Measles Catch-up Campaign Bangladesh & Pakistan

Measles Catch-up CampaignBangladesh & Pakistan Quamrul Hasan WHO - Pakistan

Sylhet Rajshahi Dhaka Khulna Barisal Chittagong Bangladesh Division: 6 District: 64 Sub district: 463 Union council: 4,451 City Corporation: 6 Municipality: 223 Area: 153,378 sq km Population: 140 million Population density: 1,045/Km2 Pakistan Province: 4 & AJK District: 134 Sub district: 474 Union council: 6,806 Area: 803,940 km2 Population: 176 million Population density: 206/km2

Phase 1 (01-18 March 07) 4 districts Phase 2 (02-18 July 07) 6 districts Phase 3A (20 Aug to 5 Sep 07) 28 districts Phase 3B (27 Aug – 12 Sep 07) 12 districts Phase 4 (12-28 Nov 07) 48 districts Phase 5 (17 March- 02 April 08) 35 districts Phase 1 (03-22 Sep 05) 2 districts + 1 City Phase 2 (25 Feb-16 March 06) 62 districts + 5 City

Campaign Target & Achievement

Few facts & figures

Political commitment & support • Political commitment • Bangladesh: • Enjoyed highest level political commitment • Multi-sectoral involvement ensured • Pakistan: • Phase 5 enjoyed better administrative support • Local people’s representatives extended excellent support • Active participation and support from education department in both countries

Campaign preparation and microplanning • Bangladesh • About 1 year uninterrupted preparation • Head count done in each and every schools and community for accurate target setting • Repeated revision and refinement of microplan • Pakistan • Short time of preparation in between repeated polio campaign rounds • School target determined by head count • Community target set by estimation from census • Microplan prepared just few weeks before campaign

Cold chain • Government in both countries provided handsome number of additional cold chain equipments from their own resources • In Pakistan, additional cold chain equipments reached country during the 4th phase • Shortage of power supply was a common challenge in both countries

Safe waste disposal • Safety box was used to collect sharp waste in both campaign without any exception • Burn and burry method was adopted in most instances in both countries • Unsupervised disposal incomplete burning during the early days of campaign

Routine EPI during campaign • Beside measles vaccination, health facility based fixed sites provided routine EPI service daily throughout the campaign days in both countries • Routine EPI is mostly outreach based in both countries • Bangladesh: went uninterrupted according to annual microplan • Pakistan: inconsistent scenario

Supervision and monitoring • Limited capacity of 1st line supervisors for providing technical support to the vaccination team • Use of common sense and pro-activeness missing • Regular evening meeting was held to monitor daily progress

International monitors • Bangladesh • 12 monitors during Phase 1 • 23 monitors during Phase 2 • Pakistan • 2 monitors during Phase 3 • 3 monitors during Phase 4 • 6 monitors during Phase 5 • Good number of well organized international monitors provide opportunity for mutual benefit

Challenges • Inadequacy of data • Number of schools and their students; especially non-government schools of different categories, religious schools • Accurate target • Daily progress and vaccine stock update during campaign • AEFI data • Skilled manpower and their training • Vaccination in private posh schools • Nomadic population and other high risk group • Power shortage  cold chain compromised • Vaccine and logistics management • Waste management • Time conflict with other priority programs

Lessons learned

Preparation • After setting strategy, adequate time is required: at least 1 year for • Data collection regarding, • Effective available human resources • Cold chain inventory • Exact target population in school and community by registration • School exam and vacation schedule • Population distribution and its ethnic and cultural diversity • Local weather pattern • Local important events • Schedule of other important program activities • Local level sensitization through advocacy among service providers, clients and other stakeholders

Strategy • School based immunization activity is easy if teachers, guardians and authorities are taken on board in advance • Outreach center based immunization program is acceptable to the community • Shifting center in a larger community rises access and acceptability • On average vaccinating 150 – 200 children daily is an easy target for a skilled vaccinator

Political commitment, Leadership and Team spirit Highest level political commitment makes challenges easy Dynamic and effective leadership from government is crucial Political and top level administrative involvement may require for access to posh private schools Team spirit among the partners is the essence for micromanagement

Microplanning • Factual microplanning is the key to success • All relevant data to be ready beforehand • Actual site wise target • Inventory of resources, • Manpower • Cold chain equipments • Transport • Social and operational mapping • Microplanning to be reviewed and refined repeatedly for fine adjustment

Training • Maintaining quality and consistency is difficult in multiple tire cascade training • Using pool of provincial/regional master trainer may give better result

Supervision & monitoring • Medical doctors were the best choice as 1st line supervisor • Responsible • Enthusiastic • Earned confidence among the team and the community • Daily evening review meeting helped in • Identification and correction of problem • Monitoring performance

Community participation • There are high demand for vaccination among the parents • Lack of awareness among community about benefits of vaccination is a false statement • Refusal is not a major issue

Teachers and students are great partners in child health • Education department can play a vital role in promoting child health activities • Through participating • Creating community awareness • Building trust

Vaccine & logistics management • Separate logistics unit for proper vaccine and logistics management • A full time consultant may lead the unit • Separate storage facility for campaign vaccine and logistics • Instead of hiring individual transportation, transport firm with good capacity can be hired • Contingency plan for on road ice pack change • Pre arrangement of traffic clearance at ferry terminal, city entry etc. • Continuous monitoring of all transporters from a central control unit up to the terminal delivery level

Local initiative • Innovative idea adopted for creating public awareness • Essay competition, letter writing competition, sms competition etc. among school children • Distributing hand note on measles campaign during polio NID • Polio vaccine was given along with measles vaccine in previously inaccessible areas

Social mobilization and communication • Top level advocacy for appropriate sensitization • Social mobilization by school teachers and community/religious leaders gives good return at grass root level • Mosque announcement most effective • House to house visit important • School students: good message disseminator • Scope of taking advantage of nationwide media coverage is limited in multi-phased campaign • Appropriate material used in appropriate place  best result

Selection of vaccine and syringes • Avoid using vaccine from multiple manufacturer for a single phase of campaign • AD syringes which are locked at 0.5 ml point are better choice Plunger stops at 0.5 ml mark. Easy to use in campaign. Plunger goes beyond 0.5 ml mark. Needs more skill for dose adjustment and prone to high vaccine wastage.

Recommendations for vaccine package and labeling • Dark color vials are preferred option than transparent vials for protection from sunlight • Both the vaccine vial and diluent ampoule label to be of similar color and graphic design • Same name (either manufacturer or trade name) to be printed on both vaccine vial and diluent label using same font type and size • Packing of vaccine vial and diluent must have same number of vials and ampoules

Measles Catch-up Campaign Bangladesh & Pakistan