MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Pakistan: The impact of the Global Polio
Eradication Initiative on health systems
Abstract
Sania Nishtar 20
Pakistan is one of the four countries in the world where polio eradication has not been achieved,
despite an unprecedented inflow of resources dedicated to the programme over the last 15 years.
The objective of this case study is to analyse the impact of Pakistan’s Polio Eradication Initiative
(PEI) on health systems in Pakistan and to document the impact of the health system on polio
eradication. Qualitative methods were used for the study.
By and large, the impact of the PEI on health systems in Pakistan was found to be positive, as
evidenced by a decline in poliovirus transmission. The programme can also be credited with
establishing a sensitive nationwide disease surveillance system, building capacity for door-to-door
outreach, and achieving the largest-ever funding allocations for a disease-specific programme in
the country. The PEI’s negative effects include the time implications of organizing and
implementing Supplementary Immunization Activities (SIAs) and reported abuse of the mode of
payment used to conduct SIAs. The failure to achieve the polio eradication goal stems from
weaknesses in Pakistan’s health systems and the country’s geo-political, security and broader
governance challenges. Salient considerations include severe conflict-related limitations in
reaching children in the tribal areas of the country, along with organizational, managerial and
operational problems in achieving sufficient coverage, even in accessible areas. In many ways, the
PEI has exposed critical weaknesses in Pakistan’s health system and its inability to deliver on
targets, even when resource availability is not an issue.
Background: Pakistan and its health systems
Pakistan is the sixth most populous country in the world, with its current population estimated at
160 million. Sixty-five percent of the population lives in rural areas [1], 35% is below the age of 15
years, and more than 46% is illiterate [2,3,4].
Pakistan has been under military rule for 31 out of the 62 years since the country came into
existence. Macroeconomic growth has been significantly dependent on the level of international
support, as opposed to the mode of governance (democracy vs. military rule), with periods of
growth in the 1960s, 1980s and more recently during the period 2001-07. Pakistan’s
macroeconomic downturn from 2007 onwards can largely be attributed to geo-political and
security factors, weaknesses in governance and the impact of the global commodity crisis. The
financial crisis of 2008 did not permeate into Pakistan as it did in most East Asian countries
because of the lack of integration of Pakistan’s financial markets with the global financial system.
However, effects of the crisis are expected in Pakistan over the coming months and years. Despite
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