Nation-wide Measles/Polio SIAs in Afghanistan, 2012

Background

The action have been prompted by the nation wide measles outbreak in 2012.

Three folds increase in the number of cases as compared with 2011

High mortality rates in initial phases (before response)

Double number of outbreaks almost in all provinces

Age-distribution of measles,2008-2011

Mapping of cases/outbreaks, Jan-June 2012

SIA Dates

Nation-wide Measles/Polio Follow up SIAs in Afghanistan, 2012SIA Dates 7-12 July 2012 (1st phase)

1-6 December 2012 (2nd phase) 18-22 November (Mop-up measles campaign in 16 districts)

Target age group

9M-10Y for measles 0-10Y for OPV

Target population (#) for Measles

5,616,580 (for Measles SIAs 1st phase) 4,279,589 (for measles SIAs 2nd phase) 106,500 (for measles mop-up campaign in 16 districts) 10,002,669 – total target

Population reached (#)

6,025,203 (Measles reported – 1st phase) 4,755,519 (Measles reported – 2nd phase) 98,778 (measles reported coverage of measles mop-up campaign) 10,879,500 – total number of children vaccinated with measles

Coverage (%) achieved

106% (measles reported coverage), 93% (PCS result) – 1st phase 111% (measles reported coverage), 96% (PCA result)- 2nd phase National coverage (all 34 provinces) based on Post Campaign

Assessment (PCA) – 94%

3rd Nation-wide Measles/Polio Follow up SIAs in Afghanistan, 2012

Number of immunization posts 1497 (fixed centers)Number of vaccination teams 17,219 (outreach/mobile teams) Total # of health workers, volunteers, supervisors, monitors and evaluators were engaged in measles SIAs

71, 872.

Other Interventions (number reached and % coverage if available)

In addition to measles vaccine, OPV was included into measles SIAs. Total # of children 0-10Y received OPV: 11,679,211 (92%) children aged 0-10Y have received a full dose of OPV.

Major national/local partners WHO,UNICEF, MOPH and all Health NGOs

Resources utilizationCost/Child immunized

So far, around $12 million spend

Challenges/Constraints

• Poor quality of district micro-plans (some provinces)• Weak strategy for remote and high-risk areas • Weak communication & social mobilization strategies• Shortage of trained health workers • Difficulty in reaching all children in problematic

provinces (Kandahar, Helmand, Farah, Zabul, Uruzgan, Badghis, Ghor, Kunar and Nooristan, Paktika, Paktya and khost); 54 districts underperformed

• Shortage of cold chain equipment • Over-reporting

Lessons learned• Early preparation and proper micro-planning is the key• Inaccurate denominator resulted in in-adequate micro-

planning including incorrect estimation of vaccine/supplies, human resource need and fund in many instances.

• Timely inventory of cold chain equipment is vital for adequate handling of vaccine and preventing shortage of vaccines at service delivery levels

• In advance identification of trained health workers and volunteers helps to timely conduct training courses

• Visiting all households for referring of children to the vaccination sites and adequate daily monitoring /reporting helps taking timely actions during the implementation

Future Plan• Local measles campaigns should be conducted

in partially covered districts to reach the un-reached children and supplement declining routine immunization coverage

• Conduct measles mop-up campaign in the districts that could not achieve 90% coverage for measles

• Implement RED strategy in all districts less than 60% coverage for EPI.

Provinces Problematic districts ( <90% SIAs coverage, <80% routine coverage, without EPI services) in need for Mop-up measles campaign, in 2013

Kandahar Maroof, Arghistan, Shorabak, Reg, Nesh, Ghorak, Khakrez, Shah wali kot

Helmand Khan Nshin, Sangin, Gramser, Deshu, Washer, Nawa Barakzai, Nawzad, Baghran, Kajaki,

Farah Poor Chaman, Gulistan, Bakwa, Bala Blook, Khaki Safid, Lash wa Joien

Zabul Daychopan, Mizan,Tarnak Wa Jaldak, ShinkayAtghar, Shamulzayi

Uruzgan Chora, Shahid Hassas, DihrawudBadghis Qadis, Jawand, Ghor Saghar, Tayawara, Pasaband, Tulak, ShahrakKunar Mrawara, Nari, Chapa Dara, NurgalNooristan Kamdesh, Waygal, Mandol, Mandol, wamaPaktika Gomal, Omna, Barmal,, Gayan, NekaPaktya Shwak, ZoormatKhost Musa Khael, SabariBadakhshan Darwaz, Jurm,

ProvincesDistricts ( <90% SIAs coverage, <60% routine

coverage) in need for Mop-up measles +pulse immunization campaign, in 2013

Additional districts coming from median coverage

Kandahar Maroof, Arghistan, Shorabak, Reg, Nesh, Ghorak, Khakrez, Shah wali kot Shah Wali Kot, Maroof

HelmandKhanshin (Reg), Sangin, Gramser, Deshu, Washer, Nawa Barakzai, Nawzad, Baghran, Kajaki,

Nahri Saraj, Musa Kala, Nad Ali, Nawa Barakzai, Sangin, Gramser, Washer

Farah Poor Chaman, Gulistan, Bakwa, Bala Blook, Khaki Safid, Lash wa Joien

Zabul Daychopan, Mizan,Tarnak Wa Jaldak, Shinkay Atghar, Shamulzayi

Uruzgan Chora, Shahid Hassas, Dihrawud Badghis Qadis, Jawand, Qala I Now, MugurGhor Saghar, Tayawara, Pasaband, Tulak, Shahrak Lal Wa SarjangalKunar Mrawara, Nari, Chapa Dara, Nurgal PechNooristan Kamdesh, Waygal, Mandol, Wama Nungaram, Du Ab, Paktika Gomal, Omna, Barmal,, Gayan, Neka Wor ManayPaktya Shwak, Zoormat Jadran, Jani Khel, Jaji Ayoub, Khost Musa Khael, Sabari KalandarBadakhshan Darwaz, Jurm, Khwahan, Ragh, Kohistan

Thank You