Hike in KP polio cases needs probe

July 20, 2019

PESHAWAR: At a time when Khyber Pakhtunkhwa has become infamous worldwide due to the recent polio outbreak, the top government officials in the province instead of working together for the common...

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PESHAWAR: At a time when Khyber Pakhtunkhwa has become infamous worldwide due to the recent polio outbreak, the top government officials in the province instead of working together for the common cause are at loggerheads by writing letters against each other, sources told The News.

This correspondent has obtained an official letter that Director General Health Services KP, Dr Arshad Ahmad had recently written to the Secretary Health under the title “Reservations regarding EPI merger into the EOC” which noted that “the EPI programme has been integrated and brought under the control of provincial coordinator EOC, meaning that all the official matters of EPI programme will be routed through the EOC coordinator, which in a sense is an attempt to undermine the authority of the office of the Director General Health Services”.

The DG Health put a question mark on the performance of Emergency Operation Centre (EOC) and demanded an investigation into the polio outbreak in KP. Senior government officials told The News that it was a long-standing demand of international health partners to integrate EPI into polio programme.

They said the aim was to improve the working capacity of the EPI and introduce its staff with the modern-day surveillance, monitoring and culture of accountability.

“Would you believe all the 33 children diagnosed with polio were not given a single drop of polio vaccine? And it was the responsibility of Expanded Programme on Immunisation to vaccinate those children,” a top government official in Peshawar said.

According to the Pakistan Demographic Health Survey 2018, the EPI coverage was only 59 percent in KP against the national target of 80 percent. In erstwhile Fata, the coverage was only 30 percent.

Repeated outbreaks of measles and diphtheria are glaring examples of the low EPI coverage.

Out of 44 polio cases, KP alone reported 33 in 2019, including 16 from Bannu.

According to officials, the issue of integration was thoroughly discussed in the Provincial Task Force (PTF) at a meeting with the chief secretary in the chair and nobody raised any issue at the time.

“This is an issue of power struggle and has nothing to do with polio eradication. Some people wanted to have unchecked powers and unaccountable resources which unfortunately is not possible in the current circumstance as the polio programme is mainly funded by foreign donors,” the officials noted.

However, the DG Health publicly opposed this initiative of the government and the global health partners and wrote a letter to the Secretary Health to record his protest on the decision.

While expressing his fear of losing control over EPI staff and its resources, the DG Health didn’t mention any valid technical reason that could damage the polio programme.

According to officials, EPI has an army of employees with huge resources all over the province, but lacked a culture of accountability and monitoring.

The DG Health mentioned in his letter that since the establishment of EOCs (Emergency Operations Centres) at the federal and provincial level in 2014, the EOCs are directly reporting to the Secretary Health whereas the EPI programmes are under the control of the DG Health being its technical head.

“It is just an attempt to divert attention from the occurrence of an increasing number of polio cases in the province,” the DG Health mentioned in the letter.

Instead of taking responsibility for EPI’s failure, the DG Health tried to hold EOC responsible for the rising number of polio cases, arguing the number of polio cases since the establishment of provincial EOC also needed to be looked into before making any decision.

He claimed the number of cases decreased from 2015 to 2018 after the establishment of EOC while there is a surge in the number of cases during the current year, which needed to be investigated instead of disturbing the established hierarchy.

“Moreover, the District Health Officers in KP are taking this notification as if they are being kept out of polio and EPI activities. I hereby submit to your goodself that due to this notification an unnecessary wave of unrest seems to be spreading in the medical staff which is quite unnecessary at this stage and will not be in the interest of the EPI and polio programme in the province,” the DG Health wrote.

He asked the government to withdraw the notification and “avoid unnecessary disturbance in the smooth functioning of the health directorate and also in the best public and programme interest as well”.

When reached on phone, an official of ECO said that synergy among essential immunisation (EPI) and Polio Eradication Initiative (EPI-PEI) was a big leap towards achieving polio-free status.

“Keeping in view the success of the dynamic and technical structure and functions of EOC, the Prime Minister in the national task force meeting held in November 2018 directed all the chief ministers to include EPI in all the oversight structures of polio eradication,” the official said on the condition of anonymity.

He said international partners believed that synergizing both the programmes will not only benefit EPI but also pave the way for smooth transition of the legacy component of polio end-game strategy.

“The Technical Advisory Group (TAG) is the highest technical body guiding polio programme. In its meeting held in January 2019, the government was urged to focus on EPI-PEI synergy. The merger of erstwhile Fata and the need to integrate EPI structures of both KP and merged districts also necessitated structural changes to align with the new political and administrative developments,” he explained.

He said the structural merger of EPI KP and erstwhile Fata along with the technical merger of EPI with EOC was presented in Provincial Task Force (PTF) meeting in February 2019. He said the Secretary Health was a compulsory member of PTF and was present in that meeting as well.

“After discussion on broad principles of structural integration of EPI programmes and technical merger of EPI and PEI, the chief secretary desired that detailed concept paper shall be developed and submitted to Health Department,” said an EOC official.

The concept paper was submitted to Secretary Health as per the decision of PTF in March 2019.

The chief secretary had directed Secretary Health to expedite the process of approval of concept paper in the meeting held in May 2019. The Secretary Health issued a notification on May 30, 2019.

“The concerns of DG Health are misplaced and with ulterior motives. The decision of EPI-PEI synergy is based on directives of Prime Minister, thorough consultation in Provincial Task Force meeting, and approval of the Health Department. The concept note on the merger was submitted to Health Department in March 2019 whereas the notification was issued on May 30, 2019,” said the EOC official.

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