The pulse polio drive in India could be a great success. The Global Polio Eradication Initiative strategy has yielded rich dividends.
The coverage has indeed been massive. But the question is whether the much vaunted programme is not detracting the attention of the nation from other equally serious health problems.
A recent official publication, Financing and Delivery of Health Care Services in India, brought out by the National Commission on Macro - economics and Health (NCMH), says, "The single-point pursuit of polio eradication has resulted in adversely affecting the routine immunisation, which was initiated in 1986 as a Technology Mission for achieving full protection against all vaccine- preventable diseases by 2000."
The background paper, written by NCMH secretary and current National AIDS Control
Organisation chief K. Sujatha Rao, states, "As per a household survey conducted in 1998 and again in 2003 (Indian Institute of Population Sciences, 2004), the data for 220 districts showed that in the majority of the districts, there was either a declining performance or no improvement at all under the Universal Immunisation Programme (UIP)."
Further, this paper says, "Discussions with field staff seemed to suggest that this decline was largely on account of the emphasis given to polio, which not only commanded better resources and visibility in the media but also consumed nearly one-third of the time, 30 times the cost and exhausted the staff."
This paper titled Delivery of health services in the public sector recalls that in 2003, the Centre had had to send half the department officials to oversee the Pulse Polio Initiative (PPI) round due to resistance from local staff. They had got tired of participating in four rounds of PPI (with each round requiring an entire month of preparation) as well as various other single-point campaigns, health melas and family planning targets.
Rao concluded, "Such isolated programmatic approaches have made it impossible to allow the health system to develop." She raises a pertinent question as to whether "vertically driven strategies implemented in a campaign mode, which are also resource intensive and neglect equally important public health functions, are worthwhile". Another recent paper, titled Financing of Health in India has drawn attention to other dubious aspects of the PPI. This paper, co-authored by Rao, S. Selvaraju, Somil Nagpal and S. Sakthivel of the Institute of Economic Growth, Delhi, is also a background paper written for the NCMH.
This paper says Rs 3,592 crore was spent on the PPI from 1996 to 2005. This amount does not include the "extra-budgetary expenditures incurred by WHO on the appointment of over 1,000 consultants to monitor the programme and the amounts being incurred by the UNICEF or IEC". Almost 13 percent of the health department's budget during 2003-04 was spent on this single activity. This paper adds, "It is estimated that one drop of polio vaccine is almost 30 times more expensive than the drop given in routine UIP."
Isn't it time to have another look at the PPI and other single-point campaigns and programmes which have increasingly dominated our health system in recent years, wonder activists.
The following resolution was passed by the Second World Social Forum on Health and adopted by the World Social Forum, 2007.
"The Second World Social Forum on Health condemns the World Health Organisation's lack of transparency in acknowledging the failure of the Global Polio Eradication Initiative strategy and instead identifying a few low-income countries as scapegoats; subjecting the children of these countries to an unprecedentedly high number of Oral Polio Vaccine (OPV) through the Pulse Polio rounds with no concern for its negative impact and the use of monovalent OPV, an untested vaccine without informed consent.
"While the WSF on Health acknowledges the place of OPV in the overall immunisation programme as part of integrated public health services, the strategy of intensive PPI rounds has had a detrimental fragmenting effect on the already weak public health systems in low-income countries.
"We demand an independent review of the Global Polio Eradication strategy with due consideration to the relevant epidemiology and different countries' health care priorities."
The Global Polio Eradication Initiative — led by WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF — was launched in 1988 when the World Health Assembly adopted a resolution to eradicate polio. At the time, more than 350 000 children were paralysed by the disease each year, and polio was endemic in more than 125 countries.
Since then, tremendous progress has been made and the disease burden has been reduced by more than 99%. In 2006, four countries remain polio endemic — Afghanistan, India, Nigeria and Pakistan — and fewer than 600 cases were reported worldwide by 21 June 2006, says a WHO document.
Three-quarters of all cases still reported are linked to just five polio "hotspots": Kano in Nigeria, Uttar Pradesh and Bihar in India, and Sindh and North West Frontier Province in Pakistan.
That is the problem is at manageable levels, such is the message. Still officials also concede it is becoming hard to keep momentum going as other health priorities clamor for attention and funds. They also note that most polio-free countries have abandoned costly immunization programs, leaving millions vulnerable to any spread of the virus from endemic countries.