The recent series of fatal attacks on teachers and public health workers associated with vaccination programmes in Pakistan (Jan 5, p 1) have been utterly devastating. These killings have shattered the lives of the families of those who died serving their communities with basic health services. They will also undermine the effectiveness of vital public health interventions through disrupted delivery, reduced confidence, and a demoralised workforce.
Yet although these events have placed the spotlight on Pakistan, and the new form of aggressive propaganda against “western” public health initiatives, they are indicative of a global problem, particularly in places with armed conflicts, which requires a global response.
First, we must insist on zero tolerance of violence against health workers, and multilateral agencies such as WHO should champion the cause. Although WHO has identified the importance of protecting health facilities in conflict zones, any strategy or recommendations on protecting public health workers against militant attacks is hard to find.
Second, donor agencies should continue to insist on reasonable protection for health workers, including programmes to prevent violence. Commissioners and managers of health services should be required to include the protection of health workers in their responsibility for delivering public health services. Health workers, by their very nature, will often want to take risks to provide services to the poor. Although we have no wish to stifle this altruistic spirit, to expose health workers to risks that could be mitigated could be seen as criminal, or at least immoral.
Third, further research is needed into effective actions to prevent violence against health workers, especially in resource-poor settings. In the otherwise excellent World report on violence and health, health workers are seen as part of the response to violence and their own need to be protected is not adequately addressed.