Strengthening Routine EPI through PEI Network

TAG Meeting, 24-25, March,2011 Islamabad

Overview of National Routine EPI ProgramDr Zahra Mohammed

Dr Rohullah

EPI Service Delivery Modality

• Routine EPI Vaccination through– Fixed EPI clinics- 1210

– Outreach

– Mobile

• PIRI (Periodic Intensification of Routine Immunization)- Child Health Weeks

• SIAs for Polio, measles, and TT

BCG DPT-3 MCV-1 TT 2+PW0

10

20

30

40

50

60

70

80

90

100

2008 2009 2010

Coverage of various EPI Antigen (National)2008-10

% Districts with >80% Coverage of DPT-3& OPV-3 - 2008-10

Central SE

Eastern

North east

erne

North

Weste

rn

South

ern

National

0%10%20%30%40%50%60%70%80%90%

100%

200820092010

Access Vs Utilization Nationally: Proportion Categories –2008-10

2008 2009 20100%

20%

40%

60%

80%

100%

120%

33% 34% 31%

38% 34% 38%

11% 15% 15%

14% 14% 14%3% 3% 2%

NR Cat 4

Cat 3 Cat 2

Cat 1

Cat1: >80% Coverage, <10% DOR; Cat2 : >80% Coverage , >10% DOR

Cat3: <80% Coverage, <10% DOR; Cat4 : <80% Coverage , >10% DOR

Districts in various categories: Access Vs utilization for 2010

Category 1Category 2Category 3Category 4

•More number of measles Outbreak•More number of NNT cases•Most of the polio cases •More non-reporting districts

Child Health Weeks- Accelerated RI

• Total 32 districts with DPT-HepB-Hib-3 coverage included• Three rounds in each district done

Target Round 1 Round 2 Round 3 Cumulative %BCG 31893 21649 5141 2405 29195 92%OPV-3 31893 1962 3665 11776 17403 55%DPT-HepB-Hib-1 31893 21532 5556 4402 31490 99%DPT-HepB-Hib-2 31893 2639 9968 5059 17666 55%DPT-HepB-Hib-3 31893 1962 3612 11785 17359 55%MCV-1 31893 11445 4903 4263 20611 65%MCV-2( 11-23 mths) 31893 1919 2783 2301 7003 22%

MCV (23-59 Mths) 106,609 83,729 83,729 79%

Issues and Challenges• Discrepancy between different sources of population data for

planning purpose• 15%-30% of populations have no access to HS/living in hard-

to-reach areas/nomads/new illegal settlements/IDPs• Poor monitoring of stakeholders (NGOs)• Insecurity : a key problem for both access and utilization• Poor outreach and mobile services

Way Forward

• Updating and strengthening of micro-plans in phase-wise manner ensuring its appropriate implementation

• Refresher training of vaccinators• Strengthening of Cold Chain capacity following

recommendation of EVM• Ensuring that Polio Program structure devotes

some percentage of the time and resources in strengthening routine immunization

PEI North

Strengthening Routine EPI is important strategy for PEI

With decreasing number of SIAs, Increasing immunity gap among population particularly in most parts of the country without poliovirus circulation.Transmission and high risk zones :

2009 =92010 =82011 =8

Areas with no circulation: 2009 =62010 =42011 =2( first 6 months)

Strengthening Routine immunization is the most effective way to maintain population immunity

Supporting routine EPI through PEI network

• Using AFP surveillance data to improve routine EPI services.

• Regular supervision of EPI fixed centers by PPO

• Supporting District EPI team in routine EPI district micro planning

• Including routine EPI activities during internal AFP surveillance review.

RegionsYear 2010 (n=1572) Year 2011(n=278)

Median Median

Northeast 65 70

North 55 68

West 76 71

Central 79 81

Eastern 88 89

Southeast 54 61

South 3 7

Badakhshan 62 68

Median of routine EPI coverage in the vicinity of AFP cases

Area coverage survey from detailed AFP case review

YRONSET EPID PROVINCE DISTRICT VILLAGEROUTP

CT

2010 AFG/02/10/030 SAMANGAN DARA-I- SUF Dara-I-Suf 81

2010 AFG/02/10/033 SAMANGAN DARA-I- SUF Zai Gholaq 26

2010 AFG/02/10/042 SAMANGAN AYBAK Larghan (2) 40

2010 AFG/02/10/111 SAMANGAN HAZRATI SULTAN Kokjar 58

2010 AFG/02/10/162 SAMANGAN KHURAM WA SARBAGH Nawbolaq 91

2010 AFG/02/10/168 SAMANGAN AYBAK Zorabi 10

2010 AFG/02/10/185 SAMANGAN KHURAM WA SARBAGH Tana Chob 57

2010 AFG/02/10/193 SAMANGAN RUYI DU AB Qashqa 29

2010 AFG/02/10/204 SAMANGAN AYBAK Jo-i-Zandan 15

2010 AFG/02/10/238 SAMANGAN KHURAM WA SARBAGH Baba Qambar (1) 24

Using AFP surveillance data to improve routine EPI services

EPID Prov DISTRICT VILLAGEOnse

tAGE

Routine

Reason

062

BALKH

CHIMTAL Ali Zayi13-Apr

9 0Insecure, not in out-reach plan, needs Taliban negotiation

094MAZAR-I-SHARIF

Mazari Sharif

08-Jun

10 0Child was in Charbolak Dist in a village for out-reach but due to security it is not well covered

082FARY

ABPASHTUN KOT

Chahar Tut (2)

19-May

18 0It is remote village and not covered by out-reach

099SAMANGAN

RUYI DU AB

Chahrchashma

11-Jun

15 0Child was sick during out reach for 2 times

066

SARI PUL

KOHISTANAT

Deh Mianeh-ye Pa'in

03-Apr

12 0Away from FC by 15 Km, not regular covered by Mob included in WHO plan

081 Saripul Behsud 21 May

14 0The house is far from clinic and it is at the periphery of the village , out-reach area, no out-reach plan

Activity to improve routine EPI-2009,2010

Regional team supported 3 rounds of Mobile activity with coordination of partners in inaccessible areas of Shortepa District of Balkh

88% vaccinated from 0-1196% vaccinated from 12-5945% TT vaccination CBA

WHO supported one round of Mobile activity in Alborz

OPV 284 0-23m, Measles 254TT 202 Four villages were missed reported by Coordinator as well as Independent Post Assessment

Activity Results

Regional team funded 3 rounds of Mobile team activity to improve routine EPI in inaccessible areas of Saripul province

Covered 2650 OPV 0-23m, in addition to Measles, Penta and other vaccines

Regional team is Improving routine EPI in Samangan (3 rounds)

Covered 1700 OPV 0-23m, in addition to other vaccines

Attend all EPI routine meetings at regional and provincial levels

•Improvement of data quality•Identify inaccessible and poorly covered areas for NGOs

PPO Observations in Fix centers

No OPV in Fix Center

No OPV for one monthBCG no diluent

NO gas for fridge180 Vials expired

Including Routine EPI During AFP Surveillance review central region

Out of 8 vaccination centers visited, vaccinator was found absent in 3 of the centers at the time of review.

Knowledge of vaccinators in general was not adequate and the micro plan was not complete. Penta 3 coverage (<60%)

according to register

Vaccine supply was more than the requirement (> 3 months supply)

Drop out rate >10%

On Job training was provided and feedback to PEMT and NGO

Conclusion• With decreasing number of SIAs in non transmission

zone, routine EPI is the only way to maintain population immunity.

• AFP surveillance was effectively used to improve routine EPI coverage in Northern region.

• Northern region experience is to be shared with other regions

• Strong coordination is required among partners to identify low routine EPI Pockets and plan to cover them accordingly.

THANK YOU