Why is Personal Protective Equipment necessary for a vaccinator? What are the Standard Operating Procedures for conducting an immunisation session? What message should be given out to the caregiver who brings the child for vaccination?

Dr Nauman Ahmed Khan, Technical Officer WHO, was patiently responding to the volley of questions during a training session on Infection Prevention and Control (IPC) amid COVID-19; a timely exercise carried out for civil society organisations working on immunisation and child health.

Conducted via Zoom, the ‘new normal’ during the pandemic, the use of technology made it possible for more than two dozen civil society organisations from far-flung and remote areas to virtually participate.

Dr Khan explained how CSOs can support the government in maintaining the continuity of immunisation services under safe conditions to avoid potential outbreaks of vaccine preventable diseases amongst children.

As a result of the ongoing pandemic, Pakistan has faced disruption in essential immunisation services. The situation entails that a significant proportion of children may be left unvaccinated, which would not only drop immunisation coverage, but lead to extensive outbreaks of diseases with high morbidity and mortality like polio, measles and diphtheria.

According to the UNICEF website, two-thirds of children in Pakistan missed routine immunisation in April 2020 as compared to January, increasing the risk of vaccine-preventable disease outbreaks, which could lead to an increase in child mortality. Almost 40 million children under the age of five children missed out on their polio immunisation as the nationwide April campaign had to be postponed.

The training also gave CSO representatives an opportunity to vent their feelings. CSOs do not have, or ensure continuous funding but they are expected to deliver and demonstrate charity services on an uninterrupted basis.

Many CSOs are entrusted and tasked for distributing cash and essential food items to the daily laborers, poor and needy affected by the lockdown. However, it is felt that the potential of CSOs is largely underutilized. Their role is far more than just ration distribution.

Earlier, the federal government had rejected registration applications of many civil society organisations as Pakistan, under strict scrutiny tightened control over the inflow of foreign funding.

The news that local non-government and civil society organisations were exempted from signing of a Memorandum of Understanding (MOU) with Economic Affairs Division (EAD) in efforts to fight against COVID-19 came as a breath of fresh air.

Civil society organisations have a long history of involvement in public health and community mobilisation. Their work in increasing access to healthcare is often targeted for people that, for geographical socioeconomic or cultural reasons are the hardest to reach, or in areas with less than optimal government infrastructure.

Working in vulnerable settings such as with Internally Displaced Persons in refugee camps, urban slums, mobile populations and immigrant communities, their role and commitment becomes more evident in times of calamities and natural disasters.

In Pakistan, whenever a catastrophe hits the country, civil society organisations are the first to respond and divert their attention, time, human and financial resources towards it.

The current COVID-19 situation was no different.

Right from day one, CSOs have offered support in whatever way possible, irrespective of the availability of funds by the donors. They mobilised their own resources through individual philanthropist or diverted them from ongoing interventions.

On one end, they are providing community health workers with Personal Protective Equipment (PPE) to enable them to do their work safely and on the other, addressing personal fears and apprehensions of the community through psych-social counselling. Whether distribution of masks, gloves and sanitisers to medical teams and community workers or installing hand washing facilities, CSOs are always eager to support.

In the current scenario, with the already stretched health system, CSOs play a vital role to support the government sustain immunisation and ensure rapid recovery through catch-up immunisation and system strengthening.

They have the capacity to work in areas of both demand and supply for immunisation and not just ration distribution, especially in the coming months of the post-COVID phase.

Responding effectively to COVID-19 will require new ways of working, innovation and the support of a diverse range of actors. Civil society organisations, in particular, can play a vital role in engaging communities to rebuild trust and demand, delivering services where there are gaps in government provision and overcoming gender-related barriers.

In a country like Pakistan, with a high number of remote communities and an unstable security situation in many parts, partnership between the public sector and the civil society organisations is vital for effective health service delivery.

Increased cooperation and coordination of efforts between the government and civil society means a greater number of children will have access to immunisation and other child healthcare services, contributing to achieving the SDGs, particularly Goal 3.

Despite the strengths and benefits that CSOs can and do bring to increasing immunisation coverage, child health and other related health services, there have been gaps in coordination.

Active engagement with CSOs can help achieve optimum results, inducing ownership and sustainability of programmes run by governments. Importantly, they can help reach the unreached.

Huma Khawar

The writer is a freelance journalist.