MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Pakistan also suffers from a number of other health challenges, particularly in relation to polio
eradication and the prevention and control of non-communicable diseases, viral hepatitis and
HIV/AIDS. Pakistan’s key health indicators have been summarized in Table 1.
Health is an inter-sectoral responsibility. A number of factors are therefore responsible for poor
health status of the country’s population; these include broader issues implicit in the social
determinants, low public investments in the health sector and poor performance of the health
system. The latter is the result of interplay between insufficient state funding for health, a
regulatory environment which enables the private sector to operate unchecked and unregulated
in the delivery of social services, and the overall lack of transparency in governance [16]. Political
factors, conflict and disaster further worsen the situation, particularly with reference to the case
study that is described below.
Objective and methodology
The objective of the case study was to analyse the impact of the Polio Eradication Initiative (PEI)—
a part of the Global Polio Eradication Initiative—on health systems in Pakistan. However, the study
also ended up documenting the impact of the health system on polio eradication.
Qualitative methods were used for the study. These included a review of academic and grey
literature and semi-structured interviews and focus group discussions with key informants. A
Medline search was conducted with the search terms “polio eradication” and “PEI Pakistan” in
combination with search terms “health systems”, “information systems”, “workforce”, “service
delivery”, “financing”, “supply chains” and “governance”. In order to review grey literature, the
same search terms were entered into Google.
Semi-structured in-depth interviews varied in length. These were conducted with managers at
various levels within the public and private sectors. A total of 27 interviews were conducted; the
professional profile of the interviewees ranged from government clerical staff and equivalent
private sector employees to Chief Executive Officers and former cabinet members. Gender, culture,
language and social considerations were taken into account when planning interviews. The
Principal Investigator also conducted focus group discussions with 5 to 10 people on particular
issues. A total of five focus group discussions were held.
Results and analysis
The PEI in Pakistan: background
The PEI was launched in Pakistan in 1994, fifteen years after the launch of the Expanded
Programme for Immunization (EPI); the latter is mandated to undertake routine immunization
activities. Since 2000, the PEI has followed the successful approach of the western hemisphere—
supplementing routine polio immunization with huge country-wide campaigns several times a
year to deliver drops of Oral Polio Vaccine (OPV) to every child under the age of five years. Over the
last nine years, 88 rounds of SIAs have been conducted with nationwide outreach, with the help of
contributions from the Global Polio Eradication Initiative—a global partnership of WHO, UNICEF,
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