By: Mark Leon Goldberg on December 03, 2012 Ed note. This is a special guest post by Dr. Zulfiqar Bhutta, Head, Division of Maternal and Child Health, Aga Khan University Medical Center. It was originally published in The Civil Society Dose: Issue 3; December 2012 and is reprinted here with permission. A year ago, Pakistan was in the news with a significant increase in polio cases – 136 cases documented across a number of affected districts and provinces. Several reasons were cited for this program failure including population displacement due to floods and conflict in the North, poor program management and political support. This year has seen a remarkable reversal with only 48 cases reported to- date in half of the districts affected in 2011. Baluchistan, one of the epicenters of polio in 2011, has had only four cases reported from two districts this year, compared to 64 cases in 11 districts in 2011. These gains are all the more remarkable considering the steady stream of challenges over the last year related to security issues and the devolution of the federal health ministry to the provinces. Political support and stewardship at the highest level have been critical. Much of Pakistan’s progress against polio this year has stemmed from the government’s internal investments and efforts to engage local communities. The President and Prime Minister have spearheaded the development and implementation of a new National Emergency Action Plan that ensures accountability in improving the quality of vaccination campaigns as well as innovative strategies to increase community engagement and ownership, especially among Pashtun populations. Community ownership is crucial to the successful implementation and sustainability of many public health interventions, and the polio program is no exception. The engagement of local community leaders, especially religious scholars, has been critical in reaching at- risk populations. Additionally, the involvement of well-trained and disciplined Pashtun vaccinators has helped decrease vaccine refusal rates. Efforts are underway to engage national and local champions for community mobilization and to involve the large private sector in the final stages of polio eradication. Notwithstanding the above, there are persistent challenges as well as opportunities. Efforts to integrate routine immunisation services with the polio program have been less than optimal, as are the persistent gaps between the —immunisation system and maternal and child health programs. A huge opportunity for immunisation advocacy has arisen as Pakistan became the first country in South Asia to introduce pneumococcal vaccine. A strong civil society movement committed to immunizing children should engage community leaders and youth. Organisations such as the Trust for Vaccines and Immunisations (TVI), Health & Nutrition Development Society (HANDS), Health and Literacy Promotion (HELP) etc. may play a major role therein. Perhaps polio eradication can open the door to accelerating national ownership and investments in Pakistan’s health issues more broadly, including maternal and child health and nutrition.