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IMPLEMENTATION STATUS OF THE NATIONAL EMERGENCY ACTION PLAN (NEAP) 2015-16

Afghanistan TAGKabul, 12 July 2016

Dr. Maiwand Ahmadzai

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Was developed for Jul 2015-Jun-2016

Endorsed by H.E the Minister of Public Health

Implementation Started with 4 months delay

Implementation was monitored by NEAP tracker

Goal: To interrupt WPV transmission by end of 2016 with zero case in the first half of 2016.

NATIONAL EMERGENCY ACTION PLAN

OVERVIEW

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GOVERNANCE AND COORDINATION

Management and coordination of PEI has changed with EOC playing the core role

Roles and responsibilities of all parties identified to avoid overlap

Direct communication of National and Regional EOCs established, bypassing all government bureaucracy

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FOCUS ON HIGH RISK AREAS

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FOCUS ON HIGH RISK AREA

19 Distric

ts 28 District

s 49

Districts

• Epidemiology (2009-2015)• Geography• Migration and

Displacement• Population Immunity• Analysis by other sources• Inaccessibility

Main Criteria:

47 VHR Districts

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LPD rounds

IPV+OPV campaign

s

HRD

LPD rounds

Enhancing Monitoring:

LQASPCA Monitors

National Monitors

Increased resources:

DPO and DCOV:S

M&A Officers

VHRD

Campaign review focuses on VHR and HR districts

District profiles developed for all VHR districts

Daily data during the campaign days is shared and is closely followed up from national level

INTERVENTIONS IN LPDS

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OUTCOME OF INTERVENTIONS IN LPDS

• Environmental Surveillance has been negative since jan-16

VHR None VHR0

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10

15 11.87.8

Sabin Like +ve

Sabin like +

• Proportion of Samples + for Sabin Like in NP-AFP is higher in LPDs

• Containment of VirusThe virus circulated for more than a year, but never got out of the surrounding immunity chain


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KEY STRATEGIES

• 37 out of 47 districts micro-plans revision were completed

• 7 districts are in process while 3 are pending owing to insecurity

• 276 additional villages, which were not in micro-plans, were included

• Integrated cluster level micro plans developed

• Maps of clusters with clear boundaries developed

Districts completed

Districts Pending

Remaining Challenges:• No exact data on

number of household and number of children

Way forward• micro

census by ICN and CHV

REVISION OF MICRO-PLANS

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IMPROVING SIAS QUALITY

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PREPARATORY MEETINGS

• Provincial taskforce chaired by governor is conducted in priority provinces

• Pre-campaign preparation meetings are conducted at national and regional level

REGULAR DISTRICT SPECIFIC PROFILE UPDATES

• District profiles were developed for 47 VHR districts and are reviewed and revised before every SIAs

MANAGEMENT SUPPORT

• Management support from national team is provided during the preparation phase.

IMPROVING QUALITY OF SIAS

CAMPAIGN READINESS

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MONITORING OF PRE-CAMPAIGN PHASE

• Regular updates of dashboards in preparatory phase is being conducted

• Intra-campaign monitoring by national level monitors has been transformed to supportive supervision and monitoring of pre-campaign and intra-campaign phase

• Readiness is assessed at 2 weeks, one week, 3 days and one day before the campaign

• Joint monitoring planning process is in place at national and regional level

EOC CORE RESPONSE TEAM TAKES CORRECTIVE ACTIONS

CAMPAIGN READINESS CONT…

Next Step• Chronogram for the pre-campaign phase has

been developed• Selection of frontline workers will also be

monitored from national level


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STANDARDIZATION OF TOOLS

• National level monitors reporting format has been standardized

• ICM data collection tools revised and simplified

• Administrative coverage data tools have been revised and simplified

• Standard evening meeting formats developed for the entire country

DATA UTILIZATION

• Administrative converge and ICM data is available on daily basis during the campaign and is used for corrective actions.

• EOC core response team meet on daily basis during the campaign and prepare response action

INTRA CAMPAIGN PHASE


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MONITORING

• National level monitors are sent to the area of highest risk aiming supportive supervision and monitoring

• Joint monitoring plan at regional level is developed to ensure all the highest risk areas are covered

• BPHS NGOs are involved in monitoring of SIAs.

REVISIT STRATEGY:

• Revisit strategy was revised and expanded to the entire country

• School students engagement in monitoring and follow up of missed children has been developed to maximize the impact of revisit strategy.

INTRA CAMPAIGN PHASE Cont..


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DATA FOR ACTION

• Post Campaign Assessment data (PCM, LQAS and Out of House FM Survey) is available within two weeks of campaign

• LQAS has been expanded to all LPD 1 and 2

• PCM is now covering 100% clusters in LPD 1 and 2 (VHR)

MAXIMIZING QUALITY OF DATA (Pre, intra and post campaign)

• Deployment of M&A officers in 47 VHR districts

• Efforts are underway for remote monitoring using mobile technology

• 10% of PCM is cross-checked in some areas but not everywhere

POST CAMPAIGN PHASE


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ASSESSMENT OF CAMPAIGN QUALITY

• Post-Campaign review and assessment take place at national and regional level.

• All failed LQAS are investigated

• Recommendation of review are followed up in the next round

POST CAMPAIGN PHASE


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Feb_16

Mar_16

Apr_16

May_16

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

100%

REDUCTION IN REJECTED LQAS LOTS• Campaign review and assessment and

follow up of the recommendations in next round resulted in decreasing proportions of lqas lots

Feb_16

Mar_16

Apr_16

May_16

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

100%

Accepted to 90% Accepted to 80%Rejected to 80%

Feb SNID Mar NID Apr SNID May NID0

20

40

60

80

100

120

0

10

20

30

40

50

60

70

93

72

102

29 28

21

13

19 18

2932

Total lots Rejected 80% Acepted 80% Acepted 90%

Axis Title

Num

ber

%


OUTCOME OF INTERVENTIONS

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Concerns regarding quality of data

• Independency of data cannot be ensured in some of the areas

• Data quality in area with limited monitoring (category 3) is of concerns

• LQAS cannot be conducted everywhere

Action for timely improvement

• Failed lots though improved in the next round, but on time corrective action for the same round is not universal.

• More closer look at implementation of campaign review recommendation in terms of selection is required

POST CAMPAIGN PHASE (CHALLENGES)


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POST CAMPAIGN PHASE (PLANS AHEAD)

REMOTE MONITORING USING MOBILE TECHNOLOGY

MONITORING OF SELECTION PROCESS OF FLW TO ENSURE RECOMMENDATION OF CAMPAIGN REVIEW AER IN PLACE

EXPLORING WAYS FOR THIRD PARTY INDEPENDENT MONITORING

ALL FAILED LQAS SHOULD BE RECOVERED IN THE SAME ROUND


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ADRESSING INACCESSIBILITY

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• GAINING ACCESS

• 2015-16 was one of the most challenging years for polio program in terms of getting access

• Negotiations at different level overcame inaccessibility, but situation is dynamic

• POLIO PLUS

• To encourage families to health facilities in area where H2H vaccination is not possible.

• Hygiene kits have been sent to Kunar province for distribution

• Mobile service are planned in Kandahar


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TRANSPORTING CHILDREN FROM INACCESSIBLE AREAS TO HEALTH FACILITY

• Initiative was taken in Kunar in which children were transported from inaccessible areas of Shegal to Health Facilities with support of BPHS implementers

PTT

• Permanent Transit Teams are established around inaccessible areas, in major transit points and market areas.

• The number of PTTs increased with expanding inaccessibility and insecurity

• Around one million children are vaccinated by 466 Permanent transit team each month


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MAXIMIZING IMPACT OF FRONT LINE WORKERS

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TRAINING

• Frontline workers training curriculum revised and implemented across the

country

ADRESSING DELAYED PAYMENT ISSUE

• Payments for any round will be delivered to FLW before the next round

• Special committee assigned in EOC to ensure timely payment of FLW.

Supportive supervision has been enhanced with decreasing Supervisor to

Vaccinator issue

MAXIMIZING IMPACT OF FRONT LINE WORKERS

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CROSS BORDER COORDINATION WITH PAKISTAN

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MEETINGS• Regular Meeting between national and regional/provincial teams of both

countries

• DATA SHARING• Focal points of both countries have weekly call

• Data related to confirmed and inadequate cases are shard regularly

• Cross notification of AFP cases conducted on timely basis

• Coverage data and SIAs performance in bordering districts is being shared

• Recording tools revised as per the IHR recommendation, assessing

coverage on the other side of border, and shared with Pakistan.


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SYNCHRONIZATION OF SIAS• SIAs dates are synchronized (same day SIAs)

• Any unforeseen change in the date of SIAs is shared in advance of the

implementation.

• Cases response plan along with list of district included shared for each case

to ensure a synchronized case response in bordering districts.

DETAILED INVESTIGATIONS OF ALL CONFIRMED CASES ARE SHARED REACHING POPULATION ON THE MOVE BTW BOTH COUNTRIES

• Target age group has been harmonized to less than 10 in all CB points

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SUPPORTING STRATEGIES

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SUPPORTING STRATIGIES

• tOPV to bOPV switch conducted successfully across

the country• VCC management committee established and meeting

regularly• VURs

• Monthly Vaccine utilization reports from all Provinces

• VURs addressing SIAs and complimentary utilization

• Vaccine wastage report• Vaccine wastage calculated on monthly basis

VACCINE AND COLD CHAIN MANAGEMENT

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VACCINE AND COLD CHAIN MANAGEMENT

East South East South Central West North North East - 2.0 4.0 6.0 8.0

10.0 12.0 14.0 16.0 18.0 20.0

Chart Title

Jan FLPD Feb SNID Mar NID Apr FLPDs May NID

VACCINE WASTAGE BY REGIONS JAN-MAY SIAS, 2016

Feedback given to

Provinces reporting

higher wastage

rates(5 – 15%)

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COMMUNNICATION AFP SURVILLANCE

WILL BE COVERED IN COMING PRESENTATIONS

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THANK YOU