Poverty and social impact analysis of expanded programme on immunization in Pakistan

International statistics on childhood health indicators reveal how Pakistan lags behind its future pursuit of a globally competitive labour. These figures become even more disappointing when one observes that Pakistan is amongst the only three countries in the world which has been unable to combat polio despite over 30 years of the Expanded Program on Immunization (EPI) operation.

This study makes two important contributions towards existing literature on health policy assessment and the Expanded Program on Immunization in Pakistan. It has carried out for the first time an impact assessment of the EPI since 1978 by adopting a Poverty and Social Impact Analysis (PSIA) methodology, this paper carries out for the first time, an impact assessment analysis of the national EPI by focusing on its contributions towards Pakistan’s social economy.

The overall finding is that a total of 0.15 million incremental workers have been able to join the labour force due to EPI activities post-1978. At the federal level, the tasks poorly addressed include: long-range policy planning for national health goals/indicators and targets; human resource planning in health sector, ensuring minimum service delivery standards; timely releases of federal funding; variance between allocations, releases and expenditures; ambiguous procurement procedures; bridging caveats, which restrict funds flow to the provinces and hinder the planning and implementation of activities as directed by Council of Common Interest (CCI); and communication channels between national and sub-national units.

The economic analysis reveals that the total number of incremental lives saved as a consequence of EPI activities is around 0.3 million out of which 0.19 million is in rural areas. Furthermore, our conservative estimate reveals that the incremental lives saved under EPI contributed Rs 11,358 million (in 1993-94 prices) towards overall gross domestic product. This growth contribution and related factors led to 8 percentage point decline in poverty headcount on average over the decade of 2000s. The Gini coefficient a measure of inequality also remained lower by 5 percentage points on average during 2000s due to EPI activities. The report argues several policy and practice level reforms for EPI in Pakistan.