MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Impact of the PEI on the health system
Notwithstanding the failure to achieve the polio eradication goal, the Polio Eradication Initiative,
as a GHI, has had a positive impact on Pakistan’s health system in several areas.
Funding for the PEI represents the largest-ever allocation for a disease-specific programme in
Pakistan. Official Development Assistance (ODA) accounts for a major proportion of the funds for
Pakistan’s PEI. Donors contribute an average of US$ 40 million annually towards the initiative. A
significant proportion of polio resources are not delivered through conventional channels and are
therefore not accounted for when calculating health expenditure.
PEI financing is the result of effective coordination between multilateral and bilateral agencies and
the government. Key stakeholders in financing the PEI include WHO, UNICEF, the World Bank, the
UK Department for International Development (DFID) and USAID. WHO supports AFP surveillance
activities and the operational costs of the SIAs. UNICEF supports social mobilization and vaccine
procurement, whereas the World Bank, Japan’s International Cooperation Agency (JICA) and
USAID provide funds for vaccine procurement.
The most significant contribution of the PEI at the outcome level is a major reduction of wild
poliovirus transmission, moving towards the ultimate goal of eradication. An important spin-off
effect is the establishment of the Polio Surveillance system, which is sensitive enough to detect
every case of polio. This is an active surveillance system where each case is actively searched out in
the community; as such it can only be used for diseases marked for elimination or in outbreak and
emergency situations. However, many of the components and attributes of the system are also
features of other surveillance systems. These include: active surveillance visits at health facilities,
laboratory specimen collection, transport and laboratory testing, channels of data reporting,
analysis and dissemination, use of indicators to measure surveillance quality, and training and
capacity-building of staff, among others. These attributes are of relevance to broader capacity
building in the wake of the threat posed by emerging infections in Pakistan, for example with the
entrenchment of avian flu. Recent developments around avian flu include evidence of cases in the
“poultry belt” of the Northwestern Frontier Province (NWFP) and a documented chain of humanto-human
transmission, which was luckily un-sustained [18]. To date, however, resources of the PEI
have not contributed to strengthening other health information systems, nor have they been
strategically used to consolidate country capacity for generating and utilizing evidence.
Pakistan’s PEI has also supported the creation of a grassroots workforce, which has capacity to
deliver services door-to-door throughout the country. The creation of this capability, by itself,
constitutes a significant outreach capacity—one that can be leveraged for episodic nation-wide
activities. However, effective harnessing of this capability is dependent on the capacity of
monitoring and oversight agencies, which is where the actual gap lies. The incentive structures
created for this workforce have been criticized as undermining the functioning of routine
immunization. However, gaps in the performance of the routine immunization programme may be
more directly attributable to issues inherent to Pakistan’s health system, as described below; in
comparison, the role played by incentive structures is marginal. In addition, the availability of
expanded resources through the PEI has improved infrastructure in terms of cold chain equipment
and transport.
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