Anyone who witnesses a polio vaccination campaign in Pakistan will notice something remarkable: in most areas, the majority of health workers moving house to house to vaccinate children against this highly infectious paralytic disease are women.
But despite their outsize role in providing life-saving vaccinations and other essential services to children in every corner of the country, these frontline workers are rarely consulted on matters of health policy. This year, as Pakistan strives to eradicate wild polio once and for all, input and feedback from the women leading these efforts on the ground must be incorporated into the program’s design. There is no hope of success otherwise.
Today, wild polio – a scourge that once caused irreversible paralysis, or even death, all around the world – remains endemic in just two countries: Afghanistan and Pakistan. Vaccination is the key to stopping this virus once and for all, and in Pakistan, the success of vaccination campaigns largely depends on female health workers. In many communities, women can enter homes where men cannot and, as a result, are able to build lasting trust with families.
Decades of progress, reflecting the work of thousands, have brought us closer to success than ever before: wild polio cases in Pakistan are at an extreme low, endemic transmission is now geographically restricted to just seven districts, and ten of the 11 strains of virus circulating in 2020 have been wiped out.
A polio-free Pakistan is within our grasp, and the women on the frontlines will help to carry us over the finish line. Recognising this reality, the country’s polio eradication program launched an unprecedented initiative to listen to underrepresented female health workers and engage them as co-partners in designing solutions to end polio in Pakistan.
The first step was to gather data at scale by surveying a representative sample of more than 2,600 women working in the highest-risk districts. They answered questions about their experiences and challenges in the field, including the barriers to reaching children during campaigns and administering vaccines in homes, as well as their motivations and safety concerns.
Based on the survey results, 14 in-person workshops were held across the country, bringing together hundreds of female frontline workers in dedicated listening sessions. In addition to swapping stories and experiences, attendees suggested solutions for the biggest hurdles to ending polio in their districts and shared their hopes for future livelihoods beyond polio. The leadership at Pakistan’s National Emergency Operations Centre (NEOC) – the heart of the country’s polio program – promised to review and act on the valuable feedback gathered from these structured listening sessions.
I was lucky enough to attend one of the workshops, and the sense of excitement was palpable. Knowledgeable women, whose extremely valuable work has been underappreciated for too long, finally had the floor and were eager to help design a more effective program that better reflects the reality they face every day.
The importance of such an exercise was evident from their creative ideas for addressing practical challenges like having to choose between walking for hours or hiring private transport during rush hour in order to get to work on time. They also brainstormed about how to overcome parents’ refusal of the polio vaccine, owing to misconceptions about how best to protect their children, and disrespect for polio workers in many communities.
This co-design initiative is just one example of the Pakistani government’s revitalised commitment to engage women more deeply in public-health efforts. The NEOC, for example, established its own National Gender Group, tasked with giving a voice to the women who are essential to eradication efforts – starting with initiatives like this one.
Pakistan’s government was the first in the Global Polio Eradication Initiative to launch such a program, and I am encouraged to see that we are not alone. With similar efforts to listen to and learn from female health workers now underway in Somalia, Nigeria, and other countries, a global movement is taking shape. In many places, it is the first time that women have a seat at the policymaking table.
As the world faces a historic convergence of crises, from climate change to pandemics and persistent conflict, women’s policy input is indispensable – and not just to improving health care. After years spent engaging with local communities in order to battle outbreaks and provide essential services, these frontline workers will play a crucial role in designing solutions far beyond the eradication of polio.
Here in Pakistan, our polio program’s National Gender Group has much work to do. Female health workers across the country have proposed hundreds of solutions to address the key challenges they face, and the program is now reviewing and refining them, and deciding which will be implemented later this year.
Thousands of women have raised their voices, and we owe it to them to act. At the workshop, I understood that the future of Pakistan rests in their hands. Following their lead in fine-tuning Pakistan’s polio eradication effort is the key to ending this disabling and life-threatening disease.
Atiya Aabroo is deputy director of Pakistan’s national health services ministry, and a core member of the national gender group within the national emergency operations centre.
© Project Syndicate 1995–2023
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