Polio eradication in afghanistan way forward 2016 17
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Transcript of Polio eradication in afghanistan way forward 2016 17
Way forward National Emergency Action Plan 2016-17
Najibullah Safi, MD, MSc. HPMDG Preventive Medicines, MoPH
Technical Advisory Group Meeting12-13 July 2016
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
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
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
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
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
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
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
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
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
Key strategies
12 July 2016 Afghanistan Polio TAG Meeting 11
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
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
14-18 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’17July 18-22, LPD Aug 22-26, NID Oct 24-28, NID Dec 19-23, SNID
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
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
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
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
5. Data management
Data Source Timeline
Pre-campaign1 Preparation of campaign EOC/PEMT 2 weeks, 1 week,
daily in last week2 Coordination meeting EOC/PEMT 10 days before SIA
Intra-campaign3 Administrative coverage EOC/PEMT Next day afternoon4 ICM EOC/PEMT Next day afternoon5 Evening meeting EOC/PEMT Next day afternoon
Post-campaign6 Administrative coverage EOC/PEMT 10 days after SIA7 PCA WHO 10 days after SIA8 LQAS WHO 10 days after SIA9 Out of house survey WHO 10 days after SIA10 Compiled ICM data EOC/PEMT 10 days after SIA11 Access data EOC/PEMT 10 days after SIA
12 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
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
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
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
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
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
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
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
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
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
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
Question to the TAG
• Is the NEAP presented, appropriate to interrupt polio transmission?
12 July 2016 Afghanistan Polio TAG Meeting 30
THANK YOU
12 July 2016 31Afghanistan Polio TAG Meeting