Frontline health workers lead Pakistan across the polio finish line

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By Wasif Mahmood

Taxila, Punjab, 17 May 2016 ---Dressed up in a shiny yellow suit and green dupatta, five years old Asiyasquats on floor with other peers singing in chorus the alphabets "A, B, C, D…." at an informal school in the hamlet of Taxila as Farzana, a Community Mobilizer, helps them learn. I do not want to go back home yet even I know that school is over for today",says little Asiya with a smile on her face and a sparkle in her eyes. "I want to be a doctor like Farzanabaji(elder sister) and help others live a healthy life", she says referring to the community mobilizer, who is taken for a doctor owing to her job in mobilising community before every polio campaign and referring them to nearby hospital or clinic in case of an ailment. Farzana is not just a role model for Asiya, but she is a household name in the entire community who look upon her as a saviour. She is a local and lives just across the neighbourhood. Her extensive interaction with the families in Taxila that hosts sizable poor communities has given her an advisory role on all matters of health.

The community mobilizer informs about the date of the polio campaign, register under-five kids who have missed vaccination due to various reasons and build trust within the community.

"Sometimes I receive calls when I am at home. Parents seek my guidance and support before going to the doctor. I refer them to the nearest health dispensary in Jalala. Sometimes I recommend them to take children to the hospital in Rawalpindi if the ailment is serious," Farzana explains.

"This is pure trust reposed by the community and I feel I cannot break it by not responding to their queries, even beyond the duty timings", she adds.

"After I have registered all children who are due for vaccination, I visit the school and help children learn. It is always a soul satisfying experience. I feel all children in my community are my own children", says the mother of four, Farzana, as her voice is choked with emotions.

More than 200,000 frontline health workers across Pakistan go beyond their traditional roles of raising awareness and mobilizing communities, to reaching children and vaccinating them on the spot. Their crucial effort is turning a tide in giving children the best start in life and ridding Pakistan the menace of polio."When I started working as community mobilizer, most of the parents who happened to be migrants from Khyber Pakhtunkhwa, had reservations about polio as well as routine vaccination. It was a challenge to trace all children and vaccinate every single child", she says.

"Today almost all children of this neighbourhood have been enrolled in the school and also in my record books", smiling Farzana says.

In the recent months, the Pakistan polio programme has refocused its efforts in tracking the virus to the remaining reservoirs and in finding and vaccinating the continuously missed children among the highest risk population to close the immunity gap.

Today the intensity of polio virus transmission has subsided and cases continue to decline. In 2015 Pakistan recorded 82% fewer cases than in 2014. During the first quarter of 2015, 23 cases were recorded in 13 districts. So far in 2016 eleven cases have been recorded from eight districts, a 65%reduction year on year.

However, the virus remains active in three remaining sanctuaries – the Khyber-Peshawar-Nahangar corridor, Karachi and the Quetta-Kandahar block. The risks span beyond these areas: the detection of virus from environmental samples in low risk areas in Punjab (Rawalpindi, Lahore, Multan and Faisalabad) and in Northern Sindh (Hyderabad and Sukkur) indicate that pockets of under immunized children are allowing the virus to survive and spread.

On and off positive environmental samples in Rawalpindi, Faisalabad, Lahore and Multan indicate consistent polio virus circulation, highlighting the need to vaccinate every single child especially from areas where immunity levels are low.

Polio Control Room data indicate over 10,000 people from Khyber and FATA visit Rawalpindi every month. As per moderate estimates nearly 250,000 migrants including seasonal workers and nomads visit Punjab every month.

Out of a total 91,000 under five children in Taxila alone, more than 31,000 belong to poor communities who are more vulnerable due to their frequent movement to polio infected districts, less opportunities to continue education, lack of access to improved sources of drinking water and sanitation facilities.

"Frontline workers alert the programme about arrival of such populations well in timein their neighbourhood.The health department subsequently ensures that no child remains unvaccinated", says District Health Communication Support Officer in Rawalpindi Bushra Ajmal, who is supervising the frontline workers like Farzanafor more than two years.

"With the support of Farzana and her fellow frontline workers, we are able to track and vaccinate almost all children during polio campaigns in Rawalpindi", saysBushra.

"The involvement of females ensures all women are involved in decision making at all levels on issues related to their families", the DHCSO explains.

"I understand that a child who is not vaccinated is vulnerable to polio and this fear keeps my passion alive to reach out to every child in every campaign so that their future is not jeopardized", says Farzana before leaving the school for the nearby community.

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