Integrating services to boost childhood immunization rates in Pakistan
An innovative initiative is linking polio vaccination to health care and nutrition services.
There was a time when Halima would have set the dog on any polio worker who arrived at her door with vaccines for her grandchildren.
But Saima Gul was not any polio worker.
For two years, Saima visited Halima’s home in Gujro, on the outskirts of Karachi. She brought medicines and mosquito nets as gifts. She spoke to Halima in Pashto, the language of many families in Gujro.
On one visit, Saima noticed that Halima had a skin allergy, and she took the 50-year-old grandmother to the nearby Jannat Gul health centre. At the health centre, Halima received help with her skin and treatment for her troublesome knees. The care convinced Halima to trust Saima and the health centre – trust them enough to allow polio vaccinations for her granddaughters, Iman, 4, and Ayd, 18 months.
As a polio front-line worker for the government locality – the Union Council – Saima is part of an Integrated Service Delivery (ISD) initiative that links polio vaccination to multiple services including health care, nutrition, water, sanitation, hygiene and birth registration.
The initiative was developed in response to feedback from parents and caregivers in poor communities whose demands for improved water, sanitation or basic health services were too often ignored. However, it also stemmed from a recognition that polio cases were more likely to arise in communities that faced multiple deprivations.
In Pakistan, the Polio Eradication Programme delivers integrated services in 43 Union Councils that face the greatest risk of polio. Gujro, a neighbourhood of about 650,000 residents in Karachi, in Sindh Province, was chosen to be part of the initiative because of its history of political, religious and cultural resistance to vaccination against polio – a disease that once instilled fear around the world, but now lingers on the brink of eradication.
In Gujro, the ISD initiative has significantly contributed to a dramatic decline in the number of people who refused to have their children vaccinated against polio: from 4,254 refusals in 2019 to 1,209 in 2022 – a 72 per cent drop. In addition, Gujro and the Karachi area have stayed polio-free even as the disease has re-emerged in Pakistan after 15 months. From April to December 2022, there were 20 polio cases reported in Pakistan.
ISD at the Mother and Child Health Centre (MCHC) Jannat Gul Town started in 2019, with the support of the Bill & Melinda Gates Foundation, Rotary International, UNICEF and World Health Organization. It now includes services such as paediatrics, nutrition, family planning, antenatal services, newborn delivery, kangaroo mother care for babies born with low birthweight, birth registration and essential vaccines. In addition, the initiative includes six dispensaries, water filtration plants and provides off-site health camps linked to polio campaigns.
“When we started, the [outpatient department] had 25 patients a day,” said Dr. Quratulain Janjua, the paediatrician who is part of the ISD initiative. “It has gone up to 500 to 600 a day now. We held community awareness sessions and, as awareness grew among people, the number went up, the patient flow increased.”
Gulmina, a mother who came to the area from Afghanistan, said she had refused to have her eldest child vaccinated against polio. But a polio worker convinced her to come to the health centre, where she gave birth to her fourth child. Since then, Gulmina has taken all her children to the health centre for check-ups and has had all her children vaccinated against polio and all other vaccine-preventable diseases. She has also told her family members about the MCHC Jannat Gul Town.
“I am happy with the treatment. My sister-in-law and other women from our families also gave birth here.”