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Strengthening Routine EPI through PEI Network
TAG Meeting, 24-25, March,2011 Islamabad
Overview of National Routine EPI ProgramDr Zahra Mohammed
Dr Rohullah
EPI Service Delivery Modality
• Routine EPI Vaccination through– Fixed EPI clinics- 1210
– Outreach
– Mobile
• PIRI (Periodic Intensification of Routine Immunization)- Child Health Weeks
• SIAs for Polio, measles, and TT
BCG DPT-3 MCV-1 TT 2+PW0
10
20
30
40
50
60
70
80
90
100
2008 2009 2010
Coverage of various EPI Antigen (National)2008-10
% Districts with >80% Coverage of DPT-3& OPV-3 - 2008-10
Central SE
Eastern
North east
erne
North
Weste
rn
South
ern
National
0%10%20%30%40%50%60%70%80%90%
100%
200820092010
Access Vs Utilization Nationally: Proportion Categories –2008-10
2008 2009 20100%
20%
40%
60%
80%
100%
120%
33% 34% 31%
38% 34% 38%
11% 15% 15%
14% 14% 14%3% 3% 2%
NR Cat 4
Cat 3 Cat 2
Cat 1
Cat1: >80% Coverage, <10% DOR; Cat2 : >80% Coverage , >10% DOR
Cat3: <80% Coverage, <10% DOR; Cat4 : <80% Coverage , >10% DOR
Districts in various categories: Access Vs utilization for 2010
Category 1Category 2Category 3Category 4
•More number of measles Outbreak•More number of NNT cases•Most of the polio cases •More non-reporting districts
Child Health Weeks- Accelerated RI
• Total 32 districts with DPT-HepB-Hib-3 coverage included• Three rounds in each district done
Target Round 1 Round 2 Round 3 Cumulative %BCG 31893 21649 5141 2405 29195 92%OPV-3 31893 1962 3665 11776 17403 55%DPT-HepB-Hib-1 31893 21532 5556 4402 31490 99%DPT-HepB-Hib-2 31893 2639 9968 5059 17666 55%DPT-HepB-Hib-3 31893 1962 3612 11785 17359 55%MCV-1 31893 11445 4903 4263 20611 65%MCV-2( 11-23 mths) 31893 1919 2783 2301 7003 22%
MCV (23-59 Mths) 106,609 83,729 83,729 79%
Issues and Challenges• Discrepancy between different sources of population data for
planning purpose• 15%-30% of populations have no access to HS/living in hard-
to-reach areas/nomads/new illegal settlements/IDPs• Poor monitoring of stakeholders (NGOs)• Insecurity : a key problem for both access and utilization• Poor outreach and mobile services
Way Forward
• Updating and strengthening of micro-plans in phase-wise manner ensuring its appropriate implementation
• Refresher training of vaccinators• Strengthening of Cold Chain capacity following
recommendation of EVM• Ensuring that Polio Program structure devotes
some percentage of the time and resources in strengthening routine immunization
PEI North
Strengthening Routine EPI is important strategy for PEI
With decreasing number of SIAs, Increasing immunity gap among population particularly in most parts of the country without poliovirus circulation.Transmission and high risk zones :
2009 =92010 =82011 =8
Areas with no circulation: 2009 =62010 =42011 =2( first 6 months)
Strengthening Routine immunization is the most effective way to maintain population immunity
Supporting routine EPI through PEI network
• Using AFP surveillance data to improve routine EPI services.
• Regular supervision of EPI fixed centers by PPO
• Supporting District EPI team in routine EPI district micro planning
• Including routine EPI activities during internal AFP surveillance review.
RegionsYear 2010 (n=1572) Year 2011(n=278)
Median Median
Northeast 65 70
North 55 68
West 76 71
Central 79 81
Eastern 88 89
Southeast 54 61
South 3 7
Badakhshan 62 68
Median of routine EPI coverage in the vicinity of AFP cases
Area coverage survey from detailed AFP case review
YRONSET EPID PROVINCE DISTRICT VILLAGEROUTP
CT
2010 AFG/02/10/030 SAMANGAN DARA-I- SUF Dara-I-Suf 81
2010 AFG/02/10/033 SAMANGAN DARA-I- SUF Zai Gholaq 26
2010 AFG/02/10/042 SAMANGAN AYBAK Larghan (2) 40
2010 AFG/02/10/111 SAMANGAN HAZRATI SULTAN Kokjar 58
2010 AFG/02/10/162 SAMANGAN KHURAM WA SARBAGH Nawbolaq 91
2010 AFG/02/10/168 SAMANGAN AYBAK Zorabi 10
2010 AFG/02/10/185 SAMANGAN KHURAM WA SARBAGH Tana Chob 57
2010 AFG/02/10/193 SAMANGAN RUYI DU AB Qashqa 29
2010 AFG/02/10/204 SAMANGAN AYBAK Jo-i-Zandan 15
2010 AFG/02/10/238 SAMANGAN KHURAM WA SARBAGH Baba Qambar (1) 24
Using AFP surveillance data to improve routine EPI services
EPID Prov DISTRICT VILLAGEOnse
tAGE
Routine
Reason
062
BALKH
CHIMTAL Ali Zayi13-Apr
9 0Insecure, not in out-reach plan, needs Taliban negotiation
094MAZAR-I-SHARIF
Mazari Sharif
08-Jun
10 0Child was in Charbolak Dist in a village for out-reach but due to security it is not well covered
082FARY
ABPASHTUN KOT
Chahar Tut (2)
19-May
18 0It is remote village and not covered by out-reach
099SAMANGAN
RUYI DU AB
Chahrchashma
11-Jun
15 0Child was sick during out reach for 2 times
066
SARI PUL
KOHISTANAT
Deh Mianeh-ye Pa'in
03-Apr
12 0Away from FC by 15 Km, not regular covered by Mob included in WHO plan
081 Saripul Behsud 21 May
14 0The house is far from clinic and it is at the periphery of the village , out-reach area, no out-reach plan
Activity to improve routine EPI-2009,2010
Regional team supported 3 rounds of Mobile activity with coordination of partners in inaccessible areas of Shortepa District of Balkh
88% vaccinated from 0-1196% vaccinated from 12-5945% TT vaccination CBA
WHO supported one round of Mobile activity in Alborz
OPV 284 0-23m, Measles 254TT 202 Four villages were missed reported by Coordinator as well as Independent Post Assessment
Activity Results
Regional team funded 3 rounds of Mobile team activity to improve routine EPI in inaccessible areas of Saripul province
Covered 2650 OPV 0-23m, in addition to Measles, Penta and other vaccines
Regional team is Improving routine EPI in Samangan (3 rounds)
Covered 1700 OPV 0-23m, in addition to other vaccines
Attend all EPI routine meetings at regional and provincial levels
•Improvement of data quality•Identify inaccessible and poorly covered areas for NGOs
PPO Observations in Fix centers
No OPV in Fix Center
No OPV for one monthBCG no diluent
NO gas for fridge180 Vials expired
Including Routine EPI During AFP Surveillance review central region
Out of 8 vaccination centers visited, vaccinator was found absent in 3 of the centers at the time of review.
Knowledge of vaccinators in general was not adequate and the micro plan was not complete. Penta 3 coverage (<60%)
according to register
Vaccine supply was more than the requirement (> 3 months supply)
Drop out rate >10%
On Job training was provided and feedback to PEMT and NGO
Conclusion• With decreasing number of SIAs in non transmission
zone, routine EPI is the only way to maintain population immunity.
• AFP surveillance was effectively used to improve routine EPI coverage in Northern region.
• Northern region experience is to be shared with other regions
• Strong coordination is required among partners to identify low routine EPI Pockets and plan to cover them accordingly.
THANK YOU