Assessment of Health-Seeking Behavior in Pakistan 

Bill and Melinda Gates Foundation (BMGF)

Project Summary

Background

Pakistan is one of the two remaining countries with endemic wild poliovirus. Analysis of polio cases reveals a marked disparity in who is affected by polio in Pakistan: while comprising approximately 18% of the population, Pashtuns have accounted for approximately 80% of polio cases since 2010. Community resistance to the polio program, including vaccination refusal during anti-polio mass vaccination campaigns, has significantly contributed to low polio vaccination coverage rates, allowing ongoing poliovirus transmission in Pashtun communities. 

Project Introduction

In the aforementioned background and partnership with Bill & Melinda Gates Foundation (BMGF), the Center for Research and Security Studies (CRSS) launched a research initiative – that ran through March 2022 to April 2022 – to establish a baseline and analyze factors as to why certain communities particularly Pashtun communities resist mass vaccination programs. Through Hujra meetings and Key Informant Interviews with Pashtun stakeholders in high polio transmission zones (HPTZs) across Pakistan, the project assessed the health-seeking behavior of these communities.

Objective

The study aimed to devise recommendations on how to better engage with these communities to overcome the refusal challenges and address other environmental and administrative issues that contribute to the spread of the poliovirus.

Impact 

35 field researchers conducted a total of 159 hujra (Focus Group Discussion) meetings in the 17 Union Councils assigned to them in the KP, Sindh and Balochistan province. This included Key Informant Interviews (KIIs), discussions with locals, and brief interviews with non-KII participants and were achieved through the following milestones:

• In-depth analysis of Pashtun demographics – e.g., population sizes across geographies/administrative boundaries, age distributions, household characteristics, birth rates, etc.

• Detailed landscaping/mapping of tribal structures within Khyber Pakhtunkhwa (KP) province, linkages with Pashtun population centers outside KP,

• Assessment of health-seeking behavior, including health-seeking behavior for essential immunizations, and other factors,

• Analysis of reasons for resistance/refusal to polio vaccine and evaluation of polio program approaches to Pashtun communities.

The findings include detailed information, primarily focusing on health seeking facilities and health seeking behavior, local community’s perception regarding immunization and significant conclusions derived from the specific UC.