Pakistan urged to focus on chronically missed children

Islamabad
Pakistan needs to shift its current focus from vaccinating children who have already been ‘reached with polio vaccine,’ to those who continue to be ‘chronically missed.’ The country should also put in place, area-appropriate customized security plans for smooth conduct of immunisation campaigns, and foster better coordination at the federal and provincial levels.
These are just a few of the many recommendations made by the Technical Advisory Group (TAG) on polio eradication, which met here on February 14-15 to take stock of the progress being made to arrest last year’s sorry trend of an unbridled rise in polio cases.
TAG made several overarching and specific recommendations for improvement. With reference to chronically missed children, the Group has called for tracking such children through all possible sources. “Local plans should be developed to reach these children between campaigns; reason-wise break down of missed children should be made available; and coverage of zero dose children should be included among the key performance indicators,” it has recommended.
Commenting on the Bhurban Plan in the light of provincial presentations, TAG pointed out that the Plan is not being meticulously followed-up and tracked. The panel urged Pakistan to stick to the Plan and ensure its full implementation as it has all the necessary ingredients to stop wild poliovirus circulation by the end-2015. “Given the population dynamics, immediate, simultaneous and synchronized implementation of the Plan by all geographical areas is of utmost importance for success,” the recommendations state.
With reference to accountability, TAG has called for appointment of permanent EOC (Emergency Operations Centre) coordinators in all provincial EOCs; enhancement of security coordination under the umbrella of EOC; and inclusion of one full-time security forces/army representative in the EOC.
In discussing the quality of vaccinators, TAG has recommended timely payment to all vaccinators, and has proposed “urgent thorough situational review and immediate fixation for late payments.” It has also suggested that frontline workers be placed at the center of the eradication campaign, particularly in high-risk Union Councils (UCs). The establishment of a retention, training and motivational plan for appropriate recruitment locally, also needs to be prioritised. TAG has also called for implementation of a strategic, holistic communication campaign to elevate the status of frontline workers in the community.
In terms of monitoring, TAG has referred to both intra-campaign and post-campaign monitoring as vital and has called for strengthening of these mechanisms. “The EOCs should establish a dashboard to review campaign performance, with a set of consistent performance indicators,” it has recommended.
The TAG has also made province-wise recommendations to improve performance and achieve better results. For Khyber-Pakhtunkhwa, it called for strengthening of the ‘Sehat Ka Ittehad’ initiative to ensure improved access and community trust; tracking of missed children due to insecurity or poor performance; and stringent accountability for performance.
In making recommendations for FATA, TAG has desired that plans for conducting door-to-door Supplementary Immunization Activities (SIAs) in Bara and Jamrud should be implemented in letter and spirit as Khyber puts the entire central KP and FATA at risk. It has also called for house-to-house vaccination in North Waziristan and FR Bannu, and has endorsed the plan for vaccination during repatriation.
With reference to Karachi, TAG has recommended that the EOC should have political support to achieve accountability, and that security and communication plans should aim to produce an enabling ground environment for the vaccinators. It also endorsed SIAs strategy for the eight super-high-risk UCs.
For Balochistan, TAG has termed permanent polio teams as a good local initiative, but has called for better evidence of impact on access and coverage. “Balochistan needs to maintain cross-border coordination with southern Afghanistan team to ensure all communities are reached,” it states.
In Punjab, TAG believes there is a need for urgent steps to ensure all the high-risk/migrant communities are included in the UC micro-plans of Lahore and Rawalpindi. “The problem of language/culture in-appropriate teams must be overcome immediately; proper implementation of mobile population strategy in the entire province, especially in southern Punjab, and efforts to improve routine EPI, particularly in high-risk UCs should be made,” it recommends.
Meanwhile, minister of state for health Saira Afzal called a meeting today (Friday) for a review of TAG recommendations, and directed the provinces to urgently implement them in entirety.
“We need to focus our energies on missed children for which we require credible data and independent analysis,” Saira said. The minister called for revision of micro plans of 497 high-risks UCs to get the number of children right. “We need to vigorously track missed children and concentrate all human resource in areas with missed children,” she added.
Saira tasked WHO and Unicef officials to work closely with the district polio eradication committees and update the micro-plans by March 10, positively. “Time is vital and we only have a window of 8 weeks to get maximum advantages of the low transmission season. We will be soon visiting the provinces to discuss the gaps in campaign quality and highlight the critical importance of implementing the recommendations of TAG with a sense of urgency,” she added.
The minister also expressed concern about sub-optimal campaign quality in central Pakistan which comprises districts of northern Sindh, southern Punjab and northern Balochistan.