Deepening our understanding of community response to mass health interventions

"Deepening our understanding of community response to mass health interventions." Pathogens and Global Health, 108(3), pp. 125–126

Notes

1 The grounded theory on which this research is based is derived mainly on a construction of refusal taken from focus group discussions and survey work with Lady Health Workers (LHW). LHWs are, nominally at least, responsible for delivering the polio programme at community level in Pakistan. Clearly, allowing LHWs to arbitrate what constitutes refusal carries with it moral hazard — since a higher estimation of demand-side refusal may cover up supply-side failures, including those of the LHW herself. Moreover, the less reasonable or rational the reasons for refusal, the more compelling the narrative of obstructive household ignorance. That the study recognizes this issue is commendable. That it does not do much to correct for such a potential skew on how refusal is constituted in the research is less so.

2 In 2013, Pakistan as a whole saw a drop in refusals of 50% year on year, resulting in a national rate of 0.19% of eligible households children — a situation in which refusal is now seen as a lesser strategic priority compared with security and physical access, in particular in KP/FATA.