the federal metropolis has also failed to satisfy the monitoring teams on LQAS and MS methods. “Sub-optimal lots were recorded in different lots of the city while conducting the LQAS. Moreover, Market Survey recorded 87% coverage only,” stated the official.
When contacted, the Director of the Directorate of Health Services (DHS) Dr. Hassan Urooj dismissed the PCM data as misleading. “You have been misguided on the issue,” he said. He presented a rosy picture of Islamabad, with an overall finger marking coverage of 96 per cent. “Ours has been the ever-best result thus far,” he added. He claimed 100 per cent finger marking coverage in Rural I (Golra), Rural III (Jangi Syedan to Motorway), Rural IV (Fateh Jang Road to PAF Colony), Rural V (Chungi No. 26 to G-14), and Mehrabadi; 99 per cent coverage in G-7 Zone; 98 per cent coverage in F-11 and Rural II (Tarnol to Sangjani); and 88 per cent coverage in I-8 and F-7 zones.
If polio teams are unable to immunise children residing in sectors like F-7, G-5, G-9 and I-8, then the future of polio eradication in Pakistan is very bleak. There can be no excuse to justify anything less than 100 per cent coverage in sectors that are not plagued by challenges of any kind whatsoever. Rather than paying attention to the number of children who have been reached, the CDA needs to focus its energies on reaching children who are being missed. “If we look at the good numbers, we will never complete the goal,” the WHO official asserted.
According to the PCM results, the performance of ICT, which falls under the control of the Chief Commissioner of Islamabad, has recorded excellent results. Not a single area within ICT has been evaluated as recording less than 95% coverage.
When Dr. Hassan’s attention was drawn to ICT’s performance, he emphasised that ICT should not be compared with the federal area because of variation in population size (ICT administration covers one-third of the population while CDA covers two-thirds), geographical features (ICT administration covers developed sectors while CDA covers urban slums, ‘katchi abadis’, mobile populations and tough areas as well), and availability of trained human resource (ICT enjoys the services of LHWs going door-to-door for immunisation while CDA does not).
However, WHO sources rejected Dr. Hassan’s point of view. “The CDA’s data is based on reported coverage, which is an estimate of the total target population. How can you derive an exact percentage when you are not aware of the exact total population of the country,” he questioned. According to him, PCM is considered as one of the best methods worldwide to evaluate the performance of a certain polio drive. Data available with the districts, on the other hand, is based on feedback of the polio teams. “The choice of three methods to evaluate the performance of a district lends further authenticity to PCM,” he remarked.
The senior coordinator for polio eradication at WHO Dr. Elias Durry, when contacted, refused to comment on the issue. “The WHO is yet to officially release and share the PCM results with the government. You will have to wait till official release of the results,” he said. So at least till then, DHS can continue to build castles in the sky!