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January 13, 2019

TAG on polio urges Pakistan to ‘obsessively’ focus on missed children

Islamabad

January 13, 2019

Islamabad : While recognising the efforts that Pakistan has invested in restraining poliovirus transmission, the Technical Advisory Group (TAG) on polio eradication Saturday urged the country to “obsessively focus on reaching still missed children in core reservoir areas through continued improvement of operations.”

Concluding its five-day technical field consultation, which was held in Karachi on January 8-10 and in Islamabad on January 11-12, TAG stressed that until solid routine immunisation is achieved, sustaining the benefits of Pakistan’s polio eradication achievements will be challenging. The Group carried out a comprehensive assessment of the programme’s progress, opportunities, and remaining challenges.

Prominent at the consultation were TAG’s Chair Dr. Jean Marc Olivé, the Prime Minister’s Focal Person for Polio Eradication Babar Bin Atta, DG Health Dr. Asad Hafeez, representatives of Provincial Governments, WHO Representative Dr Ni’ma Abid, and UNICEF Representative Aida Girma, among others.

Pakistan reported 10 polio cases in 2018, two more than in 2017. Transmission persists in the same hotspots and core reservoirs as shown by environmental surveillance. TAG sees Karachi and Peshawar as the primary areas of concern as they pose an epidemiological risk of continued transmission and exportation, and Quetta Block as presenting a continuous threat of re-establishing transmission due to persistent transmission in Southern Afghanistan.

TAG sees EPI as being critically weak in tier 1 reservoirs (Killa Abdullah, Quetta, Pishin, Karachi East, Karachi West, Khyber, Peshawar), and has maintained that Pakistan is missing a critical channel to immunize children in polio reservoirs. “Fixing EPI in tier 1 polio reservoirs should become an emergency response,” it has recommended.

The Group has also suggested that the Prime Minister’s Focus Group (PMFG) should meet on a monthly basis to implement and track recommendations of the National Task Force, and that there should be continuity of administrators (Commissioners, DCs and EOC Coordinators) in core reservoirs for at least six months.

With reference to Punjab and the twin cities (Rawalpindi/ Islamabad), TAG has appreciated the overall success of Punjab in reaching children but has expressed concern over continued transmission in the twin cities. In proposing the way forward, the Group has urged Punjab to ensure that monthly and quarterly review meetings are regularly held and that essential immunization strengthening plans for high-risk Union Councils and Tehsils in South Punjab are developed. The Group has advised Islamabad and Rawalpindi to secure sufficient and sustainable field personnel.

In recommending ways to cover all eligible children, TAG sees strengthening of the inter-personal communication skills of frontline workers as the key to reducing missed children. “Frontline workers must be supported to take the initiative to ensure every opportunity to vaccinate all eligible children. The emphasis of SIA activities should be focused on maximizing coverage of missed children within a 14 day limit,” the Group has recommended.

TAG has also recommended that Community Health Workers be capacitated and maximally supported to enable them to achieve quality work. “They should not be responsible for covering recorded refusals. The policy of covering refusals by supervisors or specific teams tasked with this should be followed everywhere,” it has stated.

The Emergency Operation Centre (EOCs) should support the detailed analysis of available data to help identify the true risks to achieving high coverage of the most vulnerable groups, and ensure appropriate plans and actions to reach these groups. TAG has also called for stringent accountability and reward for all levels.

Providing detailed feedback, TAG’s Chair Dr. Jean Marc Olivé appreciated the sustained commitment of the Pakistan to polio eradication, following a smooth political transition. “Pakistan is in a good position to stop polio in the very near future, with the exceptional political commitment, strong coordination under the umbrella of Emergency Operations Centre, and a strategy – the National Emergency Action Plan – which is delivering results. I urge everyone to continue the great work they have been doing and go the extra mile to free this country from polio. Karachi and Peshawar are the primary areas of concern for the programme, and this is where the extra efforts are needed,” he said.

Babar Bin Atta appreciated the TAG recommendations and said: “The country team will put all the effort into making sure these recommendations are implemented. I am confident that with the level of commitment which we have right now, we will eradicate polio in Pakistan very soon.”

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