The International Development Association (IDA) will provide $21.35 million for "Supplementary Second Partnership for Polio Eradication" to assist the Government of Pakistan in eradicating poliomyelitis from the country.
According to official sources, Pakistan's Polio Eradication Initiative is part of the World Health Organisation (WHO) led, multi-country effort to a global public good ie eradication of polio from the world.
In a project study report, Inaam ul Haq, Senior Health Specialist of the World Bank said that the objective is to support procurement and supply of Oral Polio Vaccine (OPV), needed during 2007, for Supplemental Immunisation Activities (SIAs) for immunising all children up to five years of age.
The proposed additional financing would contribute to the initial project objectives by financing the procurement of additional OPV required for additional SIAs in August- December 2007, he added. Inaam ul Haq, Senior Health Specialist mentioned that the proposed additional financing as the parent project will have one component, ie, procurement and supply of OPV to immunise all children up to five years of age as part of SIAs.
IDA support will ensure timely procurement and supply of the needed quantities of OPV during second half of 2007 through UNICEF, as in the parent project. He said that the on-going IDA supported Polio Eradication Initiative (PEI) has three components: (i) the procurement of OPV; (ii) supplemental operations including cold chain, social mobilisation and training; and (iii) surveillance.
All the elements of an effective program are working satisfactorily in Pakistan including quality surveillance; logistics for procurement, distribution and administration of quality OPV; micro-planning etc. The project supervision missions in February 2007 rated the development objective and the implementation progress satisfactory, he added.
He pointed out that Pakistan's polio initiative is guided by TAG, a group comprised of global and national polio experts. Based on review of the surveillance data and available epidemiological evidence indicates that virus transmission has been further restricted to four geographical zones in Pakistan and the probability of eradication remains reasonable.
The program in consultation with TAG has modified its strategy with a focus on ensuring maintaining good quality SIAs, increasing the number of sub national and case response campaigns, enhancing coordination with Afghanistan, and increasing the use of type specific monovalent vaccine for specific rounds. The increased number of rounds has increased requirements for OPV, placing additional financial burden on the program, he added.
Inaam ul Haq, disclosed that the program's additional OPV requirement for August -December 2007 is 140 million doses, at a total cost of $21.35 million equivalent. The proposed project will finance $21.35 million equivalent for procurement of OPV. The additional financing will be executed by May 15, 2007 and closed on June 30, 2008 as envisaged in the original project.
Pakistan has made steady progress in health, nutrition, and population (HNP) sector during 1990's but rate of progress has remained slow and HNP indicators lag those of its neighbours eg Pakistan's total fertility rate, at 4.5, is 50 percent higher than India's and Bangladesh's. Hence, Pakistan faces significant challenge to achieve the health related Millennium Development Goals.
Poor health outcomes and high fertility will remain an obstacle to its economic growth and, contribute significantly to high levels of poverty. Pakistan also faces a real threat from AIDS. Recent surveillance findings indicate that the country is facing a concentrated epidemic among injecting drug users (IDUs) with HIV prevalence rates ranging between 3 to 27 percent within this vulnerable group among major cities across the country.
The health outcomes are a reflection of inadequate resources and weak management of public health services. Public expenditure on health constitutes about 0.6 percent of GDP, which is among the lowest in the world.
Pakistan has seen recent improvements in intermediate health outcomes with increasing immunisation coverage (77 percent) and antenatal care attendance (50 percent). There is considerable scope for improvement that can be achieved through organisational and management innovations to improve in the delivery of publicly funded health services.
Pakistan has made good progress towards Polio eradication through sustained and intensified efforts. As a result, the numbers of confirmed Polio cases decreased from 324 in 1999 to 104 in 2003 and to only 28 in 2005. Despite effective implementation of supplementary immunisation activities (SIAs) with high coverage of the targeted population in 2006, the number of Polio cases increased from 28 in 2005 to 40 in 2006.
There is epidemiological evidence that virus transmission has been further restricted and the probability of eradication remains reasonable, but transmission of the virus continues in four geographical zones in Pakistan and neighbouring Afghanistan.
Supplemental Immunisation Activities need to be further intensified by increasing the number of sub national and case response campaigns, enhancing coordination with Afghanistan, and increasing the use of type specific monovalent vaccine for specific rounds.
The increased numbers of rounds have increased requirements for OPV, placing additional financial burden on the program. Given the limited resources and other competing priorities, the Government of Pakistan (GOP) requested the Bank for additional financing for the procurement of OPV.
IDA will finance the procurement of OPV through a normal credit that will be reduced to a grant through the innovative financing mechanism - "IDA Buy Down", as used in the parent project.
The IDA buy-down mechanism converts a normal IDA Credit to grant terms through provision of additional external donor resources under clearly defined performance criteria. The resources for the buy-down are being made available as a result of an agreement between IDA and the United Nations Foundation with funding from the Center for Disease Control.
The partners will provide funds to an IDA-administered trust fund (the Polio Eradication Trust Fund) to buy down the debt incurred for successful implementation of the project.
In addition, the fund will make commitment and service charge payments to IDA on behalf of the recipients during project implementation, and upon successful project implementation, buy down the net present value of the principal amount of the credit. The first Partnership for Polio Eradication project was successfully converted to grant through triggering of IDA buy down mechanism based on results of performance audit.