The Missing Carrots and Sticks: Motivation and Accountability in the Polio Eradication Program of Pakistan

Pakistan is one of the three countries left in the world where polio is still exists. Non-eradication of polio from Pakistan is not only a healthcare issue for the country itself but it is considered a threat to global health as the disease can be transmitted to those countries that have already been given a polio free status. Non-eradication of the disease in the context of Pakistan has become a complex issue on account of multiple causes as reported by previous studies. However, the role and performances of polio workers who actually administer the vaccine have generally not been analysed properly. Since polio eradication campaign is a human endeavour, the performance of polio workers cannot be ruled out; this study, therefore, considers poor performance of polio workers, as evident by the unsatisfactory campaign coverage of below than 80% and emergence of polio cases consistently, as one of the very important causes of non-eradication of the disease. The study finds very low level of motivation among polio workers on account of factors such as insufficient and delayed payment, improper security and capacity building issues along with poor accountability due to informal induction mechanism of volunteer polio workers to be adversely affecting the performance of staff. The study therefore recommends formal induction mechanism, better social mobilization and decentralization of financial powers for improvement in motivation and accountability that will enhance the performance of polio workers and will ultimately result in complete eradication of the disease from the country.