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Better community engagement and stronger health systems are needed to tackle polio


In this week's PLOS Medicine two independently written articles call for a shift away from the leader-centric approach that polio eradication campaigns are currently pursuing in the three countries (Nigeria, Pakistan and Afghanistan) where the disease remains endemic.

In a Policy Forum article, authors from Nigeria, Pakistan and Afghanistan led by Seye Abimbola from the National Primary Health Care Development Agency, Nigeria, argue that the global health community and governments involved in polio eradication efforts need to build trust and prioritise polio eradication as part of routine health services in order to address the problem of polio.

The authors highlight that that increasing militancy, political unrest, lack of trust, and deteriorating security conditions are common denominators that threaten polio eradication efforts in all three countries, although these are embedded in country-specific contexts. However, the authors are concerned that current strategies being used to tackle polio may not be best suited to the situation within the three countries.

The authors say, "[i]n our view, the ambition of the global health community to eradicate polio appears to be blinding it to lessons learned about health systems over the past 30 years. Polio eradication will only be achieved with stronger health systems and bottom-up community engagement, which is likely to require more time and more investment than is currently available in Pakistan, Nigeria, and Afghanistan because of their political fragility."

In an independently written Essay, Svea Closser and Rashid Jooma from Middlebury College, United States and Aga Khan University, Pakistan highlight the importance of Lady Health Workers in Pakistan who are crucial for the country's polio eradication efforts.

There are approximately 106,000 Lady Health Workers in Pakistan who in addition to working on polio campaigns, visit families monthly to promote family planning; advise on nutrition and hygiene; and create demand for antenatal care, childhood immunization, and use of skilled birth attendants.

However, the authors describe how Pakistan's Lady Health Workers are often in desperate financial straits, have little opportunity for career advancement and risk their lives as frontline health workers. The authors call for a shift away from the "leader-centric" model being employed by partners involved in the polio eradication effort and for increased support for Lady Health Workers in Pakistan.

The authors conclude, "Pakistan's [Lady Health Workers] have the potential to achieve universal immunization and polio eradication in the country. In fact, both of these goals are probably impossible without their full support. Achieving them depends on a shift from treating frontline female health staff as disposable labor to truly engaging them as well-supported, active partners in achieving a healthier Pakistan."


Dr Closser & Colleagues Essay:

Funding: The interviews quoted in this essay were conducted as part of research funded and facilitated by UNICEF in 2011. UNICEF had no role in the preparation of this manuscript and did not prompt the writing of this essay. The authors were salaried by their institutions during the period of writing; this salary support was not connected to the writing of this essay.

Competing Interests: SC received travel funding from the Independent Monitoring Board for Polio Eradication to attend their meeting in 2011, a consultancy with UNICEF in 2011, and a contract from the Bill & Melinda Gates Foundation for research on polio eradication and health systems in 2011. RJ declares no competing interests.

Citation: Closser S, Jooma R (2013) Why We Must Provide Better Support for Pakistan's Female Frontline Health Workers. PLoS Med 10(10): e1001528. doi:10.1371/journal.pmed.1001528



Svea Closser
Middlebury College

Dr Abimbola & Colleagues Policy Forum:

Funding: No specific funding was received for writing this manuscript.

Competing Interests: The authors have declared that no competing interests exist. The opinions expressed in this commentary are those of the authors and do not necessarily represent the views of their respective affiliated organisations.

Citation: Abimbola S, Malik AU, Mansoor GF (2013) The Final Push for Polio Eradication: Addressing the Challenge of Violence in Afghanistan, Pakistan, and Nigeria. PLoS Med 10(10): e1001529. doi:10.1371/journal.pmed.1001529



Seye Abimbola
National Primary Health Care Development Agency
+61 416 700 907

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