India has closed out the first polio-free year in the country’s history. As noted by the World Health Organization (WHO), this marks significant progress for a country that as recently as 1994 was experiencing as many as 4,791 cases a year. The polio-free year means that India will no longer be considered a “polio-endemic” country, leaving its South Asian neighbors, Pakistan and Afghanistan, as well as Nigeria, as the only remaining nations holding this label.
Given the public health challenges that India faces, this is a staggering achievement. With a population of about 1.18 billion, 42 percent of whom live on less than $1.25 day, India suffers from developmental challenges that make fighting health issues such as polio particularly challenging. India also has one of the lowest physician ratios in the world.
Perhaps most challenging of all is that 69 percent of the population by some estimates suffers from unimproved sanitation. Additionally, 43.5 percent of children under the age of 5 are malnourished, the most important age bracket for fighting polio. This is the age when the vaccine is most effective, and is an area in which India has achieved notable success. The lessons learned for fighting large scale public health issues shouldn’t be overlooked by either Indian health officials or, perhaps more importantly, India’s neighbors.
Indeed, the rest of South Asia could learn a great deal from India’s fight, particularly Pakistan. India’s neighbor to the west suffers from similar developmental shortcomings and, according to the Global Polio Eradication Initiative, experienced 198 cases of polio in 2011. Pakistan accounts for roughly 30 percent of polio cases worldwide.
The lessons learned by India in its fight against polio are more significant than just as a model for how to fight public health issues in developing nations, though. India’s fight is also a model for how NGO’s and international donor support can be best utilized by developing nations. The key to India’s success in the fight was to take ownership of the problem and the solution, allowing for locals to learn from the expertise of the international community while not becoming dependent.
As a recent Center for Strategic and International Studies report suggests, Indian efforts created local expertise and the logistical skills to execute the widespread education and inoculation efforts that were necessary. The Indian ownership of the effort has been so important because the primary obstacles to polio eradication are social and cultural resistance to vaccination, a problem faced by many other development endeavors.
At the local level, there’s no substitute for a member of the community being the face of any development effort, regardless of the good intentions of visiting NGOs. Community volunteers can better address and minimize resistance with educational efforts tailored to disabuse the population of its fears regarding vaccination. In addition to enabling a local to address local problems, taking possession of the problem allowed India to develop first class institutions.
The most important of these institutions is the National Polio Surveillance Project (NPSP). As the backbone of the polio efforts in India, the NPSP is an organization staffed almost entirely by Indians that operate a network of surveillance medical offices and WHO accredited laboratories for testing. Along with the Indian Ministry of Health, the NPSP has largely been responsible for designing and coordinating the activities of multiple local and international participants in the WHO Polio Eradication Initiative.
The Indian institutions, such as the NPSP, have created valuable institutional knowledge, which can’t be transferred from NGOs or donor nations as it’s something only earned through experience. The experience gained from addressing wide spread public health issues during the polio fight is invaluable, and will likely prove a boon to India in the future as it confronts similar challenges, from HIV/AIDS to tuberculosis and malaria.
The lessons for the rest of South Asia and the developing world are clear: while NGOs and international aid have been keys to India’s fight – especially the Bill and Melinda Gates Foundation and the Rotary Club – success was achieved primarily because India took ownership of the problem and the solution. Not only has India been better able to address the local problems, but they have also built an infrastructure and developed institutional knowledge that has great value to the nation going forward.
William Thomson is a research assistant at the U.S. Naval War College and an International Relations ALM candidate at Harvard University. His writings have appeared in Small Wars Journal as well as e-IR.