"Provinces are the implementing partners" -- Saira Afzal Tarar

October 12, 2014

Saira Afzal Tarar, state minister for National Health Services, Regulations, and Coordination, talks about polio eradication campaigns, their challenges and successes

The News on Sunday: What exactly are the causes for increase in the number of polio cases in Pakistan in order of importance, namely security situation, access, mindset?

Saira Afzal Tarar: I think security situation is the most important reason for increase in polio cases in Pakistan. The issue of having a mindset against polio immunisation is found all over the world but it is easy to tackle while the issue of accessibility is directly related to law and order situation. If you look at Pakistan, the concentration of polio cases is in those areas where there is an issue of accessibility. And that is because law and order situation is not good. The issue of mindset is also a problem in areas where there is a problem of security. In Punjab province, the law and order situation is under control, so it is easy to cope with the mindset issue here.

It is also true that there are some pockets where law and order situation is not bad but there is the issue of dealing with a mindset which sees polio vaccination as harmful. During our latest campaign, we found 57,000 parents refusing to give polio vaccination to their children -- 16,000 parents refused only in Swabi district. It is true that things have been getting more complex with every passing day.

TNS: Talking about polio eradication campaigns, what is the division of responsibility between federal and provincial governments? Is there enough cooperation?

SAT: Yes, there is cooperation and coordination. It is very important to understand the role and responsibilities of federal and provincial governments. The ministry of health of federal government is responsible to procure vaccine, provide it to provinces, and coordinate with all partners because the whole programme is being run by the World Health Organisation (WHO). The programme was designed by the previous government. All our developmental partners, like Islamic Development Bank, Asian Development Bank, World Bank, Bill and Melinda Gates Foundation, JICA, and Rotary said that they would give money to WHO.

The federal ministry of health was not there at that time as it had been devolved. So, Prime Minister Polio Cell was set up. The major responsibility lay with the polio cell, provinces and development partners. When I took charge of the ministry, a new focal person for PM polio cell was appointed. Now, we have made some amendments with the consultation of all stakeholders. We have also set up an emergency operation cell.

Provinces are the implementing partners. The polio cell helps provinces design plans at union council level. Provincial governments have major implementing responsibilities. They are responsible to conduct campaigns and provide security to polio workers. They are also responsible for setting up the most important body at the district council level -- to set up an operation cell in every DCO’s office. In tribal areas, this is the responsibility of Fata secretariat and the Pakistan army. Prime Minister Nawaz Sharif himself spoke to the chief of army staff and commandant of 11th core and asked them to play their role in polio eradication.

TNS: How successful are the campaigns, especially in Pashtun areas?

SAT: There was a sense of fear in those areas. The local Taliban banned polio vaccination campaigns in some areas of the Pashtun belt such as tribal areas. Dr Shakeel Afridi’s case also helped their cause. They also started attacking polio workers. This further created an environment of fear but this does not mean there was no demand for polio vaccination in those areas.

We can see the IDPs from North Waziristan have not declined polio vaccination of their children once they left their areas. So, had they refused immunisation on the basis of some ideology, they would have refused taking polio vaccine even after leaving their areas. It was basically the fear of militants and the security situation which was a major factor for their refusal to give vaccine to their children. In some areas in tribal belts and other Pashtun areas, parents would allow their children to be vaccinated but they did not want to be identified.

TNS: Which geographical areas are particularly problematic?

SAT: We have three major reservoirs of polio -- North and South Waziristan and some areas of Khyber Agency in Fata, Gadap union council of Karachi which is also known as mini Waziristan and responsible for all polio cases in Karachi, and Peshawar in KP.

Now, unfortunately, the Quetta block (district Quetta, Pishin, and Qilla Abdullah) has once again become problematic. We have conveyed to the provincial government of Balochistan many times that the quality of its campaign is not up to mark. It is true that no cases were registered from the Quetta block for the last two-three years but this does not mean the virus has been eliminated. We have been checking the quality of campaigns in Balochistan through market surveys and results were not encouraging.

There are two reasons that polio cases have emerged in big numbers. One, there was an issue of accessibility. In some areas, we could not conduct campaigns after 2012, especially in North and South Waziristan. Secondly, there was an issue of quality of campaigns. In Quetta, the issue was of quality while in Gadap, North and South Waziristan and some areas of Khyber Agency, there was an issue of accessibility.

TNS: What is the level of pressure and cooperation from international community?

SAT: There is a lot of pressure. Recently, we attended Independent Monitoring Board’s (IMB’s) meeting in Lahore. The international community is concerned and they have been expecting us to conduct quality campaigns. They want to help us. They want us to show more commitment on high level, make some out-of-the-box strategy because if the situation persists consequences would be grave.

TNS: Can you give a timeline for getting positive results?

SAT: I am not in a position to give a timeline. The military operation in North Waziristan is a blessing in disguise as far as polio vaccination is concerned as we have succeeded in reaching hundreds of thousands of children who were previously inaccessible. We have been making optimal efforts to avail this opportunity. We have been mapping them. I have also asked the KP government to focus more on these children. They have not been able to reach all children in Peshawar. They could not conduct campaigns in some union councils of Peshawar city. The federal government, KP government, and FATA are major stakeholders in eradicating polio.

TNS: Have the military operations and setting up of IDP camps improved access for polio teams in tribal areas?

SAT: Of course. But still, we need to do a lot of things. One time vaccination is not enough. We need to track them down and map them and vaccinate them again and again. Some people have not left their areas and it is very important to reach them and this can only be done by the army.

It is true that the number of registered polio cases is on the rise and it is a very alarming situation but we should not be discouraged by numbers because they have been emerging only from the areas where we could not conduct polio campaigns.

TNS: What about the rumours of removal of Dr Altaf Bosan? Do you think polio campaign can afford political appointments and removals at this stage? Will you resist such pressures?

SAT: We have reviewed the whole programme. We need to see the performances of people working to eradicate polio. Had the removal been done on political grounds, we would have removed him one and a half years ago. We requested Shahnaz Wazir Ali to continue working as Prime Minister Polio Cell’s focal person when we took over last year but she excused on personal grounds. I have not been doing any politics on the issue of polio. I have such a good working relationship with all provincial governments, including Sindh and KP governments. I think it is the prerogative of a government to build its team.

"Provinces are the implementing partners" -- Saira Afzal Tarar