Epi in Pakistan

farheen zafar butt 2


Topic of presentation:“EPI IN PAKISTAN; A SUCCESS OR A FAILURE ?”


PRESENTERS:

FARHEEN ZAFAR BUTT

SABA AHMED


PROGRAMME OVERVIEW

EPI was launched in 1987.

AIM: It aims at protecting children by immunizing them against

Child hood tuberculosis Poliomyelitis Diphtheria Pertussis Measles & Tetanus


Aim continues….

AND also protecting their mothers against tetanus.


PROGRAMME OBJECTIVES

Reduction of mortality and morbidity resulting from 7 EPI target diseases by immunizing children of age 0-11 months and women of child bearing age.90% routine immunization coverage of all EPI antigens by 2012.Interruption of polio virus transmission by 2010.


“Program objectives “continues….

Elimination of neonatal tetanus by 2015

Reduction of measles mortality by 90% by 2010.

Reduction of diphtheria ,pertussis and childhood T.B. to a maximum level.

Control of other diseases by introducing new vaccines in EPI as and when they are available using EPI as a spearhead for promoting other PHC activities and finally integrating EPI into primary health care


EPI SCHEDULE:

ROUTINE IMMUNIZATION SCHEDULE:

BCG & OVP 0 dose are given at birth,

DPT, HBV & OVP at 6, 10 and 14 weeks

Measles vaccine at the age of 9 months.

The pregnant ladies and child bearing age ladies are provided immunization against TT.


EPI schedule continues…

THE SCHEDULE OF VACCINATION OF PREGNANT WOMEN AND LADIES OF CHILD BEARING AGE IS:

TT 1 at first contact,

TT 2 at least 4 weeks after 1st dose,

TT 3 at least 6 months after 2nd dose,

TT 4 at least 1 year after 3rd dose and

TT 5 at least one year after 4th dose)


Program Responsibilities at Federal level Overall planning

guidance, support , monitoring and evaluation

Coordination with International Agencies

Purchase of vaccines/syringes and supply to provinces

Mid-level Managers Training


Program Responsibilities at Provincial level Implementation

Collection of vaccines/syringes/needles from the Federal EPI Cell for further distribution to the districts

Repair and maintenance of equipment

Monitoring, evaluation and reporting

Supervision at all EPI service delivery level

Training of all EPI workers except Mid-level Managers

Evaluation of EPI success:









%age of children immunized in each province (up to 2006)

ANTIGEN PUNJAB SINDH NWFP BALOCHISTAN

BCG 89.9 84.2 74.3 59.0

DPT3 82.6 66.5 61.3 40.2

MEASLES 80.2 63.6 57.6 40.9

FULLY IMMUNIZED

76.2 59.8 52.0 32.0


ANTIGEN AJK FATA FANA

BCG 95.5 53.4 86.9

DPT3 91.1 37.4 66.5

MEASLES 88.70 32.0 70.60

FUULY IMMUNIZED

84.0 25.6 59.6


EVALUATION RESULTS:

The trend of graphs shown in previous slides; indicates that EPI in Pakistan has been quite successful. Where as there is a room for

improvement.

Recent additions in EPI targets:


meningitis Surveillance The Federal EPI has established Sentinel sites at several tertiary care hospitals in the country to see the disease burden of Bacterial Meningitis in the country which will facilitate the EPI Program for the introduction of Hib vaccine in the country.

High levels of advocacy achieved through involvements of politicians, religious leaders and community elders using Inter Personal Communication (IPC), Print and Electronic media tools.The federal Government ensured required funding for the routine programme.EPI Diseases Surveillance system established


Combination tetravalent vaccine Introduction of Combination tetravalent vaccine (DPT + HepB) from 2008. This will eliminate the coverage difference between DPT3 and Hep B 3.

HURDLES IN ATTAING 100% RESULTS:


The course of vaccine is not completed.



In complete or last minute planning at federal and provincial level.

IDEAS FOR IMPROVEMENT:


How to improve?

BY:

• Developing integrated social mobilization /communication plans for EPI at all levels.

• Developing more responsibility and resources for social mobilization to provinces and districts for Facilitating local strategies.

• Holding more frequent meetings among partners.


How to improve the communication strategyGeneral

• Focus messages on reaching every child every round, e.g. search for the missed children beginning

• Strengthen EPI communication, especially between PEI rounds.


Mass media• Extend mass media broadcasting before and after rounds.• Work more creatively with PTV and build their capacity to plan and produce effective spots.• Improve the use of BBC, VOA and other international networks.• Place spots on cable TV channels.• Explore synergies with neighboring country mass media channels.


Other channels• Place the ‘every child, every time message’ on such as balloons, matchboxes, poster, stickers onvehicles, product labels focusing on the “every child, every time” message.• Distribute calling card to closed homes.• Employ special communication strategy for reaching hard-to-reach groups e.g. elites: glossy andspecial interest magazines, airlines, supermarkets, paediatricians, Rotary and Lions Clubs,hairdressers, housing co-operatives, GSM networks, ISPs, internet cafes, taxi drivers, colleges, etc.• Involve pre-schools (securing prior permission from parents).


Using electronic media can be a good source of generating awareness about EPI among lay men.


REFRENCES:

WHO/UNICEF Review of National Immunization Coverage1980-2003Pakistan PEI/EPI Communication Review Report By Mike Favin, Robert Tyabji and Susan Mackay Islamabad, 22 July 2001


Documents

Epi in Pakistan