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Approaching Days of Tranquility

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					    Approaching
  Days of Tranquility

Afghanistan Polio Eradication Initiative
           February 04 08
                Background
Afghanistan has the experience of practicing Days
of Tranquility in the past
• Health is neutral & each Afghan child has the
  right to be immunized
• In 1990s, Days of Tranquility
  – Announced for one week & observed for more than a
    month
  – Campaign Posters were displayed on the Tanks
  – Military vehicles were used for transportation of the
    vaccine & teams in difficult to approach areas
• Taliban & Northern Alliance frontline remained
  quiet during the polio days
                     P1 & P3 Poliovirus Isolates Afghanistan 1999, 04-07
                                                                                                                 1999                                                                          2004
                                                                                 #              #
                                                                                                #
                                                                     #          # $


                      2-3 year H-H Vaccination
                                                                                $$ $
                                                                                ##$
                                                                            #     ##
                                                                                   #
                                                                                   #




                     polio cases reduced to 04 &
    ##
    $                                                                                               #
         $                                                                                  $
            #                                                                           $
                                                                                          $
           $$
          ##                                                                              #
                                                                                       $# # #
                                                                                                                                                                                      $
           ##
         ##$#
#        #       #




                 geographically restricted to the south                                                                                                                   #
                                                                                                                                                                                          NSL1= 2
             #                                                                                      NSL1= 45                                                          #
                                                                                                                                                                                          NSL3= 2
                                          #       #             #
                                                              # $
                                                                #
                         $#                   #                #
                                                              ##
                                                                                                                                                                  $
                                                              #
                                                  $       #
                                                                                                    NSL3= 18



                 NSL1                                               NSL1 isolate from 02, Healthy Children, September 13, 05
                 NSL3

                                                                                                        2005                                                    2006                            2007

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                              $                       $                                                                          # #
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                                                                                                               #                 #   ##
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                     #    #                   #
                                                                                                                 #       #             $
                                                                                                                                       #            #



                                                      #
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                                                                                                                             #         #       #
                                                                                                                                                   ##
                                                                                                                                                                                          NSL1=06
                                                                                                                                                                                          NSL3=11

             NSL1=5                                                                                     NSL1=29
                                                                                                                                                                              Data up to 26 Jan 2008
             NSL3=4                                                                                     NSL3= 2
                   Phase 01
• In second half of 2005, P1 Outbreak started
  in the Southern region
• Program requested a meeting of both the
  UNICEF & the WHO Country
  Representatives
  – Briefed on the polio situation and gravity of the
    impact of security on campaign quality
  – Joint letter was sent to HM & SRSG
• The HM in a Cabinet meeting & SRSG
  during his weekly meeting with the President
  separately briefed the President on the
  deteriorating polio situation in the country
                       Phase 01
• The President Hamid Karzai directed the N S Council
• NSC was briefed on Polio by the WHO & UNICEF CRs
  together
• Policy Action Group chaired by the President was given
  briefing on Polio Situation by the UNICEF & the WHO
   – Polio Action Group representing cross sectoral ministries was
     constituted
   – Governor of Kandahar & Helmand were directed by the
     President office to lead the process.
• Efforts concluded, that the Anti Government Element’s
  leadership is not visible to whom to talk
• Military started responding: campaign dates were
  changed on the advise of HM. But military operation was
  also delayed and started exactly on the campaign time
UN Security Map & Polio Confirmed Cases (Jan, 2008)




                                            Very High Risk Areas
                                            High Risk Areas
                                            Medium Risk Areas
                             NSL3=11        Low Risk Area
                             NSL1=06        Date up to 27 Jan 2008
                  Phase 02
• Dr David Heymann, Advisor to WHO DG on
  Polio, visited Afghanistan
  – Meeting with ISAF/NATO & their Civilian
    Representative
  – Joint MoPH, UNICEF, WHO press briefing in
    MoPH and appealed to all the parties of the
    Conflict
  – AGE Spokesperson responded & called to media
    from unknown place and announced their
    support for the polio eradication in Afghanistan
                 Phase 02
• The WHO DG & the RD visited Kabul
  – Meeting the President Hamid Karzai, HM &
    Advisor to President
  – Meeting with Deputy Commander ISAF /
    NATO
  – Progress in the stance: Military agreed on to
    have Days of De-conflict
  – Campaign days and areas were shared but
    still Operations were conducted during the
    campaign days
                      Phase 03
• Briefing on Polio at the ISAF / NATO HQ
  Brussels by Chris Maher & Tangermann
  – Promise to keep was the de-conflict situation
• Country Team explored the possibility of
  approaching AGE
  – HM was briefed on the Concept
  – With the advise & approval of HM, ICRC was briefed
    on polio situation and the risks.
  – ICRC agreed to support PE activities in Afghanistan
     • Taliban issued the Letter of Support, announced in the media
       and communicated their field formations
     • Letter was found very useful helping polio staff in the field &
       in improving access to the areas & children
  – UN Peace day highlighted the need of DOT
Letter of
Support
from AGE is
issued for
each
campaign
separately
since
September
07
        Comparison of Children not accessed by vaccination teams
      Analysis by District, Southern Region Aug & Sept 07


            August 2007                                 September 2007



                                   80,000 more children
                                   Accessed, not covered
                                       for one year




% of missed children in the district   1-24%   25-49%             50-74%   75-100%
  Results: Improved access & maintained
              Southern Afghanistan, Dec. 07 & Jan. 08

 Dec-07 SNID                                               Jan-08 SNID




                                 Window of
                                 Opportunity
                                  Strategy
  Not Accessed because of                                     Not Accessed because of
  active fight (59271)                                        active fight (7,428)
  Not accessed because of                                     Not accessed because of
  AGE refusal (23348)                                         AGE refusal (7,455)
  Not accessed because of                                     Not accessed because of
  management (3959)                                           management (792)


Total inaccessible 86,578 (8%)                                   Snow (24,190


Total inaccessible 37,329 (3%)                       Total inaccessible 39,865 (3%)

Completely inaccessible     Partially inaccessible       Accessible        REC File 27 Jan 2008
 Continuous Technical Inputs
• Focused District Strategy was initiated in the
  security compromised districts to minimize the
  affect of security
  – Village based team, adding SM at Cluster level, more
    involvement of community & close monitoring
• Staggering Approach
  – Dividing the high risk districts in to two zones &
    placing all the human resource in one and shifting to
    the other later
• Providing additional staff from the other regions
            The Way Forward
• There is a definite progress towards understanding for
  vaccination & polio eradication on DOT
• We are in a transition from Days of De-conflict to DOT
• AGE, party of the Conflict is approachable through ICRC
• Awaiting the ISAF/NATO support on Days of Tranquility
• Efforts are in progress
   – The Advisor to the President on Health is keeping this
     issue alive in NSC meetings
   – USAID meeting the ISAF/NATO Commander on
     January 31
• Looking forward to the DOT when we can supervise &
  monitor the campaign and vaccination teams can access
  every house & access each child and do the vaccination
  safely ensuring achieving the goal.

				
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posted:4/15/2011
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