Pakistan has a high infant mortality rate, which is linked to low levels of immunisation. There is an urgent need for coordination among institutes for reducing demand and supply gaps in enhancing immunisation coverage nationally write Ghamz E Ali Siyal and Shahbaz Tufail

Siyal, Ghamz E Ali

Tufail, Shahbaz

LSE Research Online

Immunisation	programmes	in	Sindh	and	Balochistandesperately	need	a	shot	in	the	armPakistan	has	a	high	infant	mortality	rate,	which	is	linked	to	low	levels	of	immunisation.There	is	an	urgent	need	for	coordination	among	institutes	for	reducing	demand	and	supplygaps	in	enhancing	immunisation	coverage	nationally	write	Ghamz	EAli	Siyal	and	Shahbaz	Tufail.	From	the	perspective	of	public	health	investment,	immunisation	programmes	areconsidered	the	most	successful	and	cost-effective	for	saving	future	generations.	Globally,	around	6	million	childrendied	in	2015	and	out	of	that	30	percent	resided	in	South	Asia.	Eight	million	out	of	23	million	under-immunised	children	resided	particularly	in	Pakistan,	India	and	Afghanistan.Pakistan	is	considered	to	be	fastest	growing	country	in	South	Asia	with	a	growth	rate	of	2.4	percent.	However,	infantand	maternal	mortality	rates	are	very	high.	Almost	half	of	population	face	issues	relatedto	malnutrition,	particularly	children	under	the	age	of	five.	The	lower	rate	of	immunisation	and	higher	prevalence	ofdeaths	have	also	contributed	significantly	in	number	of	deaths	in	Pakistan.		Withlower	immunisation	rates,	53.8	percent	in	2012-13,	the	future	generations	of	Pakistan	are	at	a	risk.	While	it	is	easy	totarget	the	blame	on	the	government,	various	reasons	at	the	provincial	level	affect	the	demand	and	supply	aspects.Pakistan	ranks	29th	in	the	World	Infant	Mortality	Rate	(IMR)	and	8th	in	Asia,	i.e.	52.10	per	1,000	births.	The	higherrate	of	child	mortality	can	be	expected	from	lower	rates	of	immunisation.	As	per	Pakistan	Demographic	HouseholdSurvey	(2012-13),	national	coverage	rate	of	child	vaccination	is	53.8	percent	(GoP,2017).	Stunting	is	common	in	as	high	as	44	per	cent	of	children	and	31.5	per	cent	of	children	are	underweight.	Interms	of	rural–urban	division,	stunting	among	children	and	underweight	issues	are	higher	in	rural	areas	as	comparedto	urban	areas.	Almost,	35,000	children	die	of	diarrhoea	yearly	before	age	of	five.	Last	year,	threats	from	chickenpoxwere	still	looming	as	16	children	died	from	it.Vaccination	against	Polio	in	Pakistan	in	2016.	Image	credit:	Sanofi	Pasteur/Flickr/	CC	BY-NC-ND	2.0South Asia @ LSE: Immunisation programmes in Sindh and Balochistan desperately need a shot in the arm Page 1 of 3		Date originally posted: 2018-04-06Permalink: http://blogs.lse.ac.uk/southasia/2018/04/06/immunisation-programmes-in-sindh-and-balochistan-are-in-desperate-need-for-a-shot-in-the-arm/Blog homepage: http://blogs.lse.ac.uk/southasia/The	lower	rates	of	immunisation	are	a	significant	issue	in	Sindh	and	Balochistan.	Provincially,	Punjab	is	leadingKhyber	Pakthunkuwa	(KP),	Sindh	and	Balochistan.	Immunisation	coverage	in	Punjab	and	KP	has	significantlyimproved	because	of	active	role	of	local	governments	in	the	past	decade.	Immunisation	coverage	standsat	65.6	percent	in	Punjab	and	52.7	percent	in	KP.	The	accountability	factor	of	government	functionaries	at	supplyside	and	awareness	among	families	regarding	the	benefits	of	immunisation	are	possible	factorsbehind	these	such	good	rates.	However,	immunisation	rate	in	Sindh	is	29	per	cent	and	Balochistan	is	16.4	per	cent	.The	government	of	Pakistan	is	providing	free	vaccines	to	save	children	from	preventable	diseases	under	ExpandedProgramme	on	Immunisation	(EPI),	launched	in	1978	for	improving	immunisation	against	preventible	diseases.	Ittargets	to	immunise	6	million	children	of	age	group	between	0	to	11	months.	This	immunisation	process	is	based	onvaccinations	for	coping	nine	diseases:	childhood	tuberculosis,	poliomyelitis,	diphtheria,	pertussis,	tetanus,	hepatitisB,	haemophilus	influenza	type	b,	pneumonia,	and	measles.	Apart	from	vaccinations	for	children,	vaccinationsare	also	provided	to	pregnant	women	against	tetanus.	The	devolution	of	ministries	has	increased	role	of	provincialgovernment	in	implementation	of	programmes.	The	differences	in	immunisation	coverage	rate	provincially	validatedifferences	of	service	delivery	of	this	programme.Major	barriersThere	are	various	factors	which	came	on	forefront	during	a	project	conducted	by	Sustainable	Development	PolicyInstitute	(SDPI)	and	Global	Alliance	for	Vaccination	and	Immunisation	(GAVI).	This	project	focused	onless	immunised	provinces,	namely,	Sindh	and	Balochistan.	This	included	involvement	of	key	stakeholders	suchas	civil	society	organisations,	media,	local	government	representatives	and	parliamentarians	during	advocacysessions.In	Sindh	province,	major	barriers	in	routine	immunisation	are	lack	of	awareness	about	immunisation	and	itsoutcomes,	lack	of	access	to	vaccination	centres,	inadequate	financial	resources,	poor	performance	of	localgovernments,	and	inefficient	service	especially	in	urban	slums	as	well	as	rural	and	remote	areas.	Besides,	lowincome,	low	levels	of	literacy	and	less	understanding	of	social	mobilisers	about	the	issue	also	contributes	tolower	immunisation.	Additionally,	lack	of	coordination	among	federal,	provincial	and	local	governments	and	weakerrole	of	social	and	electronic	media	are	also	potential	barriers.	Few	stakeholders	identified	negative	perception	aboutvaccination	hinder	immunisation.In	Balochistan,	major	barriers	to	immunisation	are	lack	of	awareness	about	vaccination	process,	lack	of	healthservices,	lack	of	planning	and	commitment	of	staff,	shortage	and	negligence	of	field	workers.	Instead	of	securityissues,	cultural	and	religious	barriers	also	negatively	affect	immunisation	coverage.	Door-to-door	vaccination	is	notpossible	because	of	scattered	and	complex	geographic	structure	of	the	province.	Lack	of	interest	of	print	andelectronic	media	in	creating	awareness	about	routine	immunisation	and	lack	of	accountability	and	governance	inaddressing	health	programmes,	and	inefficient	role	of	EPI	staff	led	to	minimum	immunisation	coverage.	Furthermore,lack	of	legislation	on	routine	immunisation	a	major	barrier	in	tackling	the	issue	in	Balochistan.The	EPI	representatives	from	Sindh	and	Balochistan	described	lack	of	funds	was	a	major	barrier	in	achievingpossible	outcomes.	The	budget	allocation	by	PSDP	for	EPI	is	about	Rs	2792.693	million	and	assistance	by	GAVIwas	Rs	477	million.	The	EPI	staff	has	increased	its	outreach	and	improved	services	provisions	in	all	provinces.	Theyare	hopeful	to	have	achieved	80	percent	of	immunisation	coverage	nationally.These	problems	highlight	need	for	coordination	among	institutes	for	reducing	demand	and	supply	gaps	inenhancing	immunisation	coverage	nationally.	The	major	suggestions	for	improving	immunisation	given	bystakeholders	are	to	conduct	baseline	studies	for	identifying	vulnerable	areas	in	each	district.		The	awarenesscampaigns	are	needed	by	engaging	clerics,	print,	electronic	and	social	media,	andgovernment	organisations	especially	in	remote	areas.	The	formulation	of	act	or	bill	to	make	immunisation	mandatoryis	a	key	to	improve	immunisation	both	provinces.This	article	gives	the	views	of	the	authors,	and	not	the	position	of	the	South	Asia	@	LSE	blog,	nor	of	the	LondonSchool	of	Economics.	Please	read	our	comments	policy	before	posting.About	The	AuthorsSouth Asia @ LSE: Immunisation programmes in Sindh and Balochistan desperately need a shot in the arm Page 2 of 3		Date originally posted: 2018-04-06Permalink: http://blogs.lse.ac.uk/southasia/2018/04/06/immunisation-programmes-in-sindh-and-balochistan-are-in-desperate-need-for-a-shot-in-the-arm/Blog homepage: http://blogs.lse.ac.uk/southasia/Ghamz	E	Ali	Siyal,	Research	Assistant,	Sustainable	Development	Policy	Institute	(SDPI),	Islamabad.		Shahbaz	Tufail,	Advocacy	Assistant,	Sustainable	Development	Policy	Institute	(SDPI),	Islamabad.		South Asia @ LSE: Immunisation programmes in Sindh and Balochistan desperately need a shot in the arm Page 3 of 3		Date originally posted: 2018-04-06Permalink: http://blogs.lse.ac.uk/southasia/2018/04/06/immunisation-programmes-in-sindh-and-balochistan-are-in-desperate-need-for-a-shot-in-the-arm/Blog homepage: http://blogs.lse.ac.uk/southasia/

Immunisation programmes in Sindh and Balochistan desperately need a shot in the arm

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Immunisation programmes in Sindh and Balochistan desperately need a shot in the arm

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