Routine immunization support
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Transcript of Routine immunization support
48.4
Civilian
Deaths
Military
&
Police
Allies
Insurg
ents
How Serious is the Problem?
50.6
Under 5 Mortality/Day Due to VPD
Alone
War Causalities
(Deaths)/Day
48.4
Civilian
Deaths
Military
&
Police
Allies
Insurg
ents
How Serious is the Problem?
50.6
Under 5 Mortality/Day Due to VPD
Alone
War Causalities
(Deaths)/Day
How Serious is the Problem?
1936/day
War
Fatality .
2783/d
VPD
Mortality .
VPDs Result in 847 More Potential Year of Life Lost Per Day
(309155/Year) Than All Fatality of War in Afghanistan
Information Figures Source
Population of
Afghanistan
33830338 Worldmeters.info
U5 Mortality 91/1000 http://data.worldbank.org/indicat
or/SH.DYN.MORT
VPDs Mortality 17% of all http://www.who.int/immunization/m
onitoring_surveillance/global_immuni
zation_data.pdf
Birth Rate in
Afghanistan
35.3https://www.unicef.org/infobycountry/afghanistan
_statistics.html
Life Expectancy in Af 60 http://data.worldbank.org/
country/afghanistan
War Causalities Civilians:3545
Milit&Police:7000
Insurgents:7137
Year: 2015- by
Watson Institute
http://watson.brown.edu/cost
sofwar/files/cow/imce/papers
/2016/War%20in%20Afghanis
tan%20and%20Pakistan%20U
PDATE_FINAL_corrected%20d
ate.pdf
PYLL U5 Mortality
Average age 5
War Fatality:
Average age, 20
Highest for U5 and
Assumption for Wart
Fatality
Reason for Low Coverage of Immunization
1 Management National EPI
BPHS NGOsREMT/PEMT
THREE DIFFERENT PLAYERS, WITH NO LINEAR
RELATIONSHIP BETWEEN EITHER OF THEM
Reason for Low Coverage of Immunization
2 Service Delivery
Health Service Delivery Is Mostly
Centered Around Fixed Area While
Majority Of Population Need To Be
Covered By Outreach And Mobile
Services
HF
Outreach
Reason for Low Coverage of Immunization
3 Sub-Optimal Monitoring
Limited Resource of Monitoring at National and Provincial Levels
2 Monitors at National EPI for the Entire Country
One PEMT/REMT Supervisor at Provincial Level
3 Lack of Accountability Mechanism
PEI Support to EPI
ICN/CHV (Limited to 47 VHRDs)
Child Registration by ICN/CHV will enable identify the exact
number of target children in 47 VHRDs
ICN/CHV will follow with relevant health facilities to plan
outreach and mobile session with area of low coverage
ICN will also be responsible for social mobilization of
communities and education of caregivers on routine
immunization
Data from these 47 VHRDs can be used as a reliable
monitoring data
PEI Support to EPI
Microplanning and Target Setting
PEI has decided to change the microplanning practice from child based to household based
Number of households will be counted in each and every village
By July 2017, we will have data on number of household across the country
Information from this micro-plan can be used to
Set target population
Conduct microplanning for routine immunization
A registration system of having one book for one house in the catchment area of each health
facility can also be developed from this
PEI Support to EPI
Surveillance, Media Relation and Cold Chain
Currently the AFP surveillance network is used for Vaccine Preventable Disease
Surveillance Outbreak detection
As we get closer to eradication, the VPD surveillance system can be further expanded
using AFP surveillance network and the scope can be changed from outbreak
surveillance to case based surveillance
Media relation and communication of polio program is good assets as polio legacy for
routine immunization
The cold chain equipment (mainly cold boxes) can be used in supporting outreach and
mobile services
Reason for Low Coverage of Immunization (RECAPE)
2 Service Delivery
Health Service Delivery Is Mostly
Centered Around Fixed Area While
Majority Of Population Need To Be
Covered By Outreach And Mobile
Services
HF
Outreach
PEI Support to EPI
Outreach and Mobile
Plan Revision and
Monitoring
HF
: Community Based Monitors
: Outreach areas
: Polio District Staff (DPO/DCO/ICN)
1 Management and Structural Changes
Management and Structure of EPI Should be reconsidered in way to ensure accountability
For implementation of accountability framework three things are required
A system to track and review performance
Monitoring system to fed in information into accountability framework
An authorized body to take on time decisions and be able to bring changes at all level
.
Independent
Monitors
Administrative
Coverage
National
Monitors
Monitor
Review Act
Suggestion for Improvement (as lesson learned from Polio Program)
Suggestion for Improvement (as lesson learned from Polio Program)
2 Investing More on Routine Immunization
Provincial EPI Management Teams should be further strengthen to ensure that
they can properly manage performance in all district
Afghanistan is a conflict zone and need more focus and more focus from donors
for support of RI
Two areas require more investments in conflict zones
Monitoring (limited number of people can move in security compromised areas)
Social Mobilization ( Prioritizing Preventive Health Interventions in a Stressful Environment is Challenging)