Strengthening Routine Immunization

Using Polio Assets

By: Maiwand Ahmadzai

IS THE PROBLEM SERIOUS ENOUGH?

48.4

Civilian

Deaths

Military

&

Police

Allies

Insurg

ents

How Serious is the Problem?

50.6

Under 5 Mortality/Day Due to VPD

Alone

War Causalities

(Deaths)/Day

48.4

Civilian

Deaths

Military

&

Police

Allies

Insurg

ents

How Serious is the Problem?

50.6

Under 5 Mortality/Day Due to VPD

Alone

War Causalities

(Deaths)/Day

How Serious is the Problem?

1936/day

War

Fatality .

2783/d

VPD

Mortality .

VPDs Result in 847 More Potential Year of Life Lost Per Day

(309155/Year) Than All Fatality of War in Afghanistan

Information Figures Source

Population of

Afghanistan

33830338 Worldmeters.info

U5 Mortality 91/1000 http://data.worldbank.org/indicat

or/SH.DYN.MORT

VPDs Mortality 17% of all http://www.who.int/immunization/m

onitoring_surveillance/global_immuni

zation_data.pdf

Birth Rate in

Afghanistan

35.3https://www.unicef.org/infobycountry/afghanistan

_statistics.html

Life Expectancy in Af 60 http://data.worldbank.org/

country/afghanistan

War Causalities Civilians:3545

Milit&Police:7000

Insurgents:7137

Year: 2015- by

Watson Institute

http://watson.brown.edu/cost

sofwar/files/cow/imce/papers

/2016/War%20in%20Afghanis

tan%20and%20Pakistan%20U

PDATE_FINAL_corrected%20d

ate.pdf

PYLL U5 Mortality

Average age 5

War Fatality:

Average age, 20

Highest for U5 and

Assumption for Wart

Fatality

Why?

Reason for Low Coverage of Immunization

1 Management National EPI

BPHS NGOsREMT/PEMT

THREE DIFFERENT PLAYERS, WITH NO LINEAR

RELATIONSHIP BETWEEN EITHER OF THEM

Reason for Low Coverage of Immunization

2 Service Delivery

Health Service Delivery Is Mostly

Centered Around Fixed Area While

Majority Of Population Need To Be

Covered By Outreach And Mobile

Services

HF

Outreach

Reason for Low Coverage of Immunization

3 Sub-Optimal Monitoring

Limited Resource of Monitoring at National and Provincial Levels

2 Monitors at National EPI for the Entire Country

One PEMT/REMT Supervisor at Provincial Level

3 Lack of Accountability Mechanism

PEI SUPPORT TO EPI

PEI Support to EPI

ICN/CHV (Limited to 47 VHRDs)

Child Registration by ICN/CHV will enable identify the exact

number of target children in 47 VHRDs

ICN/CHV will follow with relevant health facilities to plan

outreach and mobile session with area of low coverage

ICN will also be responsible for social mobilization of

communities and education of caregivers on routine

immunization

Data from these 47 VHRDs can be used as a reliable

monitoring data

PEI Support to EPI

Microplanning and Target Setting

PEI has decided to change the microplanning practice from child based to household based

Number of households will be counted in each and every village

By July 2017, we will have data on number of household across the country

Information from this micro-plan can be used to

Set target population

Conduct microplanning for routine immunization

A registration system of having one book for one house in the catchment area of each health

facility can also be developed from this

PEI Support to EPI

Surveillance, Media Relation and Cold Chain

Currently the AFP surveillance network is used for Vaccine Preventable Disease

Surveillance Outbreak detection

As we get closer to eradication, the VPD surveillance system can be further expanded

using AFP surveillance network and the scope can be changed from outbreak

surveillance to case based surveillance

Media relation and communication of polio program is good assets as polio legacy for

routine immunization

The cold chain equipment (mainly cold boxes) can be used in supporting outreach and

mobile services

Reason for Low Coverage of Immunization (RECAPE)

2 Service Delivery

Health Service Delivery Is Mostly

Centered Around Fixed Area While

Majority Of Population Need To Be

Covered By Outreach And Mobile

Services

HF

Outreach

PEI Support to EPI

Outreach and Mobile

Plan Revision and

Monitoring

HF

: Community Based Monitors

: Outreach areas

: Polio District Staff (DPO/DCO/ICN)

1 Management and Structural Changes

Management and Structure of EPI Should be reconsidered in way to ensure accountability

For implementation of accountability framework three things are required

A system to track and review performance

Monitoring system to fed in information into accountability framework

An authorized body to take on time decisions and be able to bring changes at all level

.

Independent

Monitors

Administrative

Coverage

National

Monitors

Monitor

Review Act

Suggestion for Improvement (as lesson learned from Polio Program)

Suggestion for Improvement (as lesson learned from Polio Program)

2 Investing More on Routine Immunization

Provincial EPI Management Teams should be further strengthen to ensure that

they can properly manage performance in all district

Afghanistan is a conflict zone and need more focus and more focus from donors

for support of RI

Two areas require more investments in conflict zones

Monitoring (limited number of people can move in security compromised areas)

Social Mobilization ( Prioritizing Preventive Health Interventions in a Stressful Environment is Challenging)

Thank you