Reporting Period: September, 2015
Project Title To Implement and evaluate a single strategy of delivering IPV, routine immunization and MNCH services at scale in high risk districts of Sindh, FATA and KP linked with advocacy and local information campaigns (a health and immunization campaign)
Running Title Mother and Child Care Project (MCCP 2)
Principal Investigator Prof. Zulfiqar A Bhutta
Reporting Institution Trust for Vaccine and Immunization (TVI) Implementing Partner Prime Foundation (PF) Reporting Date 30 September, 2015
1. Background The National Emergency Action Plan (NEAP) 2014 of the Government of Pakistan aimed to stop the virus circulation by December 2014 which would be only possible with an effort to maximize the coverage of OPV, improvement in the routine immunization rates and introduction of IPV as a part of routine immunization with DPT3 as recommended by WHO. Having had firsthand experience of successful conducting a large scale trial in which intensive communication activities and delivery of Injectable Polio Vaccine in health camps following SIA was piloted in Bajaur Agency, Prime Foundation contains the required expertise and capacity to support to Aga Khan University, Trust for Vaccine & Immunization and Government of Pakistan in delivering this project and helping eradicate Polio from Pakistan. The current project represents the scale-up phase of a a recently completed project of Aga Khan University in collaboration with Prime Foundation (and its subsidiary Peshawar Medical College) and other partners. The intervention involved delivering IPV through health camps combined with a focused community mobilization effort, and achieved a coverage rate of about 80% at all sites and an increase of routine immunization. The delivery of IPV was found to be acceptable and feasible within the community and no serious adverse event following immunization was observed. The scale-up phase of this project (MCCP2) in KP and FATA targets seven districts and agencies forming a southern block, which is expected to interrupt the transmission of polio virus in the southern half of KP and FATA.
2. Objectives 2.1
To implement a single strategy of delivering IPV, routine immunization and MNCH services at scale in selected districts and areas of FATA and KP linked with advocacy and local information campaigns (a health and immunization campaign). To conduct impact evaluation of proposed strategy through standard design and assessment methods.
3. Coordination Activities During September 2015, important meetings, formal and informal communication took place with EOC at provincial level regarding health camps planning, provision of vaccines, NOC issuance and other matters. Formal coordination activities are mentioned below. Submission of NOC Extension Request for FATA Date: 21 Sep 2015 Outcome: Updated camp plans till December 2015 along with staff list was officially submitted to FATA Secretariat, requesting extension of NOC for project activities beyond 3rd October 2015.
Coordination meeting of PF with EOC KP Held: 22 Sep 2015 Outcome: Provided detailed project update to EOC and other partners; agreed on coordination with UNICEF regarding camp locations; issues regarding provision of vaccines duly noted and later facilitation extended by EOC and Focal Person BMGF in this regard. Meeting on PF with UNICEF Focal Person re Camp Locations Held: 29 Sep 2015 Outcome: Discussed and resolved all potential duplication issues; shared camp locations and service package with each other; further coordination will be continued informally. Coordination at Field Level At field level, all coordinators of Prime Foundation for various districts/agencies maintained regular and timely coordination with counterpart government administration, and also submitted formal requests for provision of staff (as per original project plan), health facilities and vaccines for conducting health camps.
Field Level Training on Community Mobilization (DI Khan) Date: 1 Sep 2015 Summary: A one day training on Community Mobilization was conducted for field staff including both community mobilizers and survey teams at National Club, DI Khan, in order to develop their capacity for executing community mobilization activities. Area Communication Officer of DI Khan and Master Trainer from Gomal Medical College were facilitators in this training activity. Some pictures from the training are shown below.
Field Level Training on Community Mobilization (SWA) Date: 2 Sep 2015 Summary: A one day training on Community Mobilization was conducted for field staff including both community mobilizers and survey teams at Agriculture Hall, Tank, in order to develop their capacity for executing community mobilization activities. Agency Coordinator and Area Communication Officer of South Waziristan Agency facilitated this training. Some pictures from the training are given below.
Field Level Trainings on Patient Record Sheet (DI Khan, Lakki, Tank) Date: 18-21 Sep 2015 Summary: Trainings were conducted in three district offices (DI Khan, Lakki Marwat and Tank) by TVI staff Mr. Muhammad Ali and Mr. Shahid Khan on Patient Record Sheet for Health Camps. The training was delivered to staff that will be involved in data collection during the camps.
Further trainings for health care providers and vaccinators are planned in first week of October.
5. DMU Set Up A team from Prime visited AKU-DMU during August to see and replicate same environment at Prime. As of this writing Data Management Unit has been successfully established at Prime. All computer and network infrastructure is in place and the software provided by DMU-AKU has been deployed. Pilot testing of the complete environment along with data entries was conducted for more than two weeks and was found so successful that the entered data will be carried over to proper data entry to save time. DMU-Prime has capacity to double the data entry staff if the need arises. Entered data and backups generated at DMU-Prime are being shared with DMUAKU on daily basis.
Data Entry Operators working at Data Management Unit, PIPH
6. Pre-Vaccination Survey Pre-vaccination survey has been successfully completed in districts Tank, Lakki Marwat and Dera Ismail Khan (all domain of Khyber-Pakhtunkhwa). Data from these three districts was received at Prime in time, and was used during pilot testing of DMU. After completion of the survey in selected UCs of these district, all arrangements have been made to survey other UCs. Teams have been provided with lists of randomly selected households to be surveyed after the health camps. Surveying in FATA has experienced delays due to late issuance of NOC. Linelisting has been completed in FR-Tank, FR DIK and SWA, and the teams have been provided with the list of randomly selected households to be surveyed.
Survey Enumerator conducting Pre-vaccination Survey in Lakki Marwat
8. Challenges Whereas the NOC for project districts of KP became available in time, the NOC for FATA areas of the project was delayed significantly despite formal request early in June 2015 and regular follow-ups. It became available only days before the Sep SIA through personal influence and efforts and then again for a limited period of around one month. Another request was submitted on 21st September for extension of NOC till end of December 2015, which is still pending. Even more challenging has been the availability of vaccines for the project. Till end of the month no headway was witnessed despite concerted efforts at all levels by PF, AKU/TVI and other partners and colleagues at provincial and national levels. With the above, the oft-changing dates of scheduled SIAs also put the project planning and activities under jeopardy. Dearth of local skilled human resource together with interferences of one type or the other in hiring followed by dropouts off and on due to hard and insecure field have been experienced in several districts/agencies.
9. Next Steps / Timeline Given that the challenges are enormous and beyond the control of implementing partner, PF has focused more and more on its preparedness for prompting health camps in KP as and when
vaccine becomes available while completing the pre-vaccination surveys and camp planning etc. in FATA soon after extension of the relevant NOCs. Any further delay in having the needed support from government quarters can practically undo the whole planning and prep in the wake of volatile SIA schedules and jumbled up connected activities. During the month, project update, next steps and help required was shared at EOC KP with all the partners. A separate meeting will be held towards start of the next month with UNICEF to create clarity re assigned areas, mutual plans, approaches and likely synergies. A meeting request with EOC FATA for Oct 2 was agreed initially but later postponed to Oct 5. Here is a Gantt chart of the completed, ongoing and planned immediate next activities.