Dr, Janbaz Afridi Program Manager EPI Khyber Pakhtunkhawa

2. Dr, Janbaz Afridi Program Manager EPI Khyber Pakhtunkhawa

3. Khyber Pakhtunkhawa

4. Basic Data EPI Khyber Pakhtunkhwa

5. EPI Program Khyber Pakhtunkhwa Vision EPI (Heath Department Khyber Pakhtunkhawa) vision is like in the world in which every child and mother attains the right of survival, protection, development and participation.

6. EPI Program Khyber Pakhtunkhwa Mission • EPI (Heath Department Khyber Pakhtunkhwa) mission is to reach every children, mother and create the demands for vaccination, inspire breakthroughs in the way the world treats children, mothers and to achieve immediate and lasting change in their lives. • Achieve Polio Free Province/Pakistan

7. Provincial EPI indicators

8. Objectives of the Meeting • To improve the knowledge of the EPI staff • To improve the capacity of the EPI staff • Introduction of new vaccines • To improve the skill of the staff • To focus on coverage • To focus on the defaulters • To focus on the out reach

9. Objectives of the Meeting • To focus on the MCV2 coverage • To improve the weekly reporting of the suspected Measles case based • To encourage the alerts reporting • To know the issues and constraints of the staff • To improve the compliance of the districts • To improve the reporting from UC to districts and to Province and National

10. Objectives of the Meeting • To improve data management • To establish data base of the staff, cold chain, facilities, equipments and vaccines at district level • To know the EPI covered population at district level • To prepare the social mobilization strategy for EPI

11. Objectives of the Meeting • To play lead role in the LHW non covered area and also play an effective role in the LHW covered to improve coverage and reduce the defaulters during the Mother Child Week( 2-9 April) • Coming MCW will be covering the whole population 4 districts ( Hari Pur, Nowshehra, Malakand and DIK)

12. Objectives of the Meeting • Improve the VPDs ( Vaccines Preventable diseases) surveillance including AFP • To focus on the supervision, monitoring and evaluation of the EPI program • To devise the Gap analysis specially on the PEI • To prepare the district EPI strengthening Plan • EPI coverage presentation must be included in the DPEC agenda

13. Objectives of the Meeting • MCW must be in the DPEC agenda before March SNID • Functional integration of the different programs and department .e.g. PWP, SWD, ED etc to improve the EPI • Sharing of experiences and practices at field level • To develop EPI carrier and training module

14. Tor Ghar district - new district • Repair of cold chain equipments for districts tor Ghar • Additional cold chain equipments provided; • 10 ILRs • 18 Cold boxes to district Tor Ghar • Generator • Fax • Still no regular EPI center is available

15. Polio Cases Update 1/2

16. Polio Cases Update 2/2

17. Polio Cases reported from KP; 2000-2011* * Data as of 14/01/2012

18. ALERTS

20. Diphtheria in KPK & FATA During week 31-2010 to wk 31-2011 total of 34 cases of diphtheria were reported and investigated by DEWS Surveillance Officers in KPK & FATA

21. Over 19 million children still unimmunized Global number of under-five children unimmunized Source/credits: WHO/UNICEF coverage estimates 1980-2009, July 2010

22. Future deaths averted through Immunization These estimates and projections are produced by the WHO Department of Immunization, Vaccines and Biologicals, based on the most up to date data and models available as of September 2011

23. 0 dose 1 - 3 doses 4 - 6 doses 7 + doses Vaccination status (Routine + SIAs) of Polio Cases 2010 2011 n =24 n =23

24. Key epidemiological characteristics 2011 • 65% (15) cases below 2 years of age • 4% (1) of polio cases reported from security compromised areas. • 26% (6) of cases from families having element of resistance to vaccination. Vaccination status • 13% (3) cases did not receive any OPV dose • 56% (13) did not receive any routine OPV dose • 43% (10) cases received 7 or more OPV doses • Median doses in other areas = 5 (Range 0 – 18) * Data as of 14/01/2012

25. Why Polio Program is failing to achieve its Goal ? • EPI was made responsible to look after PEI in 1994 without comprehensive planning • Neither Technical Capacity of EPI was enhanced nor Resources were not enhanced • PEI Instead of opportunity to strengthen the EPI it is considered as burden • Poor capacity at district level • Fixing of responsibility only on the field level staff & not taking the strategic planners to task for the failures. • Lack of ownership at lower level(HCPs) due different highierarchy of WHO and UNICEF

26. The 5 “A”s: Practical steps for promoting the uptake of vaccination • Availability • Stable supply • Free access • Accessibility • Easy reach EPI centers • Out reach mobile clinics • Adjustability / Flexibility • Proper record; preferably computerized • Adjustable schedule

27. The 5 “A”s: Practical steps for promoting the uptake of vaccination • Acceptability • Few visits • Few injections / Combined vaccines • Active provision • Proactive staff who seek out those to be immunized • Encouragement / Health education • Public awareness / media • Committed / Convinced / Knowledgeable staff

28. Way Forward Planning and Management • Provincial EPI Policy • Legislation for EPI/PEI • Provision of carrier structure for EPI technicians/Re structuring of EPI/Starting the previous pattern of EPI trainings/New curriculum development for EPI Technicians • Carrier structure for cold chain staff and increasing their number

29. Way Forward Planning and Management • Expansion of EPI fixed sites in all govt. health facilities (at least one in every UC with two vaccinators) • Quarterly plan of expansion • Set UC wise target for next quarter to achieve coverage to a certain level for specific antigens, to reduce antigen wastage and session dropout • Involvement of Education and Population welfare in planning and implementation of EPI/PEI activities. • Ensure PPP( Public Private Partnership) • Ensure accountability mechanism

30. Way Forward Planning and Management • Decentralization of EPI Program at district level • Incentives o the managers( districts and Provincial)/ it may be declare the selection post with incentives • Mobility for the managers at provincial level • Uniformity at country level for EPI staff carrier Service Delivery • Mobility support to EPI tech for outreach at BHU level • Training on IPC of EPI techs. • Waste management

31. Way Forward • Advocacy & Social Mobilization • Comprehensive planning at districts and UCs level • Orientation for parliamentarians and other stake holders • Inclusion in the school and college curriculum • Involvement of Media Surveillance • Ensure coordination.( DEWS, AFP, EPI) • Conduct refreshers on strengthening surveillance • Quarterly regular reviews at district and province • Establishment provincial and districts Surveillance cell for VPDs

32. Way Forward • Human Resource and Capacity Building • Refreshers of EPI tech and LHWs • MLM for EDOs and coordinators • Training for the new vaccine(s) introduction • Training of all LHWS and other health care providers in routine EPI. • Hiring of human resource • 150 would be more needed to remove the gap in the province • Initial support may be requested Surveillance officers, HR, IT, Procurement officer, Polio officer , communication officer, program officer , Health Education Officer and Monitoring and Evaluation officer

33. Way Forward Supervision ,Monitoring and Evaluation • Strengthening ,supervision ,monitoring and evaluation at provincial level • Starting district review Data Management and reporting • Regular feedback to and from districts • Timeliness, completeness and accuracy of data • Issue of denominator to be resolved

34. Thank You