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Feedback from the Panel Technical Consultation on Polio Eradication in Pakistan 15 th February 2015.

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Presentation on theme: "Feedback from the Panel Technical Consultation on Polio Eradication in Pakistan 15 th February 2015."— Presentation transcript:

1 Feedback from the Panel Technical Consultation on Polio Eradication in Pakistan 15 th February 2015

2 Panel acknowledges the GoP request for this Technical Consultation, at a critical juncture for Pakistan, half-way through the all important low season

3 Panel recognizes the overall heightened commitment of the GoP to eradicate polio in 2015 & formation of PM’s Focus Group, Cabinet Committee on Immunization & Ministerial Committee

4 Panel also recognizes the meticulous planning process for the low transmission season and the Bhurban (II) Workshop for finalizing the plan and developing national consensus

5 Context Global WPV Cases during the last 6 months Endemic country Wild poliovirus type 1

6 Context Mid-Term Review of Low Season Plan Implementation Is the low season plan being implemented as per envisaged alignment towards achieving the desired goals; what are the key gaps? Advise to improve reservoir specific plan implementation during the remaining low season? What would it take to make the reservoir specific plans contribute effectively towards a national success?

7 Findings / Conclusions

8 Overall Impression Epidemiology-1 Pakistan has the highest number of annual polio cases during the last decade Known reservoirs remain the key culprits There was spill over with minimal viral establishment WPV Cases 2014

9 Outbreaks in Quetta Block & South KP are concerning Central Pakistan; a possible WPV hide- out Overall Impression Epidemiology-2 Central Pakistan WPV Cases, Balochistan 2014 WPV Cases, South KP 2014 Orphan virus

10 Configuration of the Plan seems appropriate – Cornerstones, key approaches, SIAs schedule & reservoir specific strategies well poised If implemented fully, the Plan has the capacity to stop WPV circulation by the end 2015 Given the population dynamics, immediate Simultaneous & synchronized implementation by all geographical areas, is of utmost importance for success Overall Impression The Bhurban Plan

11 Panel recognizes the establishment of the EOCs at the national & provincial levels – with overall improving program oversight & accountability mechanisms Panel also commends the steps taken towards the key assumption of the plan that “all children will be reached everywhere in the country” Overall Impression Plan Implementation Status

12 However, the implementation status of reservoir plans was not presented in a way that the Panel would have liked (except FATA) – Would have been good to see concrete implementation status against each key component of the plan Overall Impression Plan Implementation Status

13 2014Now North Waziristan South Waziristan Khyber Agency (Bara) Peshawar Charsadda (Shabqadar) Karachi (high risk) Overall Impression Access Situation in Key Areas with Security Challenges Accessible partially accessibkeInaccessiblke

14 Overall Impression Implementation Status of the Key Elements of Low Season Plan PunjabKPFATASindhBalochistan Vaccinating everywhere (Security perspective) Tracking of Chronically Missed Children Monitoring Accountability Community Ownership/ Civil Society engagement Quality & Morale of FLW Polio Plus Administering IPV on track / implemented partial / in progress of track / not implemented

15 Province Specific Findings Punjab – 1 Panel recognizes the enhanced commitment from the highest level provincial leadership – Overall robust monitoring & accountability Panel commends: – the focus on routine immunization – Use of innovative approaches to reach maximum children & monitoring

16 There is persistent viral transmission in Lahore (environmental samples) indicating pockets of missed populations Segregated estimates of missed children among migrants/mobiles populations and for high risk communities were not shared in the presentation Province Specific Findings Punjab – 2

17 Panel recognizes the commitment of the political leadership Opportunity to reach the NW populations was well grabbed through transit vaccination & targeted SIAs The initiative “Sehat ka Ittehad” provides a good platform for synchronized implementation with FATA Province Specific Findings Khyber Pakhtunkhwa - 1

18 Information on tracking of missed children in key areas of Peshawar & South KP was not presented – Background data provided to the Panel indicates a good start to the low season (in terms of reaching persistently missed children) Panel noted with concern that KPK is the only province with local WPV circulation that has not kicked off the IPV-OPV SIAs – Opportunity still there to vaccinate the NW & Bara IDPs Parts of Peshawar still face difficulties due to security – Four campaigns missed in some parts (target: 19000) Province Specific Findings Khyber Pakhtunkhwa – 2

19 Polio remains in three tribal agencies & adjacent FR areas Panel commends the efforts for accessing persistently missed populations – Recent resumption of door to door SIAs in SW & Hujra vaccination in NW & FR Bannu is encouraging, indeed – >70,000 reached for the first time in more than 2 years’ time in SW Good insight of the team about the local issues and their mapping is acknowledged Province Specific Findings FATA - 1

20 Panel noted with concern that Low Season Plan implementation has not kicked off in Khyber Agency (Bara and parts of Jamrud in particular) – Infection from Bara has spread to Jamrud tehsil – There is potential risk of spread of infection to Bajour and Mohmand Agencies Province Specific Findings FATA - 2

21 With ongoing WPV circulation, Karachi may become the most dangerous polio reservoir in the country with potential to amplify & export – Unless urgent steps are taken Program oversight / accountability seems to have started scaling up very recently FCVs / FCMs initiative in line with the Bhurban Plan, is encouraging – >64,000 vaccinated in areas previously unreached But some areas are still not been vaccinated due to Security/Access Province Specific Findings Karachi-1 WPV cases – Sindh, 2014

22 Children still being missed in critical areas Province Specific Findings Karachi-2 Campaign # UCs Covered Target CoverageMissed Children Spot Survey LQAS n%NARefusal No. Lots Pass % War- ning % Fail % NID Jan 151882,236,582 2,237,98 9 100%17,3379,68690%26 7 (27%) 12 (46%) 7 (27%) NID Dec 141882,211,218 2,178,79 5 99%14,8189,62991%17 6 (35%) 6 (35%) 5 (29%) SIAD Nov 14 97846,413808,47096%8,7955,91292%13 6 (46%) 5 (38%) 2 (15%) SNID Nov 14 97829,684826,503100%6,9965,05391%7 1 (14%) 5 (71%) 2 (29%)

23 Enabling environment for all vaccinators still lacking – Operational & Security Plans not fully hand in hand – Three SIAs missed since November 2014 in parts of Karachi due to security related issues Province Specific Findings Karachi - 3

24 A new outbreak; possibly intensifying – Kila Abdullah, the epicentre Balochistan has demonstrated the capacity to stop WPV transmission – Stopped twice Available data indicates pockets of missed children due to operational reasons & refusals Province Specific Findings Quetta Block

25 Recommendations

26 Timeline 6 – 8 weeks from now Early high season starts in late April

27 Panel Reiterates the Assumption of the Bhurban Plan that “All the children everywhere are reachable during the low season” This is the foundation

28 The Plan has all the necessary ingredients; it needs proper implementation & tracking In the light of provincial presentations; Panel feels that the plan is not being meticulously followed up / tracked Overarching Recommendations Stick to the Bhurban Plan

29 Paradigm from now must be the “Chronically Missed Children”; not the ones reached Tracking through all possible sources – PTPs, health camps, AFP data monitoring Disaggregation UC by UC & House by house – Local plans should be developed to reach these children between campaigns – Reason-wise (break down not available) recording & tracking Include coverage of Zero dose children among the key performance indicators Overarching Recommendations (cont.) Chronically Missed Children Quality

30 Intra-campaign & post campaign monitoring, both are vital Intra-campaign monitoring to be immediately strengthened as per NEAP and Bhurban plan Maintain LQAS & out of house Survey as post campaign assessments – LQAS should be on a standardized and a randomized approach – Start disaggregating the reasons & track Overarching Recommendations (cont.) Monitoring

31 EOCs should establish a dashboard to review campaign performance, with a set of consistent performance indicators National guidelines on vaccination response to failed LQAS lots should be followed & results documented Overarching Recommendations (cont.) Monitoring

32 Place frontline workers at the center of the eradication campaign – Particularly in high risk UCs Establish a retention, training & motivational plan for appropriate recruitment locally Implement a strategic, holistic communication campaign to elevate the status of frontline workers in the community local community volunteers (FCVs, FCMs, LHCWs) Ensure timely payment to all vaccinators – urgent thorough situational review & immediate fixation for late payments Overarching Recommendations (cont.) Quality of Vaccinators

33 Area appropriate customized security plans should be put in place, that facilitate the operational plans – Covering implementation & monitoring – Coordinated & timely preparation – Better coordination between federal & provincial level Overarching Recommendations (cont.) Security

34 Assign permanent EOC coordinators in all provincial EOCs Enhance security coordination under the umbrella of EOC – One full time security forces/army representative in EOC Overarching Recommendations (cont.) Accountability

35 Urgent steps should be taken to ensure all the high risk / migrant communities are included in the UC micro- plans of Lahore & Rawalpindi The problem of language / culture in-appropriate teams must be overcome immediately Proper implementation of Mobile population strategy in the entire province, especially the south Punjab Continue efforts to improve routine EPI particularly in HRUCs Recommendations, Punjab

36 The initiative “ Sehat Ka Ittehad” should be utilized to ensure – Improving access and community trust – tracking of missed children due to all reasons (insecurity, performance.. ) – Stringent accountability for performance Missed children data tracking must be immediately streamlined & maintained IPV-OPV SIAs must immediately be implemented in Peshawar & Bannu – NW IDPs should get the IPV dose before returning – Bara IDPs before returning or during repatriation Recommendations; KP

37 Plans for conducting door to door SIAs in Bara and Jamrud should be implemented in letter and spirit – Khyber puts the entire central KP & FATA at risk House to house vaccination, in North Waziristan (areas with population) & FR Bannu Panel endorses the plan for vaccination during repatriation & emphasizes its proper implementation and monitoring The UAE – PAP payment mechanism for the front-line workers should be urgently streamlined Recommendations, FATA

38 The improving EOC should have political support to achieve accountability Security & communication plans should aim to produce enabling ground environment for the vaccinators – Operational, security & communication plans synchronization IPV-OPV SIAs to be implemented in the remaining high risk UCs Panel endorses the SIAs strategy for the eight super high risk UCs (Feb – Mar) – However, reaching the chronically missed children holds the key – not just vaccinating the same kids Recommendations, Karachi

39 Vaccination Status of AFP Cases (NP AFP aged 6-35 months) Karachi; 2010 – 2014 7 + 0 DOSE 1-3 4 TO 6

40 Good local initiatives (permanent polio teams); but there is need to provide better evidence of impact on access & coverage – Strengthen ground-up accountability Cross border coordination with southern Afghanistan team should be maintained ensure all communities are reached The high risk UCs / tehsils focus to be enhanced during rest of the low season Recommendations, Balochistan

41 Central Pakistan There is urgent need to have a coordinated initiative to identify & fix the gaps in vaccination activities & surveillance – Panel endorses the suggestion for coordination process

42 Document progress from NOW EOC to evaluate progress in implementation of Bhurban Plan in 8 weeks Propose TAG evaluation of implementation in June Recommendations, Evaluation

43 Twelve Weeks Left…. The Bhurban Plan addresses all the hurdles; provided that it is implemented fully

44 Thank You

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