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


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)


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


Goal of 2016-17 NEAP

• To stop wild poliovirus transmission in Afghanistan by the end of 2016, with no WPV1 from January 2017 onwards


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


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


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


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


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


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)


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


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


3. Enhancing campaign quality cont.

• Campaign coordination and review meetings

– Pre-campaign coordination meetings

– Intra-campaign review meetings

– Post-campaign review meetings


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


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


• 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


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


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


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


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


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


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


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


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


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


Question to the TAG

• Is the NEAP presented, appropriate to interrupt polio transmission?


THANK YOU


polio eradication in afghanistan way forward 2016 17

Healthcare