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					  Dr. Abdul Waheed
Provincial EPI Manager
      NWFP – Pics
   removed to reduce file
           size
Strategies for addressing rumours
     and building community
  acceptance for immunization.

         NWFP/FATA
International Communication Review
   September 17, 2007, Islamabad
CAMPAIGN UPDATE
5 Years Average Coverage 2006 – 2007 “August”
                 NWFP / FATA

                     Prov. 96%

                      < 5 Years




2006       > 95 %   90 - 94 %     < 90 %   2007
6 Months Average Coverage 2006 – 2007 “August”
                 NWFP / FATA
Prov. 95%
                                           Prov. 96%
                     < 6 Months



                     6 Months




2006                                         2007
            > 95 %   90 - 94 %    < 90 %
     Provincial Coverage 2005 – 2007 “August”
                 Cut-off Point 95%




5%
Teams Training Attendance 2006 – 2007 “Average”

  2006                                           2007
                       Provincial 97%




              > 95 %     90 - 94 %      < 90 %
AICs Training Attendance 2006 – 2007 “Average”

   2006               Provincial 99%            2007




             > 95 %      90 - 94 %     < 90 %
  Mobile Teams with 1 - Female Member 2006 - 2007

 2006

                                              2007
Prov. 50%

                                            Prov. 51%




              < 50%    51 to 79%   > 80%
                 0
                     1000
                            2000
                                   3000
                                          4000
                                                        6000
                                                               7000
                                                                      8000
                                                                                                9000




                                                 5000
      A.ABAD
      BAJOUR
       BANNU
   BATAGRAM
       BUNIR
  CHARSADDA
     CHITRAL
    D-I-KHAN
  DIR LOWER
   DIR UPPER
       HANGU
     HARIPUR
                                                                                                        Refusals Covered




      KARAK
  Khyber+Tirah
       KOHAT
   KOHISTAN
                                                                             Districts - & - Agencies




     KURRAM
LAKKIMARWAT
  MALAKAND
   MANSEHRA
     MARDAN
   MOHMAND
  NOWSHERA
                                                                                                        Refusals Reported




    ORAKZAI
   PESHAWAR
    SHANGLA
       SWABI
        SWAT
                                                                                                                            Refusal Reported & Covered Average 2007




        TANK
WAZIRISTAN-N
WAZIRISTAN-S
Poorly Covered Areas “%” 2006 - 2007 “Average”

  2006                              2007




               Cut – Off Point

                       > 10 %
Missed Areas “%” 2006 - 2007 “Average”

2006                        2007




          Cut – Off Point

                    >2%
Security Inaccessible Areas, NWFP / FATA - 2006
             (UN Staff)




                           Inaccessible areas
                           Limited Access
                           Full access
     REFUSAL
           “FATA”
Federally Administered Tribal Areas
          High Risk Agencies – Central Region
 Bajaur                                         Mohmand




                          Khyber




No Campaign
High Risk Agencies – Southern Region
                   No Campaign



North-Waziristan                 South-Waziristan
          High Risk Agencies - Refusal Reported & Covered
                         “Jan – Aug” 2007

 Agency      Refu   Jan    Feb    Mar    Apr     May      Jun    Jul    Aug
             Rep    1955    N.C   3361   4018    4074    3929    N.C    4300
 Bajaur
             Cov     917    N.C   1399   2458    2345    2008    N.C    2121

             Rep    2402   2668   3003   4008    4687    5359    5833   6334
Mohmand
             Cov     739   868    853    1543    1538    1714    1783   2257

             Rep    1358   1804   1889   1896    2517    3158    3567   3822
 Khyber
             Cov     467   854    489    583      946    1171    1556   1566

   N         Rep     507   709    1043   782      660    1323    1232    627
Waziristan   Cov     220    240    422    287     415     605    514     222

    S        Rep     162   536    320    227      506     780    N.C     923
Waziristan   Cov     12    150    116    105      154     341    N.C     395

In FATA traditional way of Jirgas were conducted in the U.C’s of Refusals with
  the support of Agency Health Team & Agency Management Team Facilitated
   by local Tribal Elders. Local F.M Channels and local contacts was used in
                                  Khyber Agency
High Risk Agencies – “Average” Jan - Aug
                   Religious         Misconception            Demand
 Agency         Reported   Covered    Reported   Covered   Reported   Covered

   Bajaur        2096        976       1201        738       310        161
 Mohmand         1704        490       1445        714       1137       208
   Khyber         589        174       1752        731       161        49
   Kurram          0          0         229        115         0         0
  Orakzai          49        24         168        109         0         0
N-Waziristan      595        214        110         65       156        87
S-Waziristan      295        108        63          18       135        56

In FATA traditional way of Jirgas were conducted in the U.C’s of Refusals with
  the support of Agency Health Team & Agency Management Team Facilitated
            by local Tribal Elders. Local F.M Channels was used in
                                 Khyber Agency
REFUSAL
DISTRICTS
Peshawar   High Risk Districts Central Region   Charsadah




Nowshera                No Campaign                Swat
Bannu   High Risk Districts – Southern Region   D.I.Khan




Lakkimarwat             No Campaign               Tank
High Risk Southern Region Districts – Refusal - Reported / covered
                       “Jan – Aug” 2007

Agency       Refu       Jan      Feb      Mar       Apr        May        Jun        Jul   Aug
                                                                                     No
              Rep       1863     2238     2981      2886       2720        2658            2903
                                                                                    Camp
 Bannu                                                                               No
              Cov       336       588      965       809        564        566             844
                                                                                    Camp
                                                                                     No
              Rep       885      1251     1577      1507       1551        1507            1530
                                                                                    Camp
D.I.Khan                                                                             No
              Cov       158       192      308       217        237        195             156
                                                                                    Camp
                                                                                     No
              Rep       1654     2022     2127      1986       2119        2528            2703
 Lakki                                                                              Camp
Marwat        Cov       702       547      867       708        489        606
                                                                                     No
                                                                                           639
                                                                                    Camp
                                                                                     No
              Rep       340       593      743       893        717        634             762
                                                                                    Camp
  Tank                                                                               No
              Cov        44       27        36       148        102         78             71
                                                                                    Camp
         In the above district mainly large Inauguration ceremonies were conducted
          at the district as well as at the U.C’s level. Chief guest include Minister’s,
            District Nazim, Tehsil Nazims , Religious Scholars and Army Personal
  High Risk Central Region Districts Refusal Reported & Covered
                        “Jan – Aug” 2007
 Agency       Refu Jan       Feb Mar       Apr     May      Jun      Jul    Aug
               Rep    1976   1669   2328   2383    2545     2750    1716    3182
Peshawar
               Cov    565    298    639     432     675      652     382     497

                                                                     No
               Rep    712    721    848     962    1056     1058
                                                                    Camp
                                                                            1090
Charsadah                                                            No
               Cov    263    214    397     374     420      466
                                                                    Camp
                                                                             500

               Rep    470    559    794    1010    1019     1061     836    1324
Nowshera
               Cov    123    234    238     289     295      240     202     380

                              No     No             No               No
               Rep    3993
                             Camp   Camp
                                           7693
                                                   Camp
                                                            8033
                                                                    Camp
                                                                            9464
  Swat                        No     No             No               No
               Cov    215
                             Camp   Camp
                                            721
                                                   Camp
                                                             754
                                                                    Camp
                                                                             666

 In the above district mainly large Inauguration ceremonies were conducted
  at the district as well as at the U.C’s level. Chief guest include Minister’s,
    District Nazim, Tehsil Nazims , Religious Scholars and Army Personal
High Risk Districts – “Average” Jan - Aug
                Religious          Misconception           Demand
 Agency       Reported   Covered   Reported   Covered   Reported   Covered

  Bannu        1033       198       1512       452        62         17
 D.I.Khan       810        85        562       117        28         7
Lakkimarwat    1385       368        486       163        292       121
   Tank         575        58         6         6         88         9
 Peshawar       809       147       1448       360        62         10
 Charsadah      510       193        403       178         8         6
 Nowshera       462       117        392       120        31         14
   Swat        7290       585         3         3          3         2
Challenge                   Actions taken
Refusals    – Seminars for religious leaders held
            – Local, provincial and national fatwas
              obtained/used
            – Press coverage of Qari Hanif Jalandari and
              his photographs during inauguration used
              at operational level.
            – CD containing speech of Qari Hanif
              Jalandari used.
            – Inauguration conducted in Islamic
              Madrassas.
            – Provincial Inauguration by prominent
              political/religious scholars.
            – District Inaugurations by religious scholars
              (Swat, Charsadda, Nowshera, NWA, Karak)
            – Jirga meetings
Challenges                     Actions taken

Access,             – Grand meeting of FATA elders.
especially to       – Jirga meetings to involve
young infants due     community.
to cultural &       – Multi hujra vaccination
conservative
society specially   – 3 members team (one local male
in FATA               and 2 females)
Challenge                       Actions taken
Anti polio          – PTV talk show in local language.
statements in       – Interviews from VOA.
some section of     – Live programme on Buraq radio.
press
                    – FM radio used at provincial and
(Wafaqul Madaris,
Jamaat Adawa,         district level
Zarbi Momin)        – Coverage of polio activities ensured
                      in media
                    – Members of media forum taken to
                      field during August round
Challenges                       Actions taken

Low involvement • Strong coordination established with
of female in        NP and LHWs have been involved.
vaccination teams • All female health staff is participating
(below 50%)         in campaign.
                  • Secretary Health asked Secretary of
                    Education, Social welfare and FP to
                    provide female teams.
                  • Involvement of nursing/public health
                    schools.
                    Achievements

• Poliovirus circulation greatly restricted to well identified
  areas
   – “from 27 District / Agencies in 1997 to only 4 in
     2007”
• Provincial and district government officials are on board
• Community influentials of FATA taken in to confidence
• Long term partnership with media established
• Sub committee on communication and social
  mobilization is functional
• District/agency specific approaches adopted for
  PEI/EPI
• Cross border coordination with Afghanistan has been
  established
           Achievements in NWFP
Overall campaign quality at district /agency
 level is satisfactory
High quality AFP surveillance system is
 reaching international standards
Poliovirus circulation greatly restricted to well
 identified areas
Cross sectional support to polio eradication
 from civic society & religious fraternity
  Initiatives in NWFP used in other countries
    like Nigeria
              Areas of Concern
   Low routine immunization coverage (<80%)
   Access to all the target children in the security
    compromising areas
   Access to young infants due to cultural &
    conservative society specially in FATA
   Low female involvement in mobile teams.
   Increasing trend of refusals and weak follow up
    of still missed children.
   Need to translate strong political commitment
    into action and accountability at district levels
                 Future plan


• Advocacy
  – Provincial launches before every round of NID
    – involving high profile political and others
    figures.
  – Updating Governor, CM, Health Minister, CS,
    DCOs and PAs, on results of the campaigns.
                 Future plan

• Social Mobilization
     • To hold Press briefing before every round of the
       campaign and ensure media coverage
     • To take members of the media forum to the high
       risk districts, during every round of the campaign
       to ensure coverage of the activities in media.
     • Issuing press releases after completion of every
       round informing general public about the
       achievements.
     • Further strengthening relationship with FM radio
       at the local level.
     • Continue dissemination of “Fatwas” obtained
       from various religious schools of thoughts.
                  Future plan
• Holding awareness seminars for parliamentarians,
  nazims, DCOs and Political Agents.
• Organizing jirga meetings in the high risk areas
  within the districts/ agencies.
• To continue with involving religious leaders,
  nazims and councilors in the UC level launches.
• Strengthening local approaches for local issues
• Polio ambassadors
• Reviews of communication activities
• Human resource/activity need based plans.
                   Future Plans
Issue based approach for improving the PEI
 activities in Districts & Agencies.
On-going refusal and not available children
 coverage plan need to be modified and strengthen.
Trying to find access for at least National staff of
 W.H.O into areas of concern specially in southern
 region.
Nomadic and Other Mobile Population vaccination
 coverage plan to be strengthen by the health
 department with the support of donor agencies like
 WHO & UNICEF
Improving Routine EPI.
              Guidance required

1. Defusing negative propaganda
2. Security situation in certain areas.
3. Internal conflicts between different tribes in
   certain agencies
4. Demand based refusals.
Update on surveillance
Confirmed Polio Cases “1997 – 2007”

         60% Fold Decline in the Number of Cases




                                    This include 1
                                   Australian Case




                           House - to - House Campaign
Districts with Confirmed Cases “1997 - 2007”


                   87%       10%
 CONFIRMED & COMPATIBLE POLIO CASES 2006,
               NWFP / FATA

District       Cases
Bannu              6    Central                        P1 Wild
Lakki              1    Region
                                                       P3 Wild
Dir Lower          1
                                                       Compatible
DI Khan            1
Khyber             1
Bajour             4
Wazir-N            2
   Total           16


        Southern
         Region



   Confirmed Cases = 16 (P1-11, P3-5) , Compatible Cases = 03
CONFIRMED and COMPATIBLE POLIO CASES
          2007, NWFP / FATA

                                                 Rep. from Australia

             Central Region




                                                          2007
                                                District/Agency    Cases
                                                                   P3 – 1
                                                   Nowshera
                                                                   P1 - 1
                                                Khyber “Tirrah”    P1 - 1
P1 Wild                                            Peshawar        P1 – 1
P3 Wild                                         Swat (Rep. from
                                                                   P1 – 1
                                                      Australia)
Compatible           * Data as of 15-09--2007
                                                     Total          5*
  Non – Polio AFP Rate 2006-2007 NWFP/ FATA
    2006
                                       2007
Provincial = 7.5
                                 Provincial = 7.9




               0. 00 – 0.75

                   0.75 - 0.99


                   0.99 - 1.99

                                    * Data as of 15-09--2007
                    > 1.99
     Case Detection with in 7 days 2006-2007
                  NWFP/ FATA
  2006                                        2007
Prov.= 77 %
                                     Prov. = 81 %




         < 60 %

         60 – 80 %
                                      * Data as of 15-09--2007
         > 80%
     Stool Adequacy 2006-2007, NWFP / FATA

   2006                                2007
Prov. = 85 %                     Prov. = 89 %




          < 60 %

          60 – 80 %

          > 80%                    * Data as of 15-09--2007
OPV Doses of Confirmed Cases 2005-2007, NWFP/FATA
Routine OPV Status of Confirmed Cases 2005-2007
                NWFP/FATA
         Vaccination status of Non-Polio AFP cases
                NWF/FATA, 2005 to 2007
                     0-11 M             12-23 M                 24-59 M




* Data as of 15-09-2007       0 DOSE   1-3        4 TO 6   7+
    Community Based Surveillance

–Community based surveillance comprises of sources
  outside current AFP surveillance network and health
  infrastructure.
  •Community elders
  •Maliks.
  •Mosque imams.
  •TBAs (Traditional Birth Attendants)
  •Teachers.
  •Councilors.
–CBS has established in an institutionalized way to
supplement the current AFP surveillance system in areas
having difficult access due to security or geographical
terrain.
Community Reported AFP Cases 2007
ZERO REPORTING 2006-2007
               Achievements

• Increase in zero reporting sites to include
  all governmental health facilities.
• Building partnership with private sector
  (NRSP/Family Physician association. Etc)
• Community based surveillance initiated
• Early case detection for the first time
  touched the benchmark of above 80%
                  Challenges

• Early case detection in some critical districts.
• Access problem in some critical districts
• Widespread quackery which makes it difficult to
  detect cases early
                  Action Plan

• Regular orientation and training of Health care
  providers on AFP surveillance according to
  health seeking behavior
• Contracts of SO changed from SSA to APW to
  improve access.
• Hiring of DSO surveillance in NW/SWA
• Community based surveillance in some critical
  districts
• To continue identifying other organizations for
  partnership on surveillance at district level.
Routine immunization
District/agency wise Routine EPI Vaccination Coverage
                     (Jan-July 07)


                                                   Chitral




                                               DIR Upper
                                                       Swat    Kohistan


                                            DIR Lower    Shangla
                                                              Batagram
                                         Bajour
                                                                 Mansehra
                                           Malakand     Bunir
                                   Mohmand
                                               Mardan
                                         Charsada
                                                     Swabi     Abotabad
                                 Khyber Peshawar           Haripur
                                             Nowshera
                     Kurram     Orakzai
                              Hangu        Kohat

                                   Karak
              Wazir-N    Bannu

                             LakkiMrwt                                      < 59 %
           Wazir-S    Tank
                                                                            60- 80 %
                        DIKhan                                              > 80 %
                  Routine EPI

• Provincial vaccination coverage is 81% (Combo-3)
• There are well performing districts. (37%) of the
  total districts having coverage more than 80%)
• The coverage divide
   – Variations of vaccination coverage among the
     districts.
   – There are well and poor performing UCs within
     districts
                Actions taken

• Through GAVI funds:
   – Provincial office strengthened (manpower,
     equipment)
   – Additional staff recruited
   – Mobile vaccination activity for all EPI antigens,
     carried out in selected poor performing UCs
   – Mobility of EPI supervisors provided
   – Health managers trained on policy making and
     management
   – Refresher training of vaccinators and other
     paramedics conducted
   – Regular quarterly reviews going on
   – Ads in print media to promote EPI
   – District EPI offices equipped – coordinators and
     supervisors trained
                Actions taken

• Support from UNICEF - through AWP
• Involvement of LHWs in routine immunization
  programme
• Phase one priority districts targeted
• Training of vaccinators and other paramedics
• District specific communication plans
• Messages for routine EPI developed
• Human resource support (data entry, accounts)
              Actions taken


• JICA support
   – Three districts have been selected (Swat,
     Bunir and Shangla)
   – Involvement of LHWs in routine
      • Provincial and district TOT conducted
   – 2 Vehicles supplied
   – Generator for Malakand cold room supplied
Communication
                 The community

• The community of NWFP/FATA
• Is diverse by:
       • Tribal ethnicity
       • Strong religious values
       • Nomadic way of life
  –   Cross border population movement
  –   Afghan population
  –   Sparsely located population
  –   Physically hard to reach due to difficult terrains
  –   Security compromised geographical areas.
  –   Having low literacy rate
  –   Having poor sanitation
          Communication strategy


• Advocacy among the policy and decision makers

• Social mobilization to create demand for
  vaccination by raising community awareness

• Develop capacity of the service providers to
  facilitate demand creation.

• Increasing human resource.
     Programme structure for
         communication

           Provincial level

    Steering Committee on PEI/EPI

Sub Committee on Communication and SM

             District level


DPEC – EDOH/AS – Coordinators –DSOS

      UCs – Area incharges - teams
Decision making process

            National level


           Provincial level


   Steering Committee on PEI/EPI


  Sub committee on Communication and
          Soc. Mobilization


          Districts/agencies
                Communication strategy
Level        Strategy       Activities


             Advocacy       Meetings with top level govt
                            functionaries, district govt heads,
Provincial                  religious leaders

             Social         Prov. Launches – media involvement
             mobilization
             Advocacy       Involvement of administration and dist
                            govt, other departments & religious
District/                   leaders
agency       Social         Launching ceremonies, involvement of
             mobilization   community, pesh imams, teachers,
             (UC level)     refusing families
        Communication strategy
•   Advocacy
    •   Among policy and decision makers at different
        levels
        – to support and promote PEI/EPI
        • Meetings with:
           •Governor
           •Chief Minister
           •Chief Secretary
           •Additional Chief Secretary, FATA
           •National religious scholars – Fatwa obtained
           •DCOs/PAs, Nazims
           •Maulana Sami - ul – Haq
           •Grand meeting for FATA elders
           • MNAs, Senators, religious leaders, Maliks, representatives
             of FM radio and Education department attended.
        Communication strategy


• Social mobilization
     • Mobilizing community at large so that every body
       play his/her due role.
     • Engagement of mass media
     • For creating awareness on importance, dates
       and places for both EPI and PEI.
     • Interpersonal channels - Messages through
       vaccination teams and IP contacts
GOVERNOR INAGURATION “FATA” – 27th March, 2007
Chief Minister Meeting 2007
Maulana Sami Ul Haq Visit 16th March 2007




Darul Uloom Haqania
  Provincial level Activities

– Provincial launching ceremonies – every
  NID round.
– Joint inauguration by Fed. Minister Health of
  Pakistan and Afghanistan at Torkham – Dec
  2007.
– Media briefings are going on before every
  round of the campaign.
– Press releases on findings, after every
  round of campaign
      Provincial level -       Contd

• Partnership with media
   • Media Forum established
   • Media Declaration endorsed
   • Capacity building going on
   • Members of media forum went out to field
     during campaign
   • PTV talk show in local language.
       –13% informed in settled and 10% in
        FATA as of August round.
   • Interviews from VOA.
   • Live programme on Buraq radio.
       District level activities

– District launching ceremonies
   • Islamic Madrassa involved. (Swat, Charsadda, Karak,
     Nowshera)
   • DCOs, PAs, Dist Nazims, Dist Khateebs (in almost all
     districts/agencies)
   • Military officials (Nowshera, Peshawar)
– UC inaugurations
   • On the average in 10 High Risk UCs - Involvement of
     religious leaders and others.
– District specific social mobilization plans
   • special emphasis on High Risk Areas within the 6 districts
     and 5 agency
– Jirga meetings.
   • Before every campaign – on the average 4 jirgas in Bajour,
     Khyber, Mohmand, NWA
   • Involvement of local religious leaders, local FM radio,
     opinion leaders.
         District level - Contd

– Use of local FM radio.
  • Live programme and announcements from local
    FM stations
      – Peshawar, Bannu, Lakki Marwat, Khyber,
        NWA, Bajour
          » In August round 16% respondents in FATA were
            informed through radio while in settled districts 8%
     Speech competition in Baeconhouse school to
      cover refusals – 16 schools participated
               District level - Contd

   – Vehicle announcements
   – Mosque announcements.
          – 22% in FATA informed while in settled districts 21%
            informed through mosque announcements
   – Poster display
          – Posters seen in 61% of the surveyed areas (Aug 07)

• IEC materials
      • Being used in line with the national guidelines
          – Posters, banners, flyers, leaflets
              Rumors about OPV
• Anti polio statements in some section of print
  media.
         • Wafaqul Madaris – Jamaat Adawa – Zarbi Momin
•   Anti polio case in Peshawar High Court Case
•   Local fatwas against OPV
•   Unsupportive statements from FM channels
•   OPV causes infertility
•   American and allied agenda
•   Anti polio CD (Nowshera)
•   Security threats
         Responses to rumours

• Coverage of polio activities ensured in print and
  electronic media.
• President press club hosted media briefing
• Members of media forum taken to field during
  August round.
• Decision about dismissal of the case from PHC
  publicized.
• Press statement and pictures of Qari Hanif
  Jalandari distributed (More specific on Khyber).
• Electronic media involved
• Fatwas used
• DHCSOs recruited in high risk districts/agencies
                  Challenges vs Strategies
Challenges                                    Actions taken
(Security)
Security situation in    •     Meetings of District nazims, DCOs, PA s and
certain areas
                               police department under chairmanship of CS
(one tahsil in Khyber,
43 areas in NWA,         •     Governors Directives to all nazims, DCOs and
Matta tahsil in Swat,          PAs
Mamoond in Bajour,
FR areas)
                         •     CS instructions to DCOs and PAs.
                         •     Jirga meetings with elders and groups (Khyber,
                               Bajour)
Breach of agreement      •     Grand meeting of FATA elders, MNAs, senators,
between tribal and
                               FM radio and Education department (28TH July)
government (Bajour,
NWA, SWA)                •     Local jirga meetings
Internal tribal feuds        • Separate meetings with different groups
(Khyber, Mohmand,
Bajour,)
   Addressing the challenge
reaching the high risk population
       mobile population
      and the very young.

        NWFP/FATA
     Communication Review
      September 18, 2007
          Islamabad
‫بسم الله الرحمن الرحيم‬


  Dr. Parvez Kamal
 EPI Manager - FATA
High Risk Population
       Criteria for high risk areas
– UC with any three of the following criteria is
  considered as very High Risk
       – < 90% vaccination coverage of under 5 years
         children
       – < 90% coverage of children < 6 months
       – > 10% poorly covered area.
       – > 2 % missed areas
       – Low female involvement in campaign – below 50%
       – Low routine vaccination coverage (below 50%)
       – Poliovirus circulation
       – Nomadic Population
       – Single hujra vaccination system
       – Evidence of increasing resistance from community
         to PEI.
           The planning process



• High Risk UC’s are identified by district PEI team
• PEI team develops social mobilization plan,
  according to the local needs
• Share with provincial team for ay required
  support
                 Planning template for Soc Mob


             Social Mobilization Activity Plan District/agency__________________
             Campaign round _______________


                               Type of                                                          Total participants
                               activity     Reason for                         Key                                       Responsibility
S.No      Date     Venue       planned      S.M activity    Objectives     influencers      1      2     3     4     5




*1.Nazims/councilors/MNAs/MPAs 2. Masjid Immams/ulema/ religious leaders   3.Teachers   4.Community elders/Maliks 5.Media



         Signature DSO ___                                                    Signature EDO Health /Agency Surgeon__________
                      Activities

• Launching ceremonies
• Briefing of nazims, councilors, religious leaders
• Jirga meetings
    – Religious leaders, UC Nazims, councilors, teachers,
      refusals families.
•   Press briefings
•   Use of printed material
•   Use of FM radio
•   Vehicle announcement
•   Mosque announcements
Mobile population
              Types of mobility

• In NWFP there are:
   – Inter district movement
        – Dir and Swat to central districts
  – Inter provincial movement
        – NWFP – Punjab - Balochistan
  – International movement
        – Pakistan - Afghanistan
Mobile Population Movements
Country, Inter-Provincial & Inter-Districts




                                   Bajaur




                                              Place of Origin

                                              Mob. Pop Cross Border Points

                                              Mob. Pop Inter-Provin Points
                                              Gypsies Dir - Kohistan
                                              Gypsies Swat - Kohistan
                                              Gypsies Hazara - Kohistan
                                              Nomads Local S - Waziristan
                                              Pawinda Movements
                                              Gypsies Movements
           Status of mobile population


            Average No     Type of         Time of      Time of    Average
Region       of Mobile     Mobile          Arrival     Departure   Duration
            Population    Population          *           *         of Stay
                           Powindah,
Central        11730       Kohistanies,     October      March     6 Months
                            Gypsies
                           Powindahs,
Northern       3283                         October      March     6 Months
                           Kohistanies

                           Powindah,
Southern       6163                        September     April     7 Months
                         Nomads, Gypsies

                           Powindahs,
 FATA          3653                        September     April     7 Months
                            Gypsies
Moving population stays at different
             places.
      Strategy for mobile population


•   Mobile population is part of the micro-plans
•   Transit teams deployed on major crossing points
•   Deployment of seasonal posts
•   Deployment of special motor bike teams
Vaccination of gypsies
Average Mobile Population Covered 2007
        Cross border movement

• Pakistan and Afghanistan share:
  – Common border.
  – Socio-cultural values.
• There is frequent population movement across
  the borders.
• About 3 million Afghan refugees reside in
  Pakistan, mainly in NWFP & Balochistan.
• Approximately 1.7million children under 5 years
  cross Pak-Afghan borders each year.
                  The strategy

• Keeping in view the:
  – Continuous population movements across the border
  – Persistent circulation of polioviruses on both border
    sides
  – Inaccessibility due to security reasons and
    conservative society
  – Pockets of inconsistent quality of SIAs on both sides
    of the border
• 9 cross border vaccination posts established
Cross Borders                                                                                                           Vaccination Point
                                                                Chitral



                                                                                                                                             Cross border movements
                                                                                                             Kohistan
                 Kunar
                                                                     Upper - Dir
                                                                                                                                             Movements “Afghanistan
                                                                                               Swat
                                                                                                        Shangla                              Transit Point Selected
                                                          BajaurLower-Dir
                                                                                                                  Batgram


                                                                    Malakand
                                                      Mohmand                                     Bunir            Manshera
          Nangarhar                                           Charsada
                                                                         Mardan

                                                                                               Swabi             Abbotabbad
                                                                                                          Haripur
                                                Khyber Peshawar Nowshera
  Khost
                                      Orakzai
                              Kuram
                                              Hangu         Kohat

                                                                             Sr                        Pakistan               Points   Selected Points   Afghanistan
                                                  Karak
               North-Waziristan       Bannu
                                                                                                        Chitral                 4            1
Paktika




                                                                                                                                                           Kunar
                                                                       Bordering Districts &

                                                                                                   Dir - Lower                  1            0
                                       Lakki Marwat                                                                                                       Province
          South -Waziristan
                                                                                                        Bajaur                  2            1
                               Tank
                                                                            Agencies




                                                                                                       Mohmand                  4            2           Nangarhar
                                 D. I. Khan
                                                                                                       Khyber                   3            1            Province
                                                                                                       Kurram                   5            2           Khost Prov
                                                                                                 N - Waziristan                 5            1            Paktika
BALOCHISTAN                                                                                      S - Waziristan                 3            1            Province
Vaccination coverage of cross border
       posts (Jan – Jul 2007)



                   Total children vaccinated = 247,000
               Coverage Cross-Border of Children
                < 5 Year age by Months & Posts
Sr                 Name of
     Districts                    Jan     Feb     Mar     Apr     May     Jun      Jul    Total
No               Border Point
1     Bajour        Ghaki Pass     152     454      0      396     629     486     241     2358

2     Chitral       Arundu Pas     316     842     729     836     615     670     355     4363

3    Khyber          Torkham      28030   22305   33847   30417   27999   29646   18606   190850

                    Terimangal            1640    1150     92       0     1169     68      4119
4    Kurram
                       Burki              2226    2436     308     989    2450    1022     9431
                       Matai       660     254     400     542     341     527     279     3003
5    Mohmand
                    Chamarkand    1723    1364    1515    1027     725     660     340     7354

6    N-Wazir     Ghulam Khan      1485    2966    1971    1109     798     940     387     9656

7    S-Wazir        Angoor Adda    580     124     155      0       0      230     53      1142

            Total                 32946   32175   42203   34727   32096   36778   21351   232276
                 Actions taken
• Situation analysis
• Coordination with Afghanistan authorities
• Consultation with all stakeholders
• Consensus on crossing points
• Inauguration of cross border post at Torkham, by
  Federal Minister Health. Governor and Minister health
  from Afghanistan also attended
• 9 Cross border vaccination posts have been established
  at Pak Afghan border
• Over 247,000 children vaccinating in last 7 months
         Action taken - Contd
• Excellent cross border collaboration established.
• Cross Border meeting with Afghanistan teams held
• Special Mop up carried out in July on the same dates
  in bordering districts/agencies
• Regular and timely sharing of information on AFP
  cases
• Synchronized SIAs in both countries
• Cross border teams trained on searching of AFP
  cases
• Financial and human resources have been increased
• Monitoring/supervision strengthened
       Strategies for young children

• In order to reach young children:
   – Team members from the same tribe are
     deployed in FATA
   – 3 members teams are constituted
   – Multiple Hujra vaccination is carried out in
     certain areas
            THANK YOU
              Working Together
            We Can Eradicate Polio




                            Dr. Abdul Ghani          Mr. Abdul Rahim
Mr. Siraj                   Agency Surgeon                Driver
EPI-Tech

                "‫"إن هللا ال يضيع أجر من أحسن عملا‬

				
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