Polio eradication in afghanistan way forward 2016 17
•Download as PPTX, PDF•
0 likes•851 views
Polio Eradication in Afghanistan Way forward
Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (19)
Similar to Polio eradication in afghanistan way forward 2016 17
Similar to Polio eradication in afghanistan way forward 2016 17 (20)
More from Najibullah Safi
More from Najibullah Safi (20)
Recently uploaded
Recently uploaded (20)
Polio eradication in afghanistan way forward 2016 17
- 1. Way forward National Emergency Action Plan 2016-17 Najibullah Safi, MD, MSc. HPM DG Preventive Medicines, MoPH Technical Advisory Group Meeting 12-13 July 2016
- 2. Presentation outline • Context • Lesson learnt from implementation of NEAP 2015-16 • Goal, objectives strategic approaches and key milestone • Key strategies • AFP surveillance • Cross border coordination • Program evaluation • Strengthening RI and transition planning • Question to TAG 12 July 2016 2Afghanistan Polio TAG Meeting
- 3. Context • High risk: – 5 provinces – 47 districts • Access status: – Category 1- fully accessible – Category 2- partially accessible – Category 3-accessible with limitations – Category 4- inaccessible 12 July 2016 3Afghanistan Polio TAG Meeting Risk categorization of districts, 2016
- 4. Lessons learnt from the implementation of 2015-16 NEAP • Strong coordination and accountability is critical • Continue adaptation to local security context • Maintaining neutrality • High quality and focused activities • Tailored plans to local context • Right selection of FLWs, quality training, sustaining motivation • Need to focus on improving quality of SIAs in accessible areas with limitations (cat. 3) 12 July 2016 4Afghanistan Polio TAG Meeting
- 5. Lessons learnt from the implementation of 2015-16 NEAP cont. • Expected challenges in 2016-17 – Insecurity – Maintaining program neutrality – Limitation in supervision and monitoring – Full implementation of accountability framework – Sustaining motivation and commitment of FLWs and all stakeholders – Possible funding gaps 12 July 2016 5Afghanistan Polio TAG Meeting
- 6. Goal of 2016-17 NEAP • To stop wild poliovirus transmission in Afghanistan by the end of 2016, with no WPV1 from January 2017 onwards 12 July 2016 6Afghanistan Polio TAG Meeting
- 7. Strategic approach • Maintain program neutrality and gain access to reach all children • Implementation of alternate strategies i.e. Polio plus and PTT for inaccessible areas • Focus on identified high risk areas and persistently missed children • Strong household and community engagement • Enhanced monitoring and accountability of all stakeholders at all levels 12 July 2016 7Afghanistan Polio TAG Meeting
- 8. Objectives • To interrupt the circulation of indigenous WPV1 in Afghanistan by the end of 2016 • To rapidly increase population immunity in high risk provinces and districts • To rapidly and effectively respond to any importation of WPV1 and/or emergence of VDPV2 into polio free areas of Afghanistan • To maintain high levels of surveillance quality across the country, and to ensure all provinces reach and maintain surveillance quality indicators meeting the global standards 12 July 2016 8Afghanistan Polio TAG Meeting
- 9. Targets and milestones • Conduct 4 SIAs in the second half of 2016 and 5 in the first half of 2017 • High risk districts to complete IPV-OPV SIA by end September 2016 • Micro plans of high risk districts revised by end July 2016 • Full-time ICN fully operational in high risk districts by end-August 2016 • Maintaining a NPAFP rate of >2/100,000 and stool adequacy of >80% in every district level across the country • Full implementation of the accountability framework by end August 2016 12 July 2016 9Afghanistan Polio TAG Meeting
- 10. Governance and coordination • Maintaining and strengthening current governance and coordination mechanism – National level: various bodies govern and oversee the implementation of NEAP • Polio steering committee • Polio high council • National EOC – Regional and provincial level • Regional EOCs • Governors’ engagement • Strengthening provincial and district levels task-forces 12 July 2016 10Afghanistan Polio TAG Meeting
- 11. Key strategies 12 July 2016 Afghanistan Polio TAG Meeting 11
- 12. 1. Focus on high risk areas • Focus on 5 provinces and 47 districts for implementation of key strategic interventions • District profiling and district specific plans for 47 VHRD, updated after every campaign • Reassessment of VHRD will take place in Dec 2016 12 July 2016 12Afghanistan Polio TAG Meeting
- 13. 2. SIA plan for 2016-17 • OPV: – 2 NIDs and 2 SNIDs in 2nd half of 2016 – 2 NIDs and 3 SNIDs in 1st half of 2017 – Dates will be synchronized with Pakistan – Case response: • 3 campaigns targeting at- least 500,000 children each • IPV: – All VHRD to complete OPV-IPV by end of 2016 – Areas not accessible for 6 months (3 campaigns) 12 July 2016 13Afghanistan Polio TAG Meeting Region Province District Target- IPV East Nangarhar Behsud 117,210 Nangarhar Jalalabad 57,559 North Frayab Qaysar 46,578 South Helmand Lashkargah 56,024 Helmand Musaqalah 26,493 Helmand Nade-e-Ali 120,835 Helmand Nahr-e-Saraj 63,484 Kandahar Kandahar 162,873 Nimroz Zaranj 49,974 Uruzgan Dehrawud 26,010 Uruzgan Tirinkot 50,448 Zabul Qalat 29,339 Southeast Paktika Bermel 19,286 826,113
- 14. 14-18 Jan-LPDs 11-15 Feb-SNIDs 15-19 Apr-SNIDs11-15 Mar-NIDs 13-17 May-NIDs bOPV SIA schedule for July’16 to June’17 July 18-22, LPD Aug 22-26, NID Oct 24-28, NID Dec 19-23, SNID
- 15. 3. Enhancing campaign quality • Revision of integrated micro-plans – Review and strengthen methodology – Complete in remaining 10 VHRD by end of Q3 2016 and 49 HRD by Q1 2017 • Frontline workers selection, motivation and capacity building – Improving team selection – Improving the quality of training – Monitoring and performance management – Ensuring timely payment of FLW – Intensified supportive supervision 12 July 2016 15Afghanistan Polio TAG Meeting
- 16. 3. Enhancing campaign quality cont. • Revisit strategy – Revisit during campaign – Increasing the time gape between the first visit and revisit • Enhanced monitoring – Pre-campaign – Intra-campaign – Post-campaign 12 July 2016 16Afghanistan Polio TAG Meeting
- 17. 3. Enhancing campaign quality cont. • Campaign coordination and review meetings – Pre-campaign coordination meetings – Intra-campaign review meetings – Post-campaign review meetings 12 July 2016 17Afghanistan Polio TAG Meeting
- 18. 4. Community health volunteer strategy • Complete the pilot planned for Spin Boldak of Kandahar, which represents the challenges of ‘very high risk districts’ • Results of the pilot will inform decisions on possible future expansion 12 July 2016 Afghanistan Polio TAG Meeting 18
- 19. 5. Data management Data Source Timeline Pre-campaign 1 Preparation of campaign EOC/PEMT 2 weeks, 1 week, daily in last week 2 Coordination meeting EOC/PEMT 10 days before SIA Intra-campaign 3 Administrative coverage EOC/PEMT Next day afternoon 4 ICM EOC/PEMT Next day afternoon 5 Evening meeting EOC/PEMT Next day afternoon Post-campaign 6 Administrative coverage EOC/PEMT 10 days after SIA 7 PCA WHO 10 days after SIA 8 LQAS WHO 10 days after SIA 9 Out of house survey WHO 10 days after SIA 10 Compiled ICM data EOC/PEMT 10 days after SIA12 July 2016 19Afghanistan Polio TAG Meeting • Data from different sources to be fed into the EOC database for analysis and display • Use of mobile technology for real time transfer of data
- 20. 6. Access challenging areas • Maintain program neutrality • Areas inaccessible for vaccination (category 2 & 4) – Negotiations at different levels through neutral and credible mediators – Cluster and village level mapping of accessibility • Conducting campaigns in all accessible areas – Deployment of PTTs at all entry and exit routes of inaccessible areas – 3 rounds of SIAs, including one round of OPV+IPV in the newly opened area – Scaling up polio plus initiatives in and around inaccessible areas – Ongoing community engagement 12 July 2016 20Afghanistan Polio TAG Meeting
- 21. 6. Access challenging areas cont. • Areas accessible with limitations (category 3) – Negotiations at all levels with key authorities/stakeholders on the quality of campaigns and independent monitoring – Deployment of monitoring and accountability officers in all 47 very high risk districts – Sharing feedback on the gaps in quality and operations with concerned authorities – Remote monitoring of campaign’s quality using mobile technology 12 July 2016 21Afghanistan Polio TAG Meeting
- 22. 6. Complementary immunization activities • Permanent transit teams – The number increased from 62 in 2015 to 233 in 2016 • Permanent polio teams • Cross border teams • Special campaigns for nomads and other under served population 12 July 2016 22Afghanistan Polio TAG Meeting
- 23. 7. Building demand and trust in immunization • Reducing chronically missed children through strengthened household and community engagement • Strengthen partnership with key influencers • Improving external relations and partnerships • Data collection and generation of evidence 12 July 2016 23Afghanistan Polio TAG Meeting
- 24. 8. Surveillance • Review and expansion of reporting network • Data analysis by districts and security status • Strengthen active surveillance visits • Case search by FLWs during SIAs • Environmental surveillance 12 July 2016 24Afghanistan Polio TAG Meeting
- 25. 9. Response to new polio case • Detail epidemiological investigation by national rapid response team – 3 SIAs covering at least 500,000 children – First campaign in 2 weeks – Preferably 1 of 3 campaign with IPV – Support to provincial team in case response campaign – Selective target age based on local epidemiology • Any type 2 virus will be responded as per global SOP 12 July 2016 25Afghanistan Polio TAG Meeting
- 26. Cross border coordination • Weekly communication between the focal points • Biannual face to face meetings and regular VCs • Monthly meetings of concerned provincial teams • Synchronization of SIAs dates • Cross notification of AFP cases • Uniform communication materials and messages at cross border transit points • Timely information sharing on high risk population movement 12 July 2016 26Afghanistan Polio TAG Meeting
- 27. Program evaluation • Operational evaluation – Mid term review of NEAP in Dec 2016 – End term review of NEAP in June 2017 – AFP surveillance review • Evaluating population immunity – Indirect: vaccination status of NPAFP cases – Direct: serological survey planned for 1st quarter of 2017 12 July 2016 27Afghanistan Polio TAG Meeting
- 28. Strengthening routine immunization • Reduced the number of unimmunized children – Polio workers to spend 20% of their time on routine immunization • Planning routine immunization sessions • Monitoring of fixed and outreach sessions • Training of health workers – Social mobilization • ICN will promote routine immunization and mobilize families • Newborn and defaulters tracking 12 July 2016 28Afghanistan Polio TAG Meeting
- 29. Initiating transition planning • Appoint a transition oversight committee • Identify a focal person within the NEOC to coordinate the formulation of transition plan • All stakeholders/partners to conduct asset mapping • Draft plan developed and shared with partners by Q2 2017 12 July 2016 29Afghanistan Polio TAG Meeting
- 30. Question to the TAG • Is the NEAP presented, appropriate to interrupt polio transmission? 12 July 2016 Afghanistan Polio TAG Meeting 30
- 31. THANK YOU 12 July 2016 31Afghanistan Polio TAG Meeting
Editor's Notes
- First of all, I would like to thank WHO, UNICEF, EOC, EPI and all partners who contributed to the formulation of NEAP 2016-17
- Low level of transmission continued in the south In east (Kunar province) 4 cases in 1.5km square area, 1st case genetically link to a case in KPK – while the 3 other cases linked to the first case
- Insecurity: increased inaccessibility
- IPV campaign also cover 13 VHRD with NO IPV-OPV in 2015-16
- Improve selectin: Local – Female – Can read and write – Selected on merit Improving the quality of training : monitoring of training in VHRDs – EOC to track attendance and quality Monitoring and performance management: track performance of vaccinators and supervisors across the country particularly in all VHRDs in each round Ensuring timely payment of FLW: within 30 days of the end of each campaign Intensified supportive supervision: identification, training and deployment of national, regional levels monitors for pre – intra and post campaigns monitoring
- 1. Pre-campaign: Deployment of national level monitors to high risk provinces and VHRDs Maintaining pre campaign dashboard Regular feedback from NEOC including corrective action 2. Intra-campaign: In 47 VHRDs one ICM for each 5 cluster supervisors ICM Data Real time using IVR Collection and analyzing data – to be used for subsequent campaigns To be used during evening meetings on daily basis Intra campaign dashboard – to be used for corrective action on daily basis 3. Post-campaign: PCM: 100% of clusters in VHRDs and 50% in other districts Oversight on selection and training from national level Formulizing the system of monitoring the monitors (5% sample cross checked) – 0 tolerance for defaulters LQAS: Expansion to all VHRDs and HRD as per security situation Review of current system and explore 3rd party engagement 10% surveyors and completed forums to be cross checked by PPO/PCO PCM and LQAS: data to be made available to program within 10 days of the end of campaigns
- Pre-campaign coordination meetings At national, regional and provincial levels 2-4 weeks prior to campaigns Monitoring preparation at national level on days 10,7,3,1 before the campaigns Corrective action to be taken If preparation not completed 3 days before the campaign, postponement of the campaign 2. Intra-campaign review meetings Meetings at all levels A standard matrix for documentation and sharing and intervention to be developed Intra campaign dashboard at national level to be maintained Daily feedback from ICM 3. Post-campaign review meetings 15 days after the end of campaigns at all levels In 5 high risk provinces representation form national level The forum to update district profile for 47 VHRD NEOC to track the outcomes
- 1. Permanent transit teams Continue to assess the number and location based on changing security situation Strengthening supervision and monitoring- tracking on monthly basis 2. Permanent polio teams Review the performance and need for existence Track and monitor the outputs 3. Cross border teams Modify number of teams as per workload Monitor the performance by independent monitors Full synchronization with vaccination operation on Pakistan side 4. Special campaigns for nomads and other under served population Plan developed at provincial level Special campaigns to target this population
- Communication plan to be part of districts specific plan Full time ICN in all VHRDs Follow-up of missed children by ICN between the campaigns Strengthen partnership with key influencers Mapping and engagement of religious leaders Consistent engagement with all partners/stakeholders Workshops for doctors, health workers, and other key stakeholders Improving external relations and partnerships Expand media partnership, regular briefing and training Develop awareness raising materials for printed and electronic media Continued engagement of other sector through Polio High Counsel Data collection and generation of evidence Implement 2nd pool to understand shift in attitude 3rd party monitoring of communication intervention in VHRDs
- Health facilities contact analysis of all inadequate cases Identify gaps and take corrective action Close supervision and tracking form national level Strengthening by emphasis during training Explore possible expansion of ES
- Information sharing on movement of nomads, displaced population, new immigrants and returnees
- Transition oversight committee to oversee planning