Dr, Janbaz Afridi
Program Manager EPI
Khyber Pakhtunkhawa
Khyber Pakhtunkhawa
Basic Data EPI Khyber Pakhtunkhwa
S. No`
Information Required
Numbers
1
No. of Districts
25
2
No. of Tehsils
68
3
No. of Union Councils
1040
4
Total No of vaccinators (Govt.)
1289
5
No. of UCs with fixed EPI Centers
950
6
No of health Facilities
1454
7
No. of UCs without fixed EPI Centers
8
No. of LHWs trained in Routine EPI
6500
9
No. of LHWs Operationalized in Routine EPI
5700
90
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.
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
Provincial EPI indicators
Indicators
2009
2010
2011
BCG coverage (%)
88
100
95
Penta-3 coverage (%)
69
87
84
Measles-1 coverage (%)
66
75
74
Measles -2 Coverage (%)
38
40
42
BCG – Measles 1 drop out (%)
22
25
21
TT2 + Coverage (%)
46
69
57
TT1-TT2 Drop out (%)
22
23
25
Penta-1-2 Drop Out (%)
17
15
11
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
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
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
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)
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
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
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
Polio Cases Update 1/2
GLOBAL POLIO CASES YEAR TO DATE COMPARISON
2011
2012
Pakistan
4
11
Afghanistan
1
3
Nigeria
0
1
India
1
0
Total Polio Cases in Endemic Countries
6
15
Total Cases Non-Endemic Countries
3
1
Total Global Cases
9
16
Country / Region / Global
15
Polio Cases Update 2/2
PAKISTAN POLIO CASES YEAR TO DATE COMPARISON
Region/ Province/Country
2011
2012
Khyber Pakhtunkhwa
1
4
FATA / FR Areas
2
2
Sindh
1
3
Balochistan
0
2
Gilgit-Baltistan
0
0
Punjab
0
2
AJK
0
0
Islamabad
0
0
Pakistan
4
13
16
Polio Cases reported from KP; 2000-2011*
Polio cases by month, 2011
6
5
60
5
4
Cases (n)
50
5
3
3
3
3
2
49
1
1
1
Jan
Feb
1
0
1
0
Mar
Apr
May
0
0
Jun
Jul
Aug
Sep
Oct
Nov
Dec
-1
38
Cases (n)
40
28
30
24
20
20
23
19
17
8
10
8
5
3
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
* Data as of 14/01/2012
ALERTS
Suspected Disease
Acute diarrhea (AD)
Acute Flaccid Paralysis (AFP)
Acute Jaundice Syndrome (AJS)
Acute Respiratory Infection (ARI)
Acute Watery Diarrhea (AWD)
Bloody Diarrhea (BD)
CCHF
Chicken Pox
Dengue Hemorrhagic Fever (DHF)
Diphtheria
H1N1
Leishmaniasis
Malaria
Measles
Meningitis
Mumps
NNT
Pertussis
Scabies
Typhoid
Unexplained Fever
Total
KPK/FATA
Alerts
Outbreaks
13
3
12
2
256
23
29
6
53
34
42
26
3
366
7
12
7
33
2
5
4
935
3
0
9
0
132
11
15
0
19
2
24
10
0
12
0
0
0
5
0
3
0
245
Measles Alerts/Outbreaks KPK
250
Number Of cases
200
150
100
50
0
Abbot Battag
Charsa D. I.
Haripu
Kohist Lower Malak Manse Marda Nows Pesha Shangl
Buner
Hangu
Karak Kohat
Swabi Swat
tabad ram
dda Khan
r
an
Dir
and
hra
n
hera war
a
Tank
Upper
Dir
Alerts
15
10
57
50
12
2
46
2
6
3
50
8
19
42
15
3
26
57
195
31
7
Outbreaks
0
0
0
3
0
0
9
0
0
2
7
3
5
2
0
0
0
0
2
0
0
Positive
3
1
2
11
0
0
21
0
0
0
39
5
2
10
2
0
8
5
139
0
2
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
Diphtheria alerts in KPK & FATA (wk 31-2010 to wk 31-2011)
N = 34
Shangla, 1
D. I. Khan, 3
Mardan, 1
Tank, 2
Nowshera, 3
Upper Dir, 1
South
Waziristan
Agency, 1
Swat, 1
Bannu, 2
Bajaur Agency,
1
Charsadda, 4
Karak, 5
Lakki Marwat,
2
Peshawar, 7
Over 19 million children still unimmunized
Global number of under-five children unimmunized
Source/credits: WHO/UNICEF coverage estimates 1980-2009, July 2010
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
Vaccination status (Routine + SIAs)
of Polio Cases
2010
2011
13%
21%
29%
43%
22%
21%
22%
29%
n =24
0 dose
n =23
1 - 3 doses
4 - 6 doses
7 + doses
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
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
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
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
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
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
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
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
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
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
Thank You