Polio Eradication Initiative Afghanistan

Southern Region

Challenges, priorities and tactics 2011

TAG Meeting IslamabadMarch 24-25, 2011

Outline of Presentation• Challenges and steps taken

– Insecurity affecting accessibility to children, staff safety and leading to internal displacements

– Management issues affecting campaign quality – Higher risk of WPV transmission in 13 key districts– Cross border population movement

• Other steps taken in Southern region• Remaining challenges • Way forward/tactics 2011

• Summary

HilmandNimroz

Kandahar

Uruzgan

Zabul

RegGarmser

Dishu

Chahar Burja

Chakhansur

Day Kundi

Panjwayi

Nad Ali

Khash Rod

Maruf

Gizab

Washer

Daman

Chora

Spin Boldak

Baghran

Shorabak

Kijran

Arghistan

Naw Zad

Shahristan

Qalat

Maywand

NeshKajaki

Shah Wali Ko

Daychopan

Shamulzayi

Kang

Arghandab

Shinkay

DihrawudTirin Kot

Ghorak

Musa Qala Shahjoy

Khas Uruzgan

Atghar

Mizan

Shahidi Hass

Khakrez

Nahri Sarraj

Lashkar Gah

Zaranj

Tarnak Wa JaSangin

Kandahar

Naway i Bara

Region Target <5 Years

Southern Region 1298495

High Risk District 699928 (54%)

13 High Risk Districts of Southern Afghanistan

>90% of the cases in Afghanistan in the last 10 years are from South & almost 90% of these are from 13 HRD

Kandahar = 5Helmand = 5Urozgan = 3

19

95 3 3

9

28

15

25

34

19

105

10152025303540

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Num

ber o

f cas

es

Year

Security situationStarted worsening

Worsening security leading to increase in number of polio cases in Southern region

No.

of s

ecur

ity in

cide

nts

© UNDSS AFG - SR Security Incidents

0

100

200

300

400

500

600

700

Jan-03

May-03

Sep-03

Jan-04

May-04

Sep-04

Jan-05

May-05

Sep-05

Jan-06

May-06

Sep-06

Jan-07

May-07

Sep-07

Jan-08

May-08

Sep-08

Jan-09

May-09

Sep-09

Jan-10

May-10

Increase in security incidents

9941895929

89980

66652

66652228

1480718408 18330

92117

70000

33819 35804 36030 38616

3001922262

17047

0

20000

40000

60000

80000

100000

120000

No:

of i

nacc

essi

ble

Child

ren

No:

of i

nacc

essi

ble

Child

ren Helmand province

Kandahar province

NGOs Involvement

NGOs Involvement

Military operation

Panjwai and SW Kot military operation

Impact of BPHS NGOs involvement on No: of Children inaccessible in NGOs districts of each Helmand and Kandahar

Steps taken to improve accessibility and staff safety in Southern Region 2010

• Making NGOs responsible for campaign implementation in 10 districts (6 among them are high risk)

– Provincial manager recruited for the 2 main provinces

– Fulltime District manager for every NGOs district

• Access Negotiators hired where ever required

• Involving of local influential and elders

• Establishing transit posts for longer period on entry/exit of districts having conflict & accessibility issue– 6 transit posts (2 in HLD & 4 in KDR) with 16 Transit Teams,

working in two shifts– Cabins prepared with seating arrangements for their

facilitation and SM material displayed

• Updating micro plans of the areas with IDPs– Supervisors & teams selected from the community– Focused SM activities in areas having IDPs

Response to internally displacements due to insecurity in High priority districts Southern Region 2009-10

Transit teams coverage in Helmand and Kandahar province by month Southern Region from Feb 10 – Feb 2011

114,097 children vaccinated Feb 10 – Feb 2011

216,407 children vaccinated Feb 10 – Feb 2011

Since establishment 549,241 children vaccinated, out of which

264, 516 are from 10 HRD

Steps taken to improve campaigns in the 13 high risk districts (Southern Region)

• District Specific Plans developed in January were refined & completed in first week of August 2010 having communication as integral part

• Appointment of District Managers in the remaining 7 HR districts not with NGOs since September 2010

• Special training of all District Managers in October 2010 at Kandahar

• Advance payment in the 3 key provinces from October 2010 having the 13 priority districts

• Capacity building of District & cluster level supervisors by consultant company. Training materials also revised by this consultant company for volunteers.

• Revision of micro plans to make the workload reasonable and include some of the areas not part of micro plan. (8 DCs, 28 CSs and 136 teams added)

• Integration of communication plan in District Plans and also expansion of SM activities. (SM teams increased from 458 to 890)

Campaign quality issue as wellFM not allowed by AGE

Performance in High risk districts Mar 10 to Mar 2011 SIAs% coverage verified through Finger Marking in accessible areas

Adjusted Coverage (FM) in 5 HRD of Kandahar province by round Mar 2010 – Mar

2011

0

10

20

30

40

50

60

70

80

90

100

Kandahar Shahwalikot Maywand Panjwayi Spin Boldak

Mar-10 May Jun Jul Oct Nov Dec Jan Mar-11

Adjusted Coverage (FM) in 5 HRD of Helmand province by round Mar 2010 – Jan 2011

0

10

20

30

40

50

60

70

80

90

100

Bust Musa Qala Naw Zad Nad Ali Sangin

Mar-10 May Jun Jul Oct Nov Dec Jan Mar-11

Adjusted Coverage (FM) in 3 HRD of Uruzgan province by round Mar 2010 – Mar 2011

0

10

20

30

40

50

60

70

80

90

100

Tirin Kot Shahidi Hass Dihrawud

Mar-10 May Jun Jul Oct Nov Dec Jan Mar-11

Covering the target children on the move crossing border from Pakistan and Iran

• Special Campaigns– Mop-up in 5 Key districts of Kandahar in response to first P1

from Shahwalikot

– Small Scale targeted campaign in 4 districts of Helmand using tOPV to respond VDPV2 in September

– Three rounds of Accelerated Campaign to boost Routine EPI Coverage in Urban Slum areas of Kandahar

• Meetings with NGOs to review their district performance

Other Steps taken in Southern Region

Challenges• Deteriorating security situation and military operations

in the region mainly in Kandahar and Helmand continues to limit access to children

• Areas where finger marking is not allowed by AGE is still an issue, making independent monitoring (FM) more difficult

• Fatigue in staff and even community due to frequent campaigns

• Improving routine is becoming more challenging in the current security situation

Way Forward/Tactics 2011• Regular revision and monitoring implementation of

district specific plan• Availing windows of opportunity to carry out SIADs in

priority areas.• High risk cluster approach to further focus efforts in 13

high risk districts• Acceleration campaigns to improve routine

immunization in areas with low routine• Identifying/enlisting new partners having district based

networks

Way Forward/Tactics 2011• Quarterly review of NGOs performance

• Identifying reasons for Zero dose cases and response vaccination campaign

• Further strengthening coordination and expanding role of ICRC

• Special communication strategies intervention to have district specific SM plan

Summary• The program has effectively engaged various stake

holders to try to access the children in conflict affected areas

• Political commitment at the Regional and provincial level is high that needs to be translated into accountability and actions at the district level

• District specific plans for high risk districts are trying to resolve operational and quality issues hampering progress

• Insecurity remains the main risk to the program

Staff lost in the last few years

Dr. Shamsul Haq "Kakar"

36Regional

Polio officer Spin

Boldak14th Sep

2008Suicide Attack

Dr. Mamoon Tahiri

32POLIO

Technical Officer

Spin Boldak

Sep --2008

Suicide Attack

Abdul Jalil 24District

ManagerKDH City

April-- 2010

Gun shot

Mohammad Haneef

45District

CoordinatorShawalikot Apr-10 gunshot

Mohammad Nasim

20 Volunteer KDH CityMar --2010

Complex attack on

prison

Maihan Toor 42Cluster

SupervisorKhashrood

district Jun-09

Kidnaped and killed

Abdul Manan 37 DST Ataghar Apr-07Land Mine

Incident Type

TitleNameIncident

datePhoto

Incident place

Age

Thanks

CDC Polio Hero Award being given to the widow of Late Mehan Tore Cluster Supervisors Khashrod district of Nimroz province

Achievements • Almost 1.2 million target children reached every campaign (8

campaign in 2010)

• Almost 50% reduction in inaccessible children that was brought down from 134,500 in Dec 2009 to 69,700 in December 2010.

• Capacity building of local staff by training almost 10,000 personal in every polio campaign and around 1,000 health care providers on AFP surveillance in 2010

• Median dose of AFP cases age between 6-59 improved from 7 in 2009 to 8 in 2010

• Supported EPI activities in micro planning, capacity building, monitoring and supervision.

More than 44% reduction in number of polio cases in 2010 as compared to 2009

Line bar showing P1 & P3 circulation Southern region Jan 2008- Feb 11

2

0

1

0

1

3

2 2

5

6

0

1

3

1 1 1

2 2 2

0 0 0 0 0 0 0 0 0

1

0

1

4

1

2 2

1

0

1

0

1

0 0 0 0 0 0 0 0 0 0 0 0 0

1

2

3 3

4

3

6

4

2

0

1

0 0 0 0 0 0 0 001234567

WPV1 WPV312 months 9 months 11 months

Steps taken to improve accessibility and Staff Safety Southern Region Afghanistan

• Expanding Role of ICRC ,– Facilitating “Letter of support” by AGE Leadership at country and at local level

• Close coordination with ISAF to exchange information on dates and areas included in campaigns while also marinating program neutrality

• Few sessions conducted for Afghan National Army/Police to brief them on polio campaign process and their role with help of OCHA. Now the mentors are briefing ANA & ANP on polio during their trainings.

Trends of Inaccessibility of children Southern RegionHigh Risk Districts Vs rest of the districts From Jan 09- to Jan 2011

Military OperationsMaiwand/SW Kot/Panjwai

Accessible Area

Inaccessible 6/ 8 rounds

Inaccessible 3- 5/8 rounds

Inaccessible 1-2/8 rounds

(10) Nadali/Marja, Bust, Tirinkot, Maywand, Shahid Hasas, Shahwalikot, Kajaki, Chora, Arghandab,(9) Nauzad , Washir, Garamser, Gizab, BaghranReg (H)Sangin , Nahrisaraj , Shorawak (7) Panjwai , Sangeen, Mosa Qala Nawa, Shanki, Shamalzai, Deshou

No of times when > 10% children were missed

Insecurity leading to inaccessibility Inaccessibility by District- Southern region Jan - Dec 2010

≥

RegGarmserDishu

Chahar Burja

Chakhansur

Day Kundi

Panjwayi

Nad AliKhash Rod

Maruf

Gizab

Washer

Daman

Chora

Spin Boldak

Baghran

Shorabak

Kijran

Arghistan

Naw Zad

Shahristan

Qalat

Maywand

NeshKajaki

Shah Wali Ko

Daychopan

Shamulzayi

Kang

Arghandab

Shinkay

Dihrawud

Ghorak

Musa Qala

Khas Uruzgan

Atghar

Mizan

Shahidi Hass

Nahri Sarraj

Lashkar Gah

Zaranj

Kandahar

Trends of Zero Dose AFP case age 6-35 months by quarter 09-11; High risk VS rest of the districts in South region

Other 37 Dist13 Priority Dist

Data up to 20 Mar 2011

Cross Border vaccination Teams coverage by three CB Posts in Southern Region Jan 10 – Feb 2011

A total of 273,169 children Vaccinated from Jan 10 to Feb 2011

Pockets of refusal families in Key districts

• Refusal not a major problem – Issue is pockets of refusal families in certain areas –

• Boldak (3%) Kandahar city (0.4%) and 2 cases in 2009 from such families

• Steps taken to address the issue – District shura and elders were taken on board– Senior health staff like REMT, PPCO and PPOs personally visited the

refusals– Awareness sessions conducted in community – father of refusal helped– Selection of local social mobilizers and expansion of Social mobilization

activities– Awareness about vaccinating their children to all coming to health

facility – Involvement of other departments like education & communication etc– Use of local FM radio channels and BBC Pashtu service, Azadi and VOA

Issue is sustainability & new IDPs moving from the war affected areas

Num

ber o

f Ref

usal

Chi

ldre

nN

umbe

r of R

efus

al C

hild

ren

Trends of refusal in Boldak and Kandahar after concerted efforts My 09- Jan 2011

tOPV bOPV

Type of OPV used in 2010 - 2011 SIAs2010

HilmandNimroz

Kandahar

Uruzgan

Zabul

May Feb Mar Jun

RegGarmser

Dishu

Chahar Burja

Chakhansur

Day Kundi

Panjwayi

Nad Ali

Khash Rod

Washer

Maruf

Gizab

Daman

Chora

Spin Boldak

Baghran

Shorabak

Kijran

Naw Zad

Arghistan

Shahristan

Qalat

Maywand

NeshKajaki

Shah Wali Ko

Daychopan

Shamulzayi

Kang

Arghandab

Shinkay

Dihrawud

Ghorak

Musa Qala

Tirin Kot

Shahjoy

Khas Uruzgan

Atghar

Mizan

Shahidi Hass

Khakrez

Nahri Sarraj

Lashkar Gah

Zaranj

Tarnak Wa JaSangin

Kandahar

Naway i Bara

Arghandab

Reg

RegGarmser

Dishu

Chahar Burja

Chakhansur

Day Kundi

Panjwayi

Nad Ali

Khash Rod

Washer

Maruf

Gizab

Daman

Chora

Spin Boldak

Baghran

Shorabak

Kijran

Naw Zad

Arghistan

Shahristan

Qalat

Maywand

NeshKajaki

Shah Wali Ko

Daychopan

Shamulzayi

Kang

Arghandab

Shinkay

Dihrawud

Ghorak

Musa Qala

Tirin Kot

Shahjoy

Khas Uruzgan

Atghar

Mizan

Shahidi Hass

Khakrez

Nahri Sarraj

Lashkar Gah

Zaranj

Tarnak Wa JaSangin

Kandahar

Naway i Bara

Arghandab

Reg

RegGarmser

Dishu

Chahar Burja

Chakhansur

Day Kundi

Panjwayi

Nad Ali

Khash Rod

Washer

Maruf

Gizab

Daman

Chora

Spin Boldak

Baghran

Shorabak

Kijran

Naw Zad

Arghistan

Shahristan

Qalat

Maywand

NeshKajaki

Shah Wali Ko

Daychopan

Shamulzayi

Kang

Arghandab

Shinkay

Dihrawud

Ghorak

Musa Qala

Tirin Kot

Shahjoy

Khas Uruzgan

Atghar

Mizan

Shahidi Hass

Khakrez

Nahri Sarraj

Lashkar Gah

Zaranj

Tarnak Wa JaSangin

Kandahar

Naway i Bara

Arghandab

Reg

RegGarmser

Dishu

Chahar Burja

Chakhansur

Day Kundi

Panjwayi

Nad Ali

Khash Rod

Washer

Maruf

Gizab

Daman

Chora

Spin Boldak

Baghran

Shorabak

Kijran

Naw Zad

Arghistan

Shahristan

Qalat

Maywand

NeshKajaki

Shah Wali Ko

Daychopan

Shamulzayi

Kang

Arghandab

Shinkay

Dihrawud

Ghorak

Musa Qala

Tirin Kot

Shahjoy

Khas Uruzgan

Atghar

Mizan

Shahidi Hass

Khakrez

Nahri Sarraj

Lashkar Gah

Zaranj

Tarnak Wa JaSangin

Kandahar

Naway i Bara

Arghandab

Reg

RegGarmser

Dishu

Chahar Burja

Chakhansur

Day Kundi

Panjwayi

Nad Ali

Khash Rod

Washer

Maruf

Gizab

Daman

Chora

Spin Boldak

Baghran

Shorabak

Kijran

Naw Zad

Arghistan

Shahristan

Qalat

Maywand

NeshKajaki

Shah Wali Ko

Daychopan

Shamulzayi

Kang

Arghandab

Shinkay

Dihrawud

Ghorak

Musa Qala

Tirin Kot

Shahjoy

Khas Uruzgan

Atghar

Mizan

Shahidi Hass

Khakrez

Nahri Sarraj

Lashkar Gah

Zaranj

Tarnak Wa Ja

Sangin

Kandahar

Naway i Bara

Arghandab

Reg

June

RegGarmser

Dishu

Chahar Burja

Chakhansur

Day Kundi

Panjwayi

Nad Ali

Khash Rod

Washer

Maruf

Gizab

Daman

Chora

Spin Boldak

Baghran

Shorabak

Kijran

Naw Zad

Arghistan

Shahristan

Qalat

Maywand

NeshKajaki

Shah Wali Ko

Daychopan

Shamulzayi

Kang

Arghandab

Shinkay

Dihrawud

Ghorak

Musa Qala

Tirin Kot

Shahjoy

Khas Uruzgan

Atghar

Mizan

Shahidi Hass

Khakrez

Nahri Sarraj

Lashkar Gah

Zaranj

Tarnak Wa JaSangin

Kandahar

Naway i Bara

Arghandab

Reg

RegGarmser

Dishu

Chahar Burja

Chakhansur

Day Kundi

Panjwayi

Nad Ali

Khash Rod

Washer

Maruf

Gizab

Daman

Chora

Spin Boldak

Baghran

Shorabak

Kijran

Naw Zad

Arghistan

Shahristan

Qalat

Maywand

NeshKajaki

Shah Wali Ko

Daychopan

Shamulzayi

Kang

Arghandab

Shinkay

Dihrawud

Ghorak

Musa Qala

Tirin Kot

Shahjoy

Khas Uruzgan

Atghar

Mizan

Shahidi Hass

Khakrez

Nahri Sarraj

Lashkar Gah

Zaranj

Tarnak Wa JaSangin

Kandahar

Naway i Bara

Arghandab

Reg

July OctSep

RegGarmser

Dishu

Chahar Burja

Chakhansur

Day Kundi

Panjwayi

Nad Ali

Khash Rod

Washer

Maruf

Gizab

Daman

Chora

Spin Boldak

Baghran

Shorabak

Kijran

Naw Zad

Arghistan

Shahristan

Qalat

Maywand

NeshKajaki

Shah Wali Ko

Daychopan

Shamulzayi

Kang

Arghandab

Shinkay

Dihrawud

Ghorak

Musa Qala

Tirin Kot

Shahjoy

Khas Uruzgan

Atghar

Mizan

Shahidi Hass

Khakrez

Nahri Sarraj

Lashkar Gah

Zaranj

Tarnak Wa JaSangin

Kandahar

Naway i Bara

Arghandab

Reg

RegGarmserDishu

Chahar Burja

Chakhansur

Day Kundi

Panjwayi

Nad AliKhash Rod

Maruf

Gizab

Washer

Daman

Chora

Spin Boldak

Baghran

Shorabak

Kijran

Arghistan

Naw Zad

Shahristan

Qalat

Maywand

NeshKajaki

Shah Wali Ko

Daychopan

Shamulzayi

Kang

Arghandab

Shinkay

Dihrawud

Ghorak

Musa QalaShahjoy

Khas Uruzgan

Atghar

Mizan

Shahidi Hass

KhakrezNahri Sarraj

Lashkar Gah

Zaranj

Tarnak Wa Ja

Sangin

Kandahar

Naway i Bara

HilmandNimroz

Kandahar

Uruzgan

Zabul

RegGarmser

Dishu

Chahar Burja

Chakhansur

Day Kundi

Panjwayi

Nad Ali

Khash Rod

Washer

Maruf

Gizab

Daman

Chora

Spin Boldak

Baghran

Shorabak

Kijran

Naw Zad

Arghistan

Shahristan

Qalat

Maywand

NeshKajaki

Shah Wali Ko

Daychopan

Shamulzayi

Kang

Arghandab

Shinkay

Dihrawud

Ghorak

Musa Qala

Tirin Kot

Shahjoy

Khas Uruzgan

Atghar

Mizan

Shahidi Hass

Khakrez

Nahri Sarraj

Lashkar Gah

Zaranj

Tarnak Wa JaSangin

Kandahar

Naway i Bara

Arghandab

Reg

2011

DecNov

Feb Mar

RegGarmserDishu

Chahar Burja

Chakhansur

Day Kundi

Panjwayi

Nad AliKhash Rod

Maruf

Gizab

Washer

Daman

Chora

Spin Boldak

Baghran

Shorabak

Kijran

Arghistan

Naw Zad

Shahristan

Qalat

Maywand

NeshKajaki

Shah Wali Ko

Daychopan

Shamulzayi

Kang

Arghandab

Shinkay

Dihrawud

Ghorak

Musa Qala

Khas Uruzgan

Atghar

Mizan

Shahidi Hass

Nahri Sarraj

Lashkar Gah

Zaranj

Kandahar

Accessibility of districts to PPO Dec 2010 Southern region

RegGarmserDishu

Chahar Burja

Chakhansur

Day Kundi

Panjwayi

Nad AliKhash Rod

Maruf

Gizab

Washer

Daman

Chora

Spin Boldak

Baghran

Shorabak

Kijran

Arghistan

Naw Zad

Shahristan

Qalat

Maywand

NeshKajaki

Shah Wali Ko

Daychopan

Shamulzayi

Kang

Arghandab

Shinkay

Dihrawud

Ghorak

Musa Qala

Khas Uruzgan

Atghar

Mizan

Shahidi Hass

Nahri Sarraj

Lashkar Gah

Zaranj

Kandahar

Accessibility of districts to PPO Jul 2010 Southern region

80-100 % 50-79 % 10-49 % 0 - 10 % Accessibility

Shahwalikot , Reg , ShorawakKhakriz ,GhorakWashir , NawzadKhashrood

Khas UrozganShahid hasas GizabKijran

Khas UrozganShahid hasas GizabKijranGhorak

ShahwalikotMaywandKhakriz

RegGarmserDishu

Chahar Burja

Chakhansur

Day Kundi

Panjwayi

Nad AliKhash Rod

Maruf

Gizab

Washer

Daman

Chora

Spin Boldak

Baghran

Shorabak

Kijran

Arghistan

Naw Zad

Shahristan

Qalat

Maywand

NeshKajaki

Shah Wali Ko

Daychopan

Shamulzayi

Kang

Arghandab

Shinkay

Dihrawud

Ghorak

Musa Qala

Khas Uruzgan

Atghar

Mizan

Shahidi Hass

Nahri Sarraj

Lashkar Gah

Zaranj

Kandahar

FM Restricted areas<55 - 2021 - 4041 - 6061 - 8081 - 100

RegGarmserDishu

Chahar Burja

Chakhansur

Day Kundi

Panjwayi

Nad AliKhash Rod

Maruf

Gizab

Washer

Daman

Chora

Spin Boldak

Baghran

Shorabak

Kijran

Arghistan

Naw Zad

Shahristan

Qalat

Maywand

NeshKajaki

Shah Wali Ko

Daychopan

Shamulzayi

Kang

Arghandab

Shinkay

Dihrawud

Ghorak

Musa Qala

Khas Uruzgan

Atghar

Mizan

Shahidi Hass

Nahri Sarraj

Lashkar Gah

Zaranj

Kandahar

No Restriction

Areas restricted for Finger Markers use

As in Jul 2010 NIDs - Southern Region

Areas restricted for Finger Markers use As in Dec 2010 SNIDs - Southern Region