neap 2016 2017 final_dr_safi
TRANSCRIPT
Polio eradication in Afghanistan
NEAP 2016-2017
NEAP Workshop, Afghanistan
24 October 2016
2
President
REOCs
National Polio Focal Point
Presidential focal point
Line Ministries Governors
Minister of Public health
NEOCAll line
department of MoPH
Changes in program management
NEAP 2016-17• Goal:
– To stop WPV transmission in Afghanistan by the end of December 2016, with no new wild poliovirus type 1 (WPV1) cases from January 2017 onwards
• Strategic approach:– Maintain programme neutrality and gain access to all
children with OPV, irrespective of the area where they reside
– Implement alternate strategies, i.e. use Polio Plus interventions and the PTT, particularly in inaccessible areas
– Focus on identified high-risk provinces and districts and areas where children are persistently missed
– Underpin all strategies by ensuring strong household and community engagement; and
– Enhance accountability of all stakeholders, at all levels
Targets and milestones
• 5 SIAs in the second half of 2016 and 5 in the first half of 2017:– Reaching over 90% of children during each SIA
– >90% LQAS lots accepted at 80% and <5% missed children in PCM
• One IPV-OPV SIA in all VHRDs by end Sept 2016
• Revise microplans of all VHRDs by the end Sept 2016
• Operationalize full-time ICN in all VHRDs by the end Sep 16
• Maintain NPAFP rate of >2 cases/100 000 with adequate stool specimens collected from >80% of AFP cases in every district across the country
• Implement the accountability framework: End August’16
NEAP 2016-17• Continue strengthening polio governance and
management structure:– EOC: Task team modality, weekly TCs– Expansion of M&A officer to all 47 districts– Provincial & district task force: Revise TOR– Implement accountability framework from August
onwards
• High risk approach:– Focus on 47 district and 5 high risk province – District profile and specific plans for all VHRDs after each
SIA– Districts in between VHRDs treated as high risk – Revision in December 2016
High risk areas
New terminology
Revision in December 2016
District profile and specific plan of action• Profiling done for all VHRDs
• Specific issues identified and action plan developed
• Updated after every campaign
• Process supervised/ guided by regional/national level
• Reviewed and tracked from national level
District profile Updated 15-May-16 Fill in light blue cells
District details Number # High risk population groups Y/N Pop size Pattern
District name Shahwalikot 117,691 Nomads Yes 600
Mobile nomads
(stays for 5
months- (Nov-
Mar)
Geo-code (DCODE) 3306 4,708 Migrant labourers, Ailaks No -
LPD (1, 2) 1 23,538 IDPs No -
Province Kandahar 52,961 Others (specify) No -
Region South
Number # Number #
Epidemiology Number # 3 2
WPVs in 2015 1 1 2
WPVs in 2010-14 7 2 1
Compatibles in 2015 No 0 0
5 0
# Planned # Implemented
3 3
24 24
16 13
Number #
139
56/day
# adeq # inadeq
5 0
10 6 28
9 3
5
0
Number #
0
2
0
Number #
72 %
1,320 23%
12 17%
165 19%
o
#
76
93
69
9
Round 1 Round 2
# No
108
13
0
Date
District Polio Officers (DPOs)
District Communication Officers (DCOs)
# of districts same PPO covers
# of districts same PCO covers
M&A Officers
Routine immunization services provided in district
Number of Health Facilities providing RI services
RI sessions per month (total incl. fixed/outrech)
RI outreach sessions per month
NameRoutine immunization
BPHS NGO BARAN
Cluster Supervisors
SIA quality (trend)
7
5
6Intra-campaign Monitors (ICM)
Post-campaign Assessment (PCA) Monitors
28
- Team workload
(# of teams by work load category)
LQAS result (March 2016. if conducted) N/A
2.3.5.7.8.9.10.11.12.13.14.15.16.19.20.22.23.24.25.26.27
2.3.5.7.8.9.10.11.12.13.14.15.16.19.20.22.23.24.25.26.27
Clusters with inaccessibility (list)
Clusters with inaccessibility >6 months (list)
Clusters under AGE influence (list)
Clusters with limited supervision (list) - Refusal
- Others
Clusters with >5% missed children during last round (list)
2.3.4.9.10.11.13.15.17.20.21.23.27
SIA quality (last round)
Reason for missed children (last round)
- House not visited
- Child not available
Missed children (last 4 rounds)
March-16
February-16
January-16
December-15
AGE influence
0
Four Picnic teans are functioning in Dalla Band during revisit day (Friday)
Index case is resident of Maghdod village, Cluster # 7. Base on revised Micro plan and according
to the old SIAs. Micro-plan the area was belong to Cluster # 26. Maghdod hamlet has only 8
households harboring 24 families, and Its population is scattered. This area is fully under control
of AGEs, almost 2 months ago the Ambulance of the Shawalikot district was burned by unknown
people, also AGEs of the area do not allow mobile health services and RI outreach activities.
Implementation, Generally Majority of local people are farmers by occupation and very poor
and have no basic facilities of life. Nutritious status and education level of the index case village
is very poor. Illiteracy level is very high at the district level in general and at the index case area
in particular. The main sources of drinking water are streams, hand pumps and shallow wells,
Area sanitation is very poor, people use pit latrines and also have habit of open defecation
AFG/08/16/141- 2016 WPV case:
IPV campaigns conducted
Start date
% target
PCA coverage
% of clusters under AGE influence 75%
%
*Narrative description of WPV cases in 2015/16
Social mobilization
# of ICN
# of influencers
No
Special events (list incl. descption, timing/frequency)
Special sites (list incl. description, location)
Clusters with no ICN (list)
Gatherings held with community elders/ shuras, mullah imams. Sports events held.
Microplan analysis#
28
6725
Villages
Teams
139
Clusters
Schools
Houses
Vaccination Teams
400-600 children
>600 children
Total
<5 teams
5-6 teams
>6 teams
Supervisors
- Supervisor workload
(# of supervisors by work load category)
Team composition
(# of teams by composition)
15/12/2015
Alternative vaccination strategies
Permanent Polio Teams (PPT)
Permanent Transit Teams (PTT)
Cross-Border Teams (CBT)
Microplan field validation
Field validation of microplan completed
at least 1 female
none local
one local
both local
at least 1 CHW
Human resources
Surveillance
AFP cases in 2014-1016
Demography
Total population
<1 years
<5 years
<15 years
Health Facilities (HFs)
- Primary HFs
- Secondary HFs
- Tertiary HFs
- Private Clinics
Health services
3
Number #
3
1
1
1
Detailed narrative description below*
Category
Total
<400 children
Inaccessible children during SIAs (last 4 rounds)
Access and security
SIA Transit Teams
Nomads Teams
Communication Cluster Supervisors
District Coordinators
%
100%
1.1
HFs which are part of reporting network
- High priority (HP)
- Medium priority (MP)
- Low priority (LP)
Weekly reporting
- Timeliness of weekly report
AFP cases
Children inaccessible for >6 months
March-16
February-16
January-16
December-15
- AFP cases expected/year in 2016
- AFP cases with 0 dose (2014+2015)
- AFP cases reported in 2016
- AFP cases reported in 2015
- AFP cases reported in 2014
Microplan
0
28
0
2 ( I each secondary and high)
Number #
941
Jan-SNID Feb-SNIDs Apr-SNIDsMar-NIDs May-NIDs
SIA Schedule for July’16 to June’17
July, VHRD Aug , NID Oct, NID Dec, SNIDNov, SNID
Q3-Q4, 2016
Q1-Q2, 2017
IPV: SIAs• Completing IPV SIAs in 9 districts of Kandahar (Sep/Oct)
Category VHR, no IPV in 2015-16 Areas inaccessible for >6 months
Districts Behsud, Jalalabad, Qaysar, Jaranj, Dehrawood, Trinkot, Qalat, Bermel, Laskargah, Musaqala, Nade Ali, Nahre Saraj, Kandahar, Kabul
Pachieragam, Kot, Achin, Mehtarlam,
Alingar, Watapur, Marawara, Dara-e-Pech,
Chapadara, Nari, Kunduz, Emamsaheb,
Qala-e-Zal, Chardarah, Aliabad, Khanabad,
Dasht-e-Archi, Kamdesh, Chora, Nad-e-Ali,
Zheray, Shahwalikot, Maywand, Reg,
Shorabak, Gardez, Pasaband
Target population 808,859 247,304
Doses required 970,631 296,765
Time period Q1 2017 As soon as access is gained
Open for discussion
Enhancing campaign quality• Complete in remaining 10 VHRD by end of Q3
2016, 49 HRD by Q4 2017 and repeat in 47 VHRD in Q1 2017
Revision of micro-plans
• Local, female and able to read/write, selected on merit (AGE or Government controlled areas)
Improving team selection
• Monitoring of training in VHRD; NEOC to track attendance and quality
Improving the quality of training
• Tracking performance of vaccinators and supervisor of VHRD over the rounds
• Reward/sanction as per accountability framework
Monitoring and performance management
• Payment within 30 days of end of campaign; tracking from National EOC. Phase wise expansion of DDM
Ensuring timely payment of FLW
Enhancing campaign quality• Identification, training and deployment of
national/ regional level monitors for pre/intra/post-campaign phase
National monitors
• Rationalized workload, monitoring by DC, tracking performance over rounds
Improving performance of
cluster supervisors
• Continue and strengthen Revisit strategy
• pre-campaign dashboard (review on 10/7/3/1 days before campaign
• Corrective actions as neededPre-campaign
• VHR districts: 1 ICM for every 5 supervisors, real time data collection using IVR technology
• ICM data use, intra-campaign dashboardsIntra-campaign
Improved campaign monitoring
• PCM: 100% of clusters in VHRD and 50% in others
• Expansion of all VHRD and HRD as feasibleExpanded scope
• Monitoring of PCM monitors (5% sample cross checking)
• 10% surveyors and completed forms to be cross checked
Ensuring quality
• Availability of data within 10 days of end of campaign
• Use of mobile technology for real time data flow
Data flow
• Detail field investigation and plan for corrective action for areas with failed LQAS lots and PCM with >3 missed children in one team area
Corrective action
Field investigation of areas with poor performance
• Detail investigation of each failed lot in LQAS and PCA with >3 missed children
• Identification of core issue and action plan for improvement
• Done by joint team from provincial level
• Review and tracking from national level
Detailed Investigation Form for failed lots in LQAS (failed at 80%) and/or >3 missed children in PCAInstructions
Date of detailed investigation
Dr. Tahsil PEI and Dr.Matiullah PPO WHO
0 UNICEF
0 MoPH
Yes
Yes, dot mark is there ( S/M working three days before and during campaign)
weak revisit , Weak supervision of DC and C/S.
Planned interventions to improve performance for next campaign
Selection of eligible volunteers, Focused on FLW training, updating itinerary, increased S/M activities for convince of family, focussed on dialy and 5th day revisit.
supportive supervision and monitoring according to the plan.
Selection of new volunteers and supervisor, non eligible volunteers, hurriedly working, weak record of missed children, weak follow up of missed children, No commitment of C/S , Volunteers and S/M .
Child 2: Reason of missed child (as per caregiver) Child was not at home
Child 3: Reason of missed child (as per caregiver) Child as vaccinated but no finger marked
Child 4: Reason of missed child (as per caregiver)
Child 5: Reason of missed child (as per caregiver)
Child 6: Reason of missed child (as per caregiver)
Core issues identified for poor performance
Has the mobilizer (if present) been paid for the last campaign?
Is there evidence of social mobilization activities in the area? Please
elaborate.Comment on awareness and acceptance of polio vaccine by
community as well as by caregivers of missed child; if household was
refusing, please explain why.
Yes
Child 1: Reason of missed child (as per caregiver) Child was not at home
Revisits (quality of revisits during and post-campaign) Working not well
Quality of supervision (was the area visited by supervisor, ICM etc
during the campaign?)
Yes
Have vaccinators and supervisor been paid for last campaign? No
Team composition (comment on whether team members are local,
has at least one female etc.)
Local and Female
Training (comment on knowledge of team, whether both members
were trained in last training)
Yes
Team work load (comment on work load i.e. number of children to be
covered, geographical challenges, etc.)
178/ day ( G1 area)
Team # T5
Is the area included in microplan Yes
Was the area/houses visited by team. If no, give reasons why. Yes
Village Rahmatulul alamin
Name of area Tortank
Name of Cluster Supervisor Sadiqa
Province Helmand
District Bost
Cluster 29
Component Inputs/Comments
Dates of campaign April, SNIDs 2016
Region Southren
Members of investigation team
1 - Detailed field investigation to be conducted for all lots failed in LQAS (rejected at 80%) and/or >3 missed children in PCA in a subcluster (village) .
2 - Investigation to be conducted within one week after availability of results.
3 - Team for detailed investigation to consists of WHO, UNICEF, and MoPH (where applicable).
4 - Team to look into the reasons for children missed by visiting the households with missed children .
5 - Investigation team to review composition, work load, and training status of concerned vaccination teams and also look into quality of supervision and microplanning .
Campaign review meetings
Pre campaign
• National, regional and provincial levels
• 2-4 weeks prior to campaign
• Dashboard
• At EOC10/7/3/1 day before campaign
Intra campaign
• National, regional, provincial and district levels
• Standard matrix for documentation
• Dashboard
• Core committee at National level for response
Post campaign
• National, regional, provincial and district levels
• 15 days after the end of each campaign
• Dashboard
• Representation from the National EOC in 5 HR provinces
Data flow Data Source Timeline
Pre-campaign
1 Preparation of campaign EOC/PEMT 2 weeks, 1 week, daily in last week
2 Coordination meeting EOC/PEMT 10 days before SIA
Intra-campaign
3 Administrative coverage EOC/PEMT Next day afternoon
4 ICM EOC/PEMT Next day afternoon
5 Evening meeting EOC/PEMT Next day afternoon
Post-campaign
6 Administrative coverage EOC/PEMT 10 days after SIA
7 PCM WHO 10 days after SIA
8 LQAS WHO 10 days after SIA
9 Out of house survey WHO 10 days after SIA
10 Compiled ICM data EOC/PEMT 10 days after SIA
11 Access data EOC/PEMT 10 days after SIA
Open for discussion
Accessibility status during recent SIA
Cat 1: Fully accessibleCat 2: Partially accessibleCat 3: Accessible with security challengesCat 4: Fully inaccessible
May NID
July SNID
Addressing inaccessibility
IPV and OPV from nearby health facility
Polio plus from nearby health facility
PTT at entry / exit points
3 rounds of SIADs (1 IPV) in newly accessible
Cluster & village level mapping
Negotiations & community engagement
Areas inaccessible for vaccination
Areas with limited access
Negotiations on quality of campaign & independence
for monitoring
Remote monitoring
Use of neutral third party
Forum for providing feedback
Complementary vaccination activities• Assess and modify the number and
location as per need of the programme and evolving accessibility situation
• Strengthen supervision and monitoring with close tracking from National EOC
PTT and CBT
• Review the performance of the existing PPTs and modify as requiredPPT
• Special vaccination campaign for NomadsNomads
• Coordination with OCHA/UNHCR/IOM through a task team
• Vaccination at UNHCR and IOM sites
• OPV & IPV
Returnee refugees
Demand generation• Communication plan as part of district specific
plan
• Full-time ICN operational in all VHR districts
Household and community
engagement
• Mapping & engagement of key religious leaders at local level building on NIUG platform
• Workshops with doctors, health workers & other key stakeholders
Partnerships with key influencers
• Regular media briefings & trainings and interactions
• Development of awareness raising materials for print & electronic media platforms
External relations and partnerships
• Implement 2nd Harvard poll
• Third party monitoring of communication interventions in VHR districts
Data collection and evidence
generation
Monthly workflow of a full time social mobiliser
Campaign
Week
Week.+1Catching up
missed children
from campaign
Week.+/-2Community
engagement
Polio+
Week.-1Pre-Campaign
preparation;
Registry;
Awareness;
Shift to sustained engagement Focus on reducing
missed children
Use of registers for child registration, follow up and vaccination of missed children after campaign by ICN Network
Tracking chronically missed children
Promoting a broader package including routine immunization referral, hygiene and sanitation and ANC in between campaigns
Open for discussion
Surveillance
• Expansion to include newly opening health facilities
• Strengthen sensitization visits and monthly tele callsReporting network
• Review the existing ES sites
• Explore possible expansion to the areas surveyed in 2015
Environmental surveillance
• Alternate mode/route of specimen shipment to RRL as a contingency
Specimen shipment
• Disaggregate data analysis by district and access status to identify gaps and corrective actionData analysis
Cross border coordination
• Weekly communication between the focal points; biannual face to face meetings and regular VCs
• Monthly meetings of concerned provincial teams
• Joint case response for cases at the borders
Evaluation
• NEAP progress review in Jan and June 2017
Operational
• Surveillance review in June 2017
Surveillance
• In Kandahar in Q1 2017Serosurvey
• OPV doses in NPAFP casesPopulation immunity
RI strengthening
• 20% time on RI
• Training of program staff of RI
• Monitoring of sessions
• Support in training of FHWs
• Feedback on monitoring to BPHS NGOs
Operations
• Inclusion of RI in the message at key stakeholders meetings
• Missed children tracking by ICN
• Tracking of newborn and mobilization of parents for RI
Mobilization
Focus of intervention in VHRDs
Tashakkur/ Dera Manana
Open for discussion