Approaching Days of Tranquility

1. Approaching Days of Tranquility Afghanistan Polio Eradication Initiative February 04 08

2. Background Afghanistan has the experience of practicing Days of Tranquility in the past • Health is neutral & each Afghan child has the right to be immunized • In 1990s, Days of Tranquility • Announced for one week & observed for more than a month • Campaign Posters were displayed on the Tanks • Military vehicles were used for transportation of the vaccine & teams in difficult to approach areas • Taliban & Northern Alliance frontline remained quiet during the polio days

3. NSL1 isolate from 02, Healthy Children, September 13, 05 NSL1 NSL3 2007 NSL1=06 NSL3=11 P1 & P3 Poliovirus Isolates Afghanistan 1999, 04-07 2004 1999 2-3 year H-H Vaccination polio cases reduced to 04 & geographically restricted to the south NSL1= 2 NSL3= 2 NSL1= 45 NSL3= 18 2006 2005 NSL1=5 NSL3=4 NSL1=29 NSL3= 2 Data up to 26 Jan 2008

4. Phase 01 • In second half of 2005, P1 Outbreak started in the Southern region • Program requested a meeting of both the UNICEF & the WHO Country Representatives • Briefed on the polio situation and gravity of the impact of security on campaign quality • Joint letter was sent to HM & SRSG • The HM in a Cabinet meeting & SRSG during his weekly meeting with the President separately briefed the President on the deteriorating polio situation in the country

5. Phase 01 • The President Hamid Karzai directed the N S Council • NSC was briefed on Polio by the WHO & UNICEF CRs together • Policy Action Group chaired by the President was given briefing on Polio Situation by the UNICEF & the WHO • Polio Action Group representing cross sectoral ministries was constituted • Governor of Kandahar & Helmand were directed by the President office to lead the process. • Efforts concluded, that the Anti Government Element’s leadership is not visible to whom to talk • Military started responding: campaign dates were changed on the advise of HM. But military operation was also delayed and started exactly on the campaign time

6. Very High Risk Areas High Risk Areas Medium Risk Areas Low Risk Area NSL3=11 NSL1=06 UN Security Map & Polio Confirmed Cases (Jan, 2008) Date up to 27 Jan 2008

7. Phase 02 • Dr David Heymann, Advisor to WHO DG on Polio, visited Afghanistan • Meeting with ISAF/NATO & their Civilian Representative • Joint MoPH, UNICEF, WHO press briefing in MoPH and appealed to all the parties of the Conflict • AGE Spokesperson responded & called to media from unknown place and announced their support for the polio eradication in Afghanistan

8. Phase 02 • The WHO DG & the RD visited Kabul • Meeting the President Hamid Karzai, HM & Advisor to President • Meeting with Deputy Commander ISAF / NATO • Progress in the stance: Military agreed on to have Days of De-conflict • Campaign days and areas were shared but still Operations were conducted during the campaign days

9. Phase 03 • Briefing on Polio at the ISAF / NATO HQ Brussels by Chris Maher & Tangermann • Promise to keep was the de-conflict situation • Country Team explored the possibility of approaching AGE • HM was briefed on the Concept • With the advise & approval of HM, ICRC was briefed on polio situation and the risks. • ICRC agreed to support PE activities in Afghanistan • Taliban issued the Letter of Support, announced in the media and communicated their field formations • Letter was found very useful helping polio staff in the field & in improving access to the areas & children • UN Peace day highlighted the need of DOT

10. Letter of Support from AGE is issued for each campaign separately since September 07

11. 1-24% 25-49% 50-74% 75-100% Comparison of Children not accessed by vaccination teams Analysis by District, Southern Region Aug & Sept 07 September 2007 August 2007 80,000 more children Accessed, not covered for one year % of missed children in the district

12. Jan-08 SNID Not Accessed because of active fight (7,428) Not accessed because of AGE refusal (7,455) Not accessed because of management (792) Not Accessed because of active fight (59271) Snow (24,190 Total inaccessible 37,329 (3%) Total inaccessible 39,865 (3%) Not accessed because of AGE refusal (23348) Not accessed because of management (3959) Completely inaccessible Partially inaccessible Accessible Results: Improved access & maintainedSouthern Afghanistan, Dec. 07 & Jan. 08 Dec-07 SNID Window of Opportunity Strategy Total inaccessible 86,578 (8%) REC File 27 Jan 2008

13. Continuous Technical Inputs • Focused District Strategy was initiated in the security compromised districts to minimize the affect of security • Village based team, adding SM at Cluster level, more involvement of community & close monitoring • Staggering Approach • Dividing the high risk districts in to two zones & placing all the human resource in one and shifting to the other later • Providing additional staff from the other regions

14. The Way Forward • There is a definite progress towards understanding for vaccination & polio eradication on DOT • We are in a transition from Days of De-conflict to DOT • AGE, party of the Conflict is approachable through ICRC • Awaiting the ISAF/NATO support on Days of Tranquility • Efforts are in progress • The Advisor to the President on Health is keeping this issue alive in NSC meetings • USAID meeting the ISAF/NATO Commander on January 31 • Looking forward to the DOT when we can supervise & monitor the campaign and vaccination teams can access every house & access each child and do the vaccination safely ensuring achieving the goal.