tag afghanistan 2016 challenges and way forward 22 jan 2016
TRANSCRIPT
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Current challenges and plan for next 6 months to interrupt polio virus transmission
Dr. Najibullah SafiDG Preventive Medicines, MoPH
Technical Advisory Group Meeting24-25 January 2016
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Current issues and challenges
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Program management• New EOC structure
– Realignment of the program and data flow as per new management structure
• Streamlining the oversight and management structures
• Need to strengthen program management and oversight in provinces
• Sub-optimal involvement of BPHS implementing NGOs
Access• Increased inaccessibility – particularly due to
deteriorating situation in eastern region following the emergence of new groups
Feb'
14 S
NID
Mar
'14
NID
May
'14
NID
Jun'
14 S
NID
Aug'
14 N
ID
Sep'
14 S
NID
Oct
'15
NID
Nov
'14
SNID
Feb'
15 S
NID
Mar
'15
NID
May
'15
NID
Jun'
15 S
NID
Aug'
15 N
ID
Oct
'15
SNID
Nov
'15
NID
Dec
'15
SNID
Dec
'15
LPD0%
2%4%6%8%
10%
Percentage of inaccessible target children in SIAs - ER 2014 - 2015
Region
Perc
enta
ge o
f tar
get c
hild
ren
73217
19885
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Access Cont. • Southern region: access to conduct quality campaign is
often used as political leverage for unrelated issues• Quality of manpower: interference in selection• In some areas, capacity to supervise and monitor is limited• Tracking of internally displaced population is not yet
systematic
SIA can not be conducted
SIA can be conducted in only some of the area
SIA can be conducted with limitations
SIAS can be conducted in all areas of the district
District_boundaries.shp1234
Provincial_boundries.shp
Nov 2015 NID
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Quality of campaign• Chronically missed children in accessible areas (Kandahar,
Helmand and Farah):– Quality of manpower selection– Quality of training for vaccinators – Suboptimal revisit strategy
• Use of monitoring data (ICM and PCA) for program correction is still suboptimal
• Quality of PCA in Kunar is a concern
• Ability to conduct LQAS in selected areas as per sampling methodology is compromised due to security challenges
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Communication• High levels of awareness but lack of knowledge
about the disease and ongoing mistrust, particularly in the east
• Challenge in reaching audience, particularly women
• Sub-optimal data quality in monitoring performance of ICN network
• Limited activities between campaigns at cluster/district level
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Cross-border coordination• Coordination between east/south east region and
FATA/KP is not regular
• Face-to-face meetings at national level are not happening regularly
• Coordination of communication approaches between Afghanistan and Pakistan is not systematic
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Epidemiology and surveillance• Orphan virus in environmental surveillance from
Nengarhar (only virus in 2015 as compared for 4 in 2014)
• Low stool adequacy in Nimroz and Kandahar provinces
• Repeated importations from Pakistan
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Vaccine management and cold chain
• Sub-optimal RI coverage in high risk provinces
• Vaccine utilization reports not systematically received from the provinces
• Denominator issues result in last-minute additional vaccine requests from provinces
• SOPs for vaccine and cold chain management not followed in the field as required
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Plan for next 6 months to interrupt polio virus transmission
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Oversight, coordination and management• Strengthen engagement of political leadership at
provincial/district level to enhance program oversight
• Further engage line ministries through office of presidential focal point for polio
• Make EOCs fully functional with dashboards and strong accountability framework by mid-Feb
• Systematically engage BPHS NGOs in program (CHWs, ICM and EOC) at provincial/district levels
• Establish polio coordination units in 5 priority provinces by end-Feb
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National emergency action plan
• Full implementation of NEAP and close monitoring of progress through EOCs
• Use of NEAP activity tracker dashboard
• Review of NEAP implementation in mid-February and adjustment of action plan accordingly
• Develop NEAP 2016/2017 by May 2016
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Interventions in LPDs
LPD category
Specific SIAs Increased resources Monitoring
LPD 1 LPD SIAs 1 DPO (possibly one PPO) and 1 DCO
Decreased Vaccinator to supervisor ratio
M and A offcers
LQAS in each campaign National level monitors Increased post campaign
monitors Close tracking of Preparation
and activity LPD 2 LPD SIAs 1 DPO and 1 DCO
Decreased Vaccinator to supervisor ratio
M&A officers
LQAS in each campaign Increased post campaign
monitors Close tracking of Preparation
and activity LPD 3 LPD SIAs Fill existing vacancies, if any
M&A officers to be considered
PCA and ICM to be continued. 25% of LPD 3 target for LQAS
in each campaign on rotation
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Supplementary immunization activities
• Implement 6 SIAs synchronized with Pakistan in first half of 2016 and OPV-IPV SIAs in 28 high risk districts
• Ensure highest quality of activities in all 47 (LPD 1&2) high risk districts:1. Fast track micro plan revision to complete in all high
risk districts by end of Q1 20162. Roll out revised training methodology by end-Feb 20163. Operationalization of updated revisit strategy country
wide (strengthen daily revisit & 5th day revisit) by March NID
- Day 4 for the planning of revisit
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Supplementary immunization activities Conti. 4. Use of PCA data to identify and address chronically
missed children5. Streamline flow and use of ICM information using mobile
technology for concurrent correction6. Direct oversight of 19 priority 1 high risk districts by
national level monitors
• Introduce CHV approach in one LPD in southern region in Feb– Phased expansion in poor performing priority 1 districts in
east and south by May NIDs
• Review and improve quality of PCA in Kunar• Fully implement IPV SIA plan for Q1 of 2016• Tracking displaced population for immunization
12-15 Jan-LPDs 16-19 Feb-SNIDs
19-22 Apr-SNIDs
15-18 Mar-NIDs
17-20 May-NIDs 7-10 Jun-LPDs
tOPV bOPV
SIA Schedule for Q1 - Q2 20162 NIDs, 2SNIDs and 2 LPD campaigns during the low transmission season / fully synchronized with PAK SIAs
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Plan of IPV SIAs - Q1 2016PHASE Districts Dates Target
PopulationDoses
required
Phase 1 Nangarhar-Achin, Lalpura, MomandaraFarah (Balabaluk, Gulistan)Herat (Shindand)
31st Jan to 6th Feb 2016
180,243 212,686
Phase 2 Nangarhar-(Batilkot, Dehbala, Kot)Kandahar (10 districts)
28th Feb to 5th Mar 2016
261,443 308,503
Phase 3 Helmand (Kajaki, Nawa-e Barakzaly, Nawzad, Sangin, Washer, Lashkargah, Nadali/Marja, Nahre Siraj, Musaqala)
27th Mar to 2nd April 2016
371,298 438,132
Total 812,984 959,321
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Communication
• Strengthen communication HR capacity • Create a more focused enabling environment to
promote trust in vaccination– Expand radio partnerships focused on high risk districts
• Scale up household and community engagement approaches, including between campaigns– Standardized ICN structure/activities throughout high risk
districts– Monthly district-specific communication action plans
• Improve monitoring of communication approaches• Equip CHVs and FLWs with IPC training and polio plus
materials
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Inaccessible areas
• Develop and implement area specific plans for eastern and southern regions, and for the rest of country, by mid-Feb
• Maintain program neutrality
• Continue negotiations through partners for full access in high risk districts
• Sub-district-level mapping of access and area specific approaches completed for high risk districts of eastern region by mid-Feb
• Engage NGOs who have access for delivery of vaccine and monitoring of campaign
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Inaccessible areas Cont.
• Systematic engagement of local communities and elders; ensure use of locally appropriate vaccinators
• Explore feasibility of delivering OPV combined with other services (e.g. health camps) by end-Feb
• Review and strengthen permanent vaccination points by end-Feb
• Maintain preparedness to conduct SIAs (including IPV SIAs) when any area becomes accessible
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Cross border coordination
• Quarterly VC between Afghanistan - Pakistan national EOCs with bi-annual face-to-face meeting
• Fortnightly TC at regional level with regular exchange of information
• Sharing of information on cross-border population movements to ensure coordinated vaccination
• Synchronized communication approaches between Afghanistan - Pakistan at border sites
• Produce and analyse data as per epidemiological blocks from Feb 2016
Synchronized SIAs in Pakistan & Afghanistan in 2011AFGHANISTAN PAKISTAN
NIDs SNIDs SNIDs NIDs
Series1 NID 11-14 Jan 2016
LPD7-10 Jun
SIA schedule AFG & PAK, 1st semester 2016
LPD 12-15 Jan
SNID 15-18 Feb 2016
NID 15-18 Mar
SNID 19-22 Apr
NID 14-17 Mar 2016
SNID 18-21 Apr 2016
NID 17-20 May SNID 16-19 May, 2016
SNID 16-19 Feb
LPDs
bOPVtOPV
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Vaccine management
• Ensure vaccine availability for all planned SIAs, complimentary immunization activities (CB, PTTs, PPTs) and sufficient buffer stock to address case responses
• Functionalise systematic delivery of vaccine utilization reports from the provinces
• Strengthen capacity of provincial and district-level SIA service providers to ensure SOPs for vaccine and cold chain management during SIAs are followed
• Update cold chain equipment requirement for SIAs bi-annually
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Surveillance• Explore expansion of environmental sampling sites and
expand by end of Q1 2016
• Track quality of surveillance in inaccessible and security compromised areas through disaggregated data analysis and disaggregate analysis of surveillance data by district
• Conduct reason analysis of low stool rate in Kandahar and Nimroz and take corrective action
• Conduct Surveillance review in Q2 of 2016
• Tracking displaced population for surveillance
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Questions to the TAG
• Is the 6-month plan presented, appropriate to achieve interruption of polio transmission?
• What should the target age group be for cross-border vaccination?
• Is the plan to introduce the CHV approach in the southern
region and phased expansion to poor performing priority 1 districts appropriate?
• Does the TAG endorse the plan presented for reaching children in inaccessible areas?
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THANK YOU