Since the commencement of house-to-house NIDs in our country and particularly in FATA, the incidence of OPV refusal cases has been increased campaign-to-campaign. The WHO has recruited several CCSPs, DHCSOs and prominent religious leaders in Mohmand Agency, but the chronic problem of refusal cases in Polio NIDs has not been resolved yet.
Ø The major purpose of this paper is to conduct a social and scientific research to find out the ways and means of detection and resolving the OPV refusal cases at UC and District level in Mohmand Agency as well as all over the country and especially in FATA.
Ø To make sure the 100% vaccination target of OPV.
Ø Maximum decrease in OPV refusal cases.
Ø To eradicate Polio before 2012.
Ø To socially mobilize the innocent Tribal Community about the OPV and routine EPI Program.
Ø To establish a Research and Analysis Wing for social research of EPI Program at District Level.
During Polio NIDs the following types of OPV refusal cases has been observed.
6. ILL Child.
7. NO reason.
Each of the above-mentioned types of refusal cases has been explained as given below in detail.
1. Religious Refusal Cases:
Due to lack of sufficient formal and religious education the illiterate Tribal parents hesitate to vaccinate their <5 years of children against Polio. They wish to consult the Pesh-Imam (Community Religious Leader) either to vaccinate their children or not.
On the other side the religious leader knows nothing about the OPV, that’s why he advises his innocent and illiterate followers to refuse to vaccinate their children against Polio (OPV).
Ø The WHO Surveillance Officers/DSOs at each District / Agency level in FATA should register all the Pesh-Imans / Religious Leaders in their respective District/Agency.
Ø The SOs / DSOs should communicate / consult the Pesh-Imans (Community Religious Leaders) at their door steps, there must be workshops at UC level to educate the Pesh-Imams about the OPV/AFP and Polio eradication Program.
Ø Booklets or published material about the AFP disease and surveillance in Pashto Language must be provided to the religious leaders at UC level all over the Mohmand Agency.
2. Demand Based Refusal Cases:
a. As we know that all the citizens of a country have some expectations from their governments. FATA is the most backward area of Pakistan. Some Tribal refused their children against Polio and demanded for Primary Schools, Water Supply Schemes, and Jobs etc.
b. Demand based refusal due to social injustice:
The public refuses to OPV, because the government (Local Agency Political Administration) committed an injustice and social inequality to a family or tribe, and consequently the family or tribe to vaccinate their children against Polio.
i. Arrest of a tribal man by the (Local Agency Political Administration) without any reason.
ii. The tribal also refuses to OPV, when the Political Administration snatch/arrest a vehicle and its tribal driver without committing any violation against the law.
The government of Pakistan should address all the problems faced by the Tribal Community of Mohmand Agency, regarding basic facilities of life, and economic justice as well.
3. Political Refusal Cases:
Different people have different political thoughts about certain political issues in a society. Due to lack of proper education and sufficient medical sense, the illiterate and innocent Tribal of Mohmand Agency thought that the OPV has been produced and sent by the USA to Pakistan. The parents in FATA refused to vaccinate their children against Polio, because the President of USA and his allies are killing the innocent Muslim in Iraq, Afghanistan, Palestine, Pakistan and other parts of the Muslim World, on the other hand they send OPV for the Muslim Children to save them from Polio. This contradiction has created a wrong concept in the minds of Tribal community that there is something wrong behind the OPV.
The Agency Surgeons/DSOs and SOs should communicate and mobilize the tribal community at UC level, that the USA and her allies have not produced the OPV. The people should be informed that the Muslim countries like Malaysia and Indonesia, and Pakistan have produced the OPV. The OPV has also been checked and approved by W.H.O. The USA does not send the OPV to Pakistan.
4. Personal Refusal Cases:
There are two major types of Personal refusal cases i.e. (a) Personal favor and disfavor. (b) Personal knowledge.
a) Personal favor and disfavor refusal cases.
Some people refuse to vaccinate their children due to their personal favor and disfavor. For Example,
Mr. Pazir was a team member of Area Manzari Cheena Mohamand Agency, most of the people of the village Manzari Cheena refused to vaccinate their children by him, because he was not acceptable to the people/parents.
Local neutral and morally sound social workers must be selected in OPV teams. The social workers must have good IPC skills.
b) Personal knowledge refusal cases
The Tribal of Mohmand Agency being illiterate and lack of knowledge about EPI/Routine Immunization & Polio NIDs, refuses to vaccinate their children against Polio.
There must be well established and regular Routine Immunization at EPI Centers all over the FATA. The health education and out reach immunization program must be established at each UC level.
5. Silent Refusal Cases:
Due to lack of Micro Census data about the <5 years of children at UC level in Mohmand Agency as well as all over the FATA, the unwilling parents Hide/conceal their children from the OPV teams at their door steps.
Secondly, the parents do not want to disturb their children from sound sleep for easily available free OPV, when OPV teams knock their door, because such parents have no knowledge about the importance of OPV/Polio disease.
a) Micro Census data must be collected at house-to-house level about the OPV target children at each UC/Area. It will help the OPV teams to know about to exact number of <5 years of children in a house, hence the parents could never hide/conceal the exact number of children.
b) The nearest government health facility should keep the valid record of the new born children in their respective catchments area.
6. ILL Child Refusal cases:
It has been observed in winter that the parents do not vaccinate their children in Polio NIDs in Mohmand Agency because the parents says that their children are ILL due to fever, common cold and diarrhea etc, and the OPV is cold and will increase the severity of the disease.
a) Strong social mobilization at house-to-house level in each Area/UC.
b) The social workers should advise the parents to take their ILL children to the nearest health facility, they also should educate the parents that the OPV has no side to the ILL children.
7. NO Reason Refusal Cases:
Some tribal refuses to OPV without any reason, if they are asked about the possible reason of refuse, there answer is silence or they close the door.
Active social mobilization at house-to-house level in each Area/UC.
Ø Strong effective and regular social mobilization through well established Routine Immunization network at UC level.
Ø The DHT, DSO/SO should take keen interest to convince the refusal cases at UC level prior the upcoming Polio NIDs.
Ø There must be an Active Networking System for AFP Surveillance and a Research & Analysis Wing for social and scientific issues regarding Polio NIDs /AFP cases.