Polio Eradication: the final challenge Finding the people While strong political engagement and substantial financial and in-kind resources are essen- tial to the success of the polio initiative, they are not sufficient. These two elements have had to be complemented with sufficient people to implement the eradication strategies in every corner of the world. Although high-income and higher-middle-income countries could usu ally rely on strong health services to implement the eradication strategies, a massive gap in the critical area of human resources for health, particularly in low-income and lower-mid dle-income countries with the greatest polio burden, threatened the success of the entire global effort. The number, mix and distribution of people required to eliminate polio from countries dif- fered, depending on the strategy. The most labour-intensive strategies were the massive, time limited, supplementary immunization activities such as NIDs and"mop-up" can s The most skill-intensive strategy was that involving continuous disease surveillance and labora tory activities. In general, the very different human resource requirements of the two types of strategy were met through different approaches The number of people required to implement NIDs is tremendous. As noted above, an esti- mated 10 million volunteers and health workers immunized 575 million children during such polio eradication activities in 2001. Two key aspects of NIDs were critical to resolving the gap between existing, trained vaccinators in a country and the number needed for NIDs First, because NIDs only require administering 2 OPV drops to a child and then recording the number immunized, with 1-2 hours of training community volunteers could safely de liver the service. Second, the time-limited nature of Nids meant that volunteers were willing to participate and that other government ministries, nongovernmental organizations and private sector partners could bear the opportunity costs incurred by having their staff par ticipate. Consequently, the major challenge for national and subnational health authorities and the polio partnership became the mobilization, training, equipping and management of these human resources. Given the scale of this mass mobilization a substantial effort was made to include other interventions in nids where feasible and safe it has been estimated that the inclusion of vitamin A supplementation in polio NIDs averted 1. 25 million child hood deaths (9) The high-quality surveillance required for guiding supplementary immunization activities and monitoring their impact called for a different human resources response. Far fewer pe ple were required than for NIDs, but with a much higher level of skills to identify, notify, Box 4.3 A public-private partnership for polio eradication Rotary International is one of the four spearheading partners of the tary International has provided financial support to polio eradi- Global Polio Eradication Initiative, having endorsed the concept of a cation on an unprecedented scale. By 2005, Rotary's direct financing global effort even before the World Health Assembly resolution of 1988. will have reached over USS 500 million since 1988, 20% of the total In 1985, Rotary pledged its commitment to the international health goal external financing for the entire initiative. In addition, Rotary has been of a" polio-free world"by the time of its centenary in 2005. at the centre of the multi-agency advocacy effort that has mobilized In endemic areas, Rotarians- from more than 160 countries- USS 2.4 million in further external funding from donor governments, have volunteered their time to help ministries of health with every as. foundations, development banks and the private sector. pect of the programme, including polio vaccine delivery, health worker Rotary International has campaigned with key political leaders of transport, provision of critical equipment, and community mobilization. both endemic and polio-free countries to ensure their active participa In polio-free countries, Rotarians have continuously raised the profile tion in the programme. This regular, high-level advocacy by a private and importance of polio eradication through advocacy and public infor- sector partner has kept polio eradication high on the global agenda, mation campaigns despite many competing prioritiesPolio Eradication: the final challenge 65 Finding the people While strong political engagement and substantial financial and in-kind resources are essen￾tial to the success of the polio initiative, they are not sufficient. These two elements have had to be complemented with sufficient people to implement the eradication strategies in every corner of the world. Although high-income and higher-middle-income countries could usu￾ally rely on strong health services to implement the eradication strategies, a massive gap in the critical area of human resources for health, particularly in low-income and lower-mid￾dle-income countries with the greatest polio burden, threatened the success of the entire global effort. The number, mix and distribution of people required to eliminate polio from countries dif￾fered, depending on the strategy. The most labour-intensive strategies were the massive, time￾limited, supplementary immunization activities such as NIDs and “mop-up” campaigns. The most skill-intensive strategy was that involving continuous disease surveillance and labora￾tory activities. In general, the very different human resource requirements of the two types of strategy were met through different approaches. The number of people required to implement NIDs is tremendous. As noted above, an esti￾mated 10 million volunteers and health workers immunized 575 million children during such polio eradication activities in 2001. Two key aspects of NIDs were critical to resolving the gap between existing, trained vaccinators in a country and the number needed for NIDs. First, because NIDs only require administering 2 OPV drops to a child and then recording the number immunized, with 1–2 hours of training community volunteers could safely de￾liver the service. Second, the time-limited nature of NIDs meant that volunteers were willing to participate and that other government ministries, nongovernmental organizations and private sector partners could bear the opportunity costs incurred by having their staff par￾ticipate. Consequently, the major challenge for national and subnational health authorities and the polio partnership became the mobilization, training, equipping and management of these human resources. Given the scale of this mass mobilization, a substantial effort was made to include other interventions in NIDs where feasible and safe: it has been estimated that the inclusion of vitamin A supplementation in polio NIDs averted 1.25 million child￾hood deaths (9). The high-quality surveillance required for guiding supplementary immunization activities and monitoring their impact called for a different human resources response. Far fewer peo￾ple were required than for NIDs, but with a much higher level of skills to identify, notify, Box 4.3 A public–private partnership for polio eradication Rotary International is one of the four spearheading partners of the Global Polio Eradication Initiative, having endorsed the concept of a global effort even before the World Health Assembly resolution of 1988. In 1985, Rotary pledged its commitment to the international health goal of a “polio-free world” by the time of its centenary in 2005. In endemic areas, Rotarians – from more than 160 countries – have volunteered their time to help ministries of health with every as￾pect of the programme, including polio vaccine delivery, health worker transport, provision of critical equipment, and community mobilization. In polio-free countries, Rotarians have continuously raised the profile and importance of polio eradication through advocacy and public infor￾mation campaigns. Rotary International has provided financial support to polio eradi￾cation on an unprecedented scale. By 2005, Rotary’s direct financing will have reached over US$ 500 million since 1988, 20% of the total external financing for the entire initiative. In addition, Rotary has been at the centre of the multi-agency advocacy effort that has mobilized US$ 2.4 million in further external funding from donor governments, foundations, development banks and the private sector. Rotary International has campaigned with key political leaders of both endemic and polio-free countries to ensure their active participa￾tion in the programme. This regular, high-level advocacy by a private sector partner has kept polio eradication high on the global agenda, despite many competing priorities