KARACHI: No polio cases have been detected in the province of Sindh in the last one year but Karachi and Qamber-Shahdadkot have been rated as high risk areas. This was revealed during a meeting regarding the progress made in the polio program on Tuesday at the CM House. The meeting was presided over by Sindh Caretaker Chief Minister (CM) Fazul-ur-Rehman. The meeting was attended by Provincial Coordinator POCC Shahnaz Wazir Ali, Principal Secretary to CM Sohail Rajput, Secretary Health Fazal Pechuho, Provincial Coordinator Emergency Operation Center (EOC) Fayaz Jatoi and Aziz Memon of International Polio plus Committee Rotary International. The chief minister was told that all polio activities were guided by the National Emergency Action Plan (NEAP). Globally, Pakistan and Afghanistan are the only remaining countries with polio. From 2018 till date, three cases of polio were reported in Pakistan (all from district Dukki of Balocistan), and eight cases were reported in Afghanistan. In Sindh, all six districts of Karachi are still classified as ‘Tier 1’ core reservoir (high risk). The CM was informed that no Polio case had been detected in Sindh since last year. Two polio cases were reported last year and both were from Karachi. Officials during the meeting explained that the virus isolated from environmental sites (taken from sewage system), indicated ongoing virus transmission. They said that in Karachi, samples were taken from 11 sites every month. In May only Machhar Colony Gadap were positive. In Northern Sindh, samples were taken from six sites and Qamber was positive. On this the CM said that the situation could not be termed as normal. He added that all the stakeholders, partners and civil society have to work together to make Pakistan polio free zone. The chief minister was told that the three tiers structure provided oversight and direction to the polio program. He was further informed that the Provincial Task Force led by CM and/or Chief Secretary met quarterly and had the membership of the secretary of Health, secretary of Education, all Commissioners, Law Enforcement Agencies (LEAs), and provincial heads of partner agencies. The CM was told that Divisional Task Forces led by Commissioners operated in all six divisions and District Commissioners (DCs) and District Health Officers along with their district teams were all members of the Divisional Task Forces. The CM was informed that District Polio Eradication Committees (DPECs) had been formed in all 29 districts, led by deputy commissioner. He was told that DPECs were supported by the District Polio Control Rooms (DPCRs) which were responsible for the day-to-day running of all polio-related activities in the districts. Most DPCRs function throughout the month. The CM was further briefed on the role of the provincial Emergency Operations Centre (EOC) which serves as the technical lead at the provincial level and coordinates all activities between government, partners and the federal level (National EOC). Mr Fayaz Jatoi highlighting the challenges said that stopping virus transmission in Karachi required sustained polio activities of highest quality in selected high-risk areas of the city. He said that the energy and morale of the workforce was in a precarious balance – back-to-back activities for many months, high expectations, constant pressure, punitive measures and inadequate support had taken a toll on front line workers and led to high staff turnover. According to Jatoi, further accountability measures were required for both good and bad performance. He added that Human resource issues remained a key obstacle, including the ability to fill vacancies with motivated, well-performing staff- both in government and with partners. He added that highest-quality surveillance was critically important as fewer polio cases were reported. Jatoi suggested that surveillance would be able to detect and quickly investigate each weakness case to be sure that zero meant zero. The chief minister directed the Principal Secretary to call a meeting of provincial task force on July 2, 2018 to further develop the polio eradication strategy. The epidemiological situation in Karachi has improved and virus from environmental site has been restricted to only Gadap. Even though the campaign quality has improved, eradication levels are still not consistently achieved due to high number of missed children due to refusals. After the outbreak in lower Sindh (Badin, Thatta, Sujawal) between September -December 2016, these districts received significant inputs (human resources, monitoring, supervision, accountability) with a subsequent improvement in performance quality. This improvement has been sustained. In Northern Sindh, all polio eradication activities are well managed by DPCRs under joint leadership of DC/DHO. Routine immunization in Sindh remains weak and still leaves too many young children without immunity against polio. Large efforts have been made together with the EPI program to improve the situation. Currently, a large- scale measles campaign is being jointly conducted in Karachi (and later also in other districts of Sindh) by EOC and EPI. Published in Daily Times, June 12th 2018.