Typhoid fever is a life-threatening infection caused by the bacterium Salmonella Typhi. It is usually spread through contaminated food or water. Once Salmonella Typhi bacteria are ingested, they multiply and spread into the bloodstream.
Urbanization and climate change have the potential to increase the global burden of typhoid. In addition, increasing resistance to antibiotic treatment is making it easier for typhoid to spread in communities that lack access to safe drinking water or adequate sanitation.
Pakistan being an underdeveloped country faces burden of Typhoid cases annually.Irrational use of antibiotics led to alarming increase in the number of drug-resistant (XDR) Typhoid cases especially in two cities of Sindh,Karachi and Hyderabad.Therefore Sindh Health Department decided to launch a Typhoid Conjugate Vaccine)TCV) campaign in these two cities.The decision was taken by Sindh Health Minister,Dr Azra Afzal Pechuho at the meeting of provincial task force.A campaign was conducted that kicked start on May 13,2024 and continued for 12 days till 25 May,2024.The aim of campaign was to cover 9.8 million children between the ages of 9 months to 15 years with TCV
.However, the campaign was marred by corruption, embezzlement, and irregularities.The corruption and embezzlement have serious implications for public health, particularly for children. Typhoid is a major public health challenge in Pakistan, with over 5,000 cases reported in Karachi and Hyderabad last year. The World Health Organization (WHO) estimates that 110,000 people die of typhoid worldwide each year.The vaccination campaign was intended to curb the spread of drug-resistant Typhoid, but it was compromised by the very officials entrusted with its implementation. The campaign’s effectiveness was further hindered by misinformation, distrust, and reluctance among parents to vaccinate their children. Incompetent personnel were hired, exacerbating vaccine hesitancy.
Massive corruption has been found in the anti-typhoid campaign in Sindh in an investigation which revealed that a list of 227 supervisors submitted to the Expanded Programme on Immunization (EPI) from District Central Karachi was largely fabricated.
A total of Rs.38.88 million fund was allocated for the transportation expenses of these supervisors. However, a report disclosed that only 11 of the listed individuals were legitimate supervisors involved in the campaign. The remaining 216 names were unrelated to the effort.
Following this revelation, EPI officials halted the payments.
A probe conducted by Health Minister Dr. Azra Fazal Pechuho also confirmed that 216 out of the 227 listed supervisors were not active in the field.
Similar type of corruption has surfaced in District Keamari of Karachi where embezzlement and nepotism damaged the campaign.Recently a web of corruption in the typhoid vaccination campaign in Karachi’s District Kemari has been uncovered. According to sources, health department officials including Dr. Arif ur Rehman,DHO(The then District Health Officer,Keamri Distruct),Arif Mirani,DSV(District Surveillance Vaccinator) and other employees of Health department Asif Khan, Farina, and Ahsan Abbas, exploited their positions to embezzle funds meant for the campaign. They allegedly registered private individuals and family members as first-level supervisors transferring payments to their own accounts, despite the absence of these “supervisors” in the field.These ghost team members who never visited the field are sister.Only 20% of teams shown in the Microplan actually worked in the field, according to sources from the health department.
This scheme wasn’t isolated to one area; multiple towns in District Kemari were affected, with payments made to individuals with no connection to the health department. The vaccination campaign was intended to curb the spread of drug-resistant Typhoid, but it was compromised by the very officials entrusted with its implementation.
The World Health Organization’s funding for the typhoid vaccination campaign was compromised, putting the integrity of public health initiatives at risk. Strict action is necessary to hold accountable those responsible and recover the misappropriated funds.A high-level inquiry into this matter, free from influence of those alleged is imperative. Donor agencies like WHO and UNICEF must intervene to ensure transparency. Government officials must be sensitized to focus on this critical issue, which pertains to health, lives, and the country’s reputation.
To ensure transparency, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) can take several steps. They can make information about their programs and operations publicly available, including financial data, program results, and organizational policies. Regular external evaluations can be conducted to assess program effectiveness and identify areas for improvement. WHO and UNICEF can also foster open communication with stakeholders, including governments, partners, and beneficiaries, and establish online platforms to provide real-time information on program progress and finances. Additionally, they can protect whistleblowers and ensure accountability through clear policies. By providing training and capacity-building programs for staff and partners, WHO and UNICEF can promote a culture of transparency and accountability. Furthermore, they can leverage technology, such as data analytics and visualization tools, to enhance transparency and collaborate with other organizations to promote best practices. Finally, engaging with local communities and ensuring that their needs are addressed and their voices are heard can help build trust and credibility. By implementing these measures, WHO and UNICEF can demonstrate their commitment to transparency and accountability, ultimately enhancing the effectiveness of their initiatives.
The Sindh Health Minister must take immediate action to address the corruption and embezzlement, and ensure that those responsible are held accountable.To prevent embezzlement and nepotism in public health initiatives, the government and officials must take stringent measures. Firstly, transparent hiring practices should be implemented, ensuring that only qualified and experienced personnel are recruited for campaigns. Secondly, robust monitoring and evaluation systems should be put in place to track campaign finances and personnel performance. Thirdly, whistleblower protection policies should be established to encourage reporting of corrupt practices. Fourthly, regular audits and investigations should be conducted to identify and address discrepancies. Fifthly, officials found guilty of embezzlement or nepotism should face severe penalties, including termination and prosecution. Sixthly, training programs should be introduced to educate officials on ethical practices and the consequences of corruption. Lastly, community engagement and awareness campaigns should be launched to promote transparency and accountability, encouraging citizens to report suspicious activities. By implementing these measures, the government can prevent corruption, ensure accountability, and protect public health initiatives from embezzlement and nepotism.
The people of Pakistan and people of Sindh deserve better. They deserve a healthcare system that is transparent, accountable, and effective. The corruption and embezzlement that marred the typhoid vaccination campaign in Karachi and Hyderabad must be investigated, and those responsible must be brought to justice.
