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Reaching the Hard-to-Reach
Migrants, Nomads, IDPs & Border Communities
Lessons from the CORE Group Polio Project in India,...
Session Objectives
By the end of this session, participants will have:
(1) Examined strategies to reduce inequity in local...
Current CGPP country
Past CGPP country
647
2,710
319
4,296
1,238
9,210 community mobilizers in five countries
CORE Group Spring 2015
Global Health Practitioner Conference
Hilton ,Alexandria , VA
16 April 2015
Reaching the hard – to – reach population
Lessons from India Polio Eradication Program.
Presentation outline
• About CORE Group Polio Project India
• Inequity
• Strategies to reach out to marginalized
groups
• ...
The CORE Group Polio Project (CGPP)
– Partners : ADRA, PCI and CRS and 10 national
NGOs
– The secretariat works in close c...
01
42
741
559
874
676
66
134
225
268265
1126
0
300
600
900
1200
1500
1800
2100
1998 1999 2000 2001 2002 2003 2004 2005 200...
Location of poliovirus by type, 2011*
Wild Poliovirus
13 January, 2011
Howrah, West Bengal
Rukhsar : The Last
case of poli...
Dr Poonam Khetrapal Singh, Regional Director, WHO SEARO receiving
the polio-free certificate from the Chairperson of Regio...
India/Uttar Pradesh
Polio Stats
NIDs started from 1995.
2.3 million vaccinators reach about 175 million <5 children on eac...
Non-
migratory
93%
Migratory
7%
Non-
migratory
98%
Migratory
2%
Uttar Pradesh
(N= 111)
Bihar
(N= 83)
WPV cases by migratio...
4 - 6 doses
12%
>=10 doses
65%
1 - 3 doses
5%
7 - 9 doses
18%
0 dose
0%
(N=171)
Migratory * Non-migratory
* data as on 31 ...
Marginalized Groups
Brick Kilns workers
Construction sites
Nomads
Reaching out to marginalized
groups: Bringing equity in Health
System
Tracking of High Risk Groups
• Mapping of HRGs
sites.
• Regularly updating the
data
• Joint validation of data
with WHO & ...
Tracking of High Risk Groups (HRGs)
• Identifying informers
 Brick kiln
owners/managers
 Construction contractors
 Barb...
HRGs Tracking Format
1. Inclusion of > 400,000 high risk settlements with
Routine Immunization micro plans
~ 257,000 Migrant sites
Migrant site...
Unreached
the
Barbers
Shopkeepers
Brick kiln owners
Small contractors
Identification
of informers
More than 1000
informers identified
Need to shift from
extensive mass awareness
approach to addressing
specific conditions/needs
of specific groups
Tailor made strategies
Revised communication package
Focus on skill
building of
communicators
Shift from instructive to
negotiation approach
A strong MIS supported activity
planning and implementation
2. Orientation of informers
These platforms helped clarify
myths/misconception related to the program.
Role of informers
Inform the mobilizers immediately about
new settlements and families
3. One to one and group meetings
Went as per their convenience
4. Pictorial materials displayed at strategic locations
Any where you go
Give shots & polio drops
5. Health camps/outreach services held
Tapping opportunities for
announcements of key messages
Tapping opportunities for
announcements of key messages
More than 250000 sites were
identified
Lessons learnt
• Working in partnership works!
• Strong Government ownership at all levels
• Synergistic & non-overlapping...
Thanks
Community volunteers support in strengthening weak
health system in South Sudan to reach the hard to reach
population
Core...
Presentation outline
• Definition of terms
• Brief introduction on the health situation in South
Sudan
• Background to CGP...
Definition of terms
• Community Volunteers: a group of individuals who has
undergone basic or no formal education at all b...
Cont….
• Weak health system: a health system which is
unable to meet the basic health needs of its people.
Weakness in lig...
Brief introduction on the health situation in
South Sudan
• South Sudan become independent in July 2011, 10 States
and 79 ...
Cont…..
• It has the worst shortage of health workers put at 1.5
doctors and 2 nurses per every 100,000 population.
• Extr...
Background to Core Group South Sudan
• Started operations in 2011, within eight worst performing
counties in immunization ...
Cont…
• Works in Eight counties ( Western, Central and Eastern
Equatoria States)
• 955 volunteers (358 vaccinators, 54 col...
Why these counties?
Selected by MoH
Criteria of selection:
Poor performance routine
immunization.
Along the border areas t...
Contribution of community volunteers
• Under this theme we shall be looking into the following areas of
health system stre...
Community-centered planning
• Engagement of community
leaders in social mapping
• Wealth of knowledge by the
community
• T...
Service delivery
Shortage in professional trained health
workers.
Only 30% of South Sudanese have
access to basic health s...
Improving knowledge on immunization services using local
acceptable means in the community
Mothers group dialogue
Drama
Lo...
Overcoming challenges in transport means to reach the unreachable
during polio campaign
Improving vaccine stock outs in the remote health facilities
Reduced stock out of
vaccines from 100% in 2011
to less than ...
Community disease surveillance
319 community mobilizers
Conduct active AFP case search
Report other diseases e.g. measles
...
48%
41%
45%
32%
36% 34%
76%
59%
78%
118%
109%
88%
120%
116%
74%
104%
0%
20%
40%
60%
80%
100%
120%
140%
Magwi Morobo Kajo-K...
Contribution of community volunteers in surveillance 2012-2014
54
2012
2014
Data source: WHO & project reports
Monitoring of polio campaigns
• 224 independent monitors
• Reaching every town and village
• Focus on hard to reach areas-...
Cross border vaccination • To interrupt transportation of wild polio
virus.
• Implementing partner-Implementer
• Done in c...
Challenges
• Inadequate funding to strengthen the already improving
services and scaling to other poorly performing counti...
Lessons learnt
• Integration of the community volunteers’ activities into the
formal health system is critical for the suc...
Cont…..
• Working with community volunteers who hail from that
community leads to a lot of trust resulting in acceptance o...
conclusion
• Due to the weak health system in South Sudan resulting in
worsening health indicators, there is no doubt that...
61
Questions?
Photo: Gatesfoundation.org
Reaching Border Communities for
Polio Eradication in Horn of Africa
CORE Group Spring Meeting 2015
Virginia, USA
Bal Ram B...
Presentation Objectives
• To provide an overview of process of Cross
Border Initiative for Polio Eradication in Horn
of Af...
Outline
• Overview of PEI in HoA
• Overview of cross border efforts for polio
eradication in HOA
– Cross border issues in ...
Confirmed Polio Cases, Kenya,
2006 — 2014*
South
Sudan
Ethiopia
Somalia
Uganda
19 Cases onset on
3rd Feb to 30th July
2009...
4/27/2015 66
Outbreak following importation, 2004-08
Outbreak started
04 April 2008;
Latest Case
27 April 2008
N=3
Somali Region WPV-1 Outbreak Affected Woredas
from July 2014 up to January 14
• The total polio cases during the 2008-09
epidemic were 64 cases
– 24 cases in 2008
– 40 cases in 2009
• The last polio c...
Border Population at Risk
• The cross border community and population at high risk for
outbreak and transmission of infect...
Cross border meetings for polio
eradication
• 2012 Cross border meetings of Ethiopia, Somalia, South
Sudan, Sudan and Keny...
Source: http://kenya.iom.int/about-iom/iom-kenya-strategic-focus
Major Migration
Routes
Strategic, irregular
Multitude of ...
CORE Group in HoA
• HOA regional secretariat in Nairobi
• CGPP Project in Ethiopia since 2001
• CGPP Project in South Suda...
Cross border initiative (CBI) for Polio
Eradication
• What is CBI
– Understanding about border
communities, border crossin...
Goal and Objectives of CBI
• Goal: Contribute to global eradication by improving
population immunity in cross border commu...
CORE Group CBI approach
• Country internal approach
– Situation assessment of polio eradication in border
health facilitie...
Country internal approach
• Situation assessment
– Profiling of border communities, crossing points, transit hubs
– Mappin...
Show Table data – CBI tools
1. List of Fixed posts, Villages, Markets, Nomadic/Pastoral camps and Border communities and crossing posts by health faci...
Bordering country(ies): KENYA/SOMALIA Bordering location/districts: LIBOI DIVISION/DADAAB SUB COUNTY
DOBLEY/HOSUNGOW
Date:...
1.1. INTERNATIONAL CROSS BORDER PLAN - Border communities
Bordering country(ies): KENYA/SOMALIA Bordering location/distric...
Cross border mapping
Social map of a border health facility
Profiling of border communities
Cross border joint approach
• Cross border initiative operation guide
• Joint action planning workshop
• Review, reporting...
Implementation
• Monthly meeting of cross border health committees on
each side
• Joint quarterly meeting of cross border ...
Progress to date (1)
• Initiated in October 2014 as a process
• Developed necessary assessment, planning and
reporting too...
CBI Progress (2)
Country Dates of meeting Venue Countries attended Key objective
Kenya September 22-23,
2014
Turkana Kenya...
Plans ahead
• Plan to expand
– North Horr, Kenya between Kenya and Ethiopia
– Mandera, Kenya between Kenya, Ethiopia and S...
Reaching the Hard-to-Reach
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Reaching the Hard-to-Reach

  1. 1. Reaching the Hard-to-Reach Migrants, Nomads, IDPs & Border Communities Lessons from the CORE Group Polio Project in India, South Sudan, and the Horn of Africa
  2. 2. Session Objectives By the end of this session, participants will have: (1) Examined strategies to reduce inequity in local health systems by reaching marginalized groups and improving immunization systems (2) Considered how these strategies can be applied to other public health initiatives
  3. 3. Current CGPP country Past CGPP country 647 2,710 319 4,296 1,238 9,210 community mobilizers in five countries
  4. 4. CORE Group Spring 2015 Global Health Practitioner Conference Hilton ,Alexandria , VA 16 April 2015
  5. 5. Reaching the hard – to – reach population Lessons from India Polio Eradication Program.
  6. 6. Presentation outline • About CORE Group Polio Project India • Inequity • Strategies to reach out to marginalized groups • Communication Package • Lessons learnt
  7. 7. The CORE Group Polio Project (CGPP) – Partners : ADRA, PCI and CRS and 10 national NGOs – The secretariat works in close collaboration with the Ministry of Health, WHO, UNICEF, Rotary International and USAID. – In 2003, UNICEF & CGPP started working together as the ‘Social Mobilization Network’ (SM Net) to provide concentrated support in high risk areas (for polio) of Uttar Pradesh state. – CGPP reaches about 600,000 under 5 children in 12 districts of UP through 1300 + mobilizers
  8. 8. 01 42 741 559 874 676 66 134 225 268265 1126 0 300 600 900 1200 1500 1800 2100 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012* P1 wild P3 wild* data as on 14 September 2012 P2 wild Polio : Progress in India – A snapshot • 1995: Polio SIAs (campaigns) launched • 1997: Acute Flaccid Paralysis (AFP) Surveillance initiated • 1999: Last case of Wild Polio Virus (WPV) type 2 – (U.P) • 2010: Last case of WPV type 3 - (Jharkhand) • 2011: Last case of WPV type 1 - ( West Bengal) • 2012: India removed from list of endemic countries 1600 mOPV 1 bOPV 1 & 3
  9. 9. Location of poliovirus by type, 2011* Wild Poliovirus 13 January, 2011 Howrah, West Bengal Rukhsar : The Last case of polio in Inida
  10. 10. Dr Poonam Khetrapal Singh, Regional Director, WHO SEARO receiving the polio-free certificate from the Chairperson of Regional Certification Commission for Polio Eradication 27 March 2014 WHO South-East Asia Region certified polio-free
  11. 11. India/Uttar Pradesh Polio Stats NIDs started from 1995. 2.3 million vaccinators reach about 175 million <5 children on each NID. Govt. of India contribution to Polio Eradication 1985- 2012 $1237.28 million U.P State 75 Districts Population: 199.6 million Under 5 population: 25 million 33 million houses visited by polio vaccination teams per SIA round
  12. 12. Non- migratory 93% Migratory 7% Non- migratory 98% Migratory 2% Uttar Pradesh (N= 111) Bihar (N= 83) WPV cases by migration status, 07-09* Non- migratory 58% Migratory 42% Rest of India (N= 31) * data as on 30 october 2009 Non- migratory 85% Migratory 15% Non epidemic UP* (N= 54) *Non epidemic UP excludes Moradabad, JP Nagar,Badaun, Kanshi ram nagar, Bareilly and Rampur dists of UP Inequity : disproportionate number of Polio cases were reported among migrant population
  13. 13. 4 - 6 doses 12% >=10 doses 65% 1 - 3 doses 5% 7 - 9 doses 18% 0 dose 0% (N=171) Migratory * Non-migratory * data as on 31 October 2009 4 - 6 doses 8% >=10 doses 77% 1 - 3 doses 1% 7 - 9 doses 14% 0 dose 0% (N=20458) Immunization status among 6 months to 5 years : 2009 • Urban slums have been excluded from the migratory category • OPV coverage among Non-Polio AFP cases
  14. 14. Marginalized Groups Brick Kilns workers Construction sites Nomads
  15. 15. Reaching out to marginalized groups: Bringing equity in Health System
  16. 16. Tracking of High Risk Groups • Mapping of HRGs sites. • Regularly updating the data • Joint validation of data with WHO & Govt.
  17. 17. Tracking of High Risk Groups (HRGs) • Identifying informers  Brick kiln owners/managers  Construction contractors  Barbers  Gate keepers in slums
  18. 18. HRGs Tracking Format
  19. 19. 1. Inclusion of > 400,000 high risk settlements with Routine Immunization micro plans ~ 257,000 Migrant sites Migrant sites High risk areas in settled population ~ 154,000 HR areas in settled population = 10 Migrant sites = 10 HR sites
  20. 20. Unreached the
  21. 21. Barbers Shopkeepers Brick kiln owners Small contractors Identification of informers More than 1000 informers identified
  22. 22. Need to shift from extensive mass awareness approach to addressing specific conditions/needs of specific groups
  23. 23. Tailor made strategies
  24. 24. Revised communication package
  25. 25. Focus on skill building of communicators Shift from instructive to negotiation approach
  26. 26. A strong MIS supported activity planning and implementation
  27. 27. 2. Orientation of informers These platforms helped clarify myths/misconception related to the program.
  28. 28. Role of informers Inform the mobilizers immediately about new settlements and families
  29. 29. 3. One to one and group meetings Went as per their convenience
  30. 30. 4. Pictorial materials displayed at strategic locations Any where you go Give shots & polio drops
  31. 31. 5. Health camps/outreach services held
  32. 32. Tapping opportunities for announcements of key messages Tapping opportunities for announcements of key messages
  33. 33. More than 250000 sites were identified
  34. 34. Lessons learnt • Working in partnership works! • Strong Government ownership at all levels • Synergistic & non-overlapping support by partners enhances programme effectiveness • Data driven decision making to identify and respond to unreached areas/populations • Communication strategies need to be tailor made as per audiences profile • Simple, picture & action oriented communication materials works better • Tracking system can used in other programs like TB, Ebola.
  35. 35. Thanks
  36. 36. Community volunteers support in strengthening weak health system in South Sudan to reach the hard to reach population Core Group Spring Meeting Presenter: Anthony Kisanga Core Group South Sudan April 13-17, 2015
  37. 37. Presentation outline • Definition of terms • Brief introduction on the health situation in South Sudan • Background to CGPP Sudan • Contribution of community volunteers • Outcome of community volunteers contribution • Challenges • Lessons learnt • Conclusion
  38. 38. Definition of terms • Community Volunteers: a group of individuals who has undergone basic or no formal education at all but provides significant community health intervention. They are selected, trained and working for their own communities but not necessarily part of the formal health system, they include vaccinators, cold chain assistants, community mobilizers and independent monitors. • Hard to reach communities: communities who are not easily accessible to health services due to one or more adverse conditions: distance from the nearest health facility, difficult terrain (mountainous areas, forested areas), flooding, insecurity, poor or unreliable road networks, nomadic lifestyle.
  39. 39. Cont…. • Weak health system: a health system which is unable to meet the basic health needs of its people. Weakness in light of insufficient qualified health workers, diseases surveillance, public awareness, chronic shortage of supplies e.g. vaccines, inequality in distribution of health workers and health facilities, limited or no community outreach programs and engagement of the local population.
  40. 40. Brief introduction on the health situation in South Sudan • South Sudan become independent in July 2011, 10 States and 79 counties • Population project (2012) puts the figure for South Sudan at 11,532,241 • Only one third of the country has access to basic health services • It has 1,090 functional health facilities with 37 of them being hospitals.
  41. 41. Cont….. • It has the worst shortage of health workers put at 1.5 doctors and 2 nurses per every 100,000 population. • Extreme inequality in distribution of health facilities and health workers with urban areas most favored • Its maternal mortality ratio stands at 2,054/100,000 and under five mortality rate was estimated at 135/1,000 live births. (Sudan HH Survey 2006/2010) • 2011 EPI survey shows 16.5% of children under the age of one fully vaccinated and only 22.1% completed OPV3.
  42. 42. Background to Core Group South Sudan • Started operations in 2011, within eight worst performing counties in immunization mostly based at the Southern borders of South Sudan. • Core Group South Sudan has three partners: American Refugee Committee, World Vision South Sudan and Amref Health South Sudan. • It supports comprehensive EPI services that focuses on; 1. Routine immunization both at facility and community level 2. Support Polio National Supplementary Immunization Days 3. Community-based disease surveillance
  43. 43. Cont… • Works in Eight counties ( Western, Central and Eastern Equatoria States) • 955 volunteers (358 vaccinators, 54 cold chain assistants, 319 community mobilizers and 224 independent monitors)
  44. 44. Why these counties? Selected by MoH Criteria of selection: Poor performance routine immunization. Along the border areas to Interrupt transmission Hard to reach (MOH Administrative Data)
  45. 45. Contribution of community volunteers • Under this theme we shall be looking into the following areas of health system strengthening that community volunteers have supported: 1. Community-centered planning 2. Service delivery 3. Supply chain 4. Monitoring and evaluation (disease surveillance, monitoring quality of polio immunization campaigns) 5. Cross border initiatives
  46. 46. Community-centered planning • Engagement of community leaders in social mapping • Wealth of knowledge by the community • Trust in whatever is done • Acceptance • Ownership • Accountability
  47. 47. Service delivery Shortage in professional trained health workers. Only 30% of South Sudanese have access to basic health service. Inequality in health facility and health workers distribution. Outreaches: 5 kms and above Other facilities with no cold chain Vaccination under trees, churches, schools in the villages
  48. 48. Improving knowledge on immunization services using local acceptable means in the community Mothers group dialogue Drama Local music Community leaders meetings
  49. 49. Overcoming challenges in transport means to reach the unreachable during polio campaign
  50. 50. Improving vaccine stock outs in the remote health facilities Reduced stock out of vaccines from 100% in 2011 to less than 10% in 2014 By using the cost effective means of transport . Delivering vaccines from county Vaccine stores to the most remote areas
  51. 51. Community disease surveillance 319 community mobilizers Conduct active AFP case search Report other diseases e.g. measles Report to the nearest health center or WHO Field assistant for investigation Educate households Refer mothers & children for vaccination Organize for outreach in their villages in Collaboration with vaccinators
  52. 52. 48% 41% 45% 32% 36% 34% 76% 59% 78% 118% 109% 88% 120% 116% 74% 104% 0% 20% 40% 60% 80% 100% 120% 140% Magwi Morobo Kajo-Keji Nzara Yambio Ibba Kapoeta East Kapoeta South Coverage(%) Counties DPT3 Performance in Core Group supported counties from 2011-2014 Baseline 2014 (MOH Administrative Data) Using resources in the polio eradication to support routine immunization Outcome of the contributions of the community volunteers
  53. 53. Contribution of community volunteers in surveillance 2012-2014 54 2012 2014 Data source: WHO & project reports
  54. 54. Monitoring of polio campaigns • 224 independent monitors • Reaching every town and village • Focus on hard to reach areas-hard to reach communities. • Report all missed areas to campaign supervisor-map ups • Use information for planning
  55. 55. Cross border vaccination • To interrupt transportation of wild polio virus. • Implementing partner-Implementer • Done in collaboration with MoH, WHO and UNICE
  56. 56. Challenges • Inadequate funding to strengthen the already improving services and scaling to other poorly performing counties • Due to the level of poverty in the community, the expectation of pay among project volunteers • Poor transport infrastructure- poor roads, flooding, inadequate transport means. • Insecurity in the remote areas- arrest of volunteers in doing their work in some insecure areas.
  57. 57. Lessons learnt • Integration of the community volunteers’ activities into the formal health system is critical for the success of the program. • Collective planning with the community leaders, facility based health workers and volunteers results to ownership of the program • Community volunteers play a very pivotal role in strengthening the health system through their engagement and participation.
  58. 58. Cont….. • Working with community volunteers who hail from that community leads to a lot of trust resulting in acceptance of the program and improved uptake of vaccine which culminated in improvement in immunization coverage in most of the counties. • Strong collaboration between community leaders, the local health authorities and presence of supporting partner on the ground
  59. 59. conclusion • Due to the weak health system in South Sudan resulting in worsening health indicators, there is no doubt that involving community volunteers and linking them to the formal health system is important if we are to reach the unreached with lifesaving health interventions.
  60. 60. 61 Questions? Photo: Gatesfoundation.org
  61. 61. Reaching Border Communities for Polio Eradication in Horn of Africa CORE Group Spring Meeting 2015 Virginia, USA Bal Ram Bhui, CGPP HOA
  62. 62. Presentation Objectives • To provide an overview of process of Cross Border Initiative for Polio Eradication in Horn of Africa • To describe various tools for planning, reporting and monitoring. • Progress, challenges and plans ahead
  63. 63. Outline • Overview of PEI in HoA • Overview of cross border efforts for polio eradication in HOA – Cross border issues in HoA for polio eradication – Cross border meeting for SIA in HoA • Cross border initiative for polio eradication – CORE Group model for reaching hard reach/high risk and mobile population in along borders
  64. 64. Confirmed Polio Cases, Kenya, 2006 — 2014* South Sudan Ethiopia Somalia Uganda 19 Cases onset on 3rd Feb to 30th July 2009; in 3 Turkana districts 2 Cases reported in 2006, Sept and Nov Garissa District 1 Case onset on 30th July 2011; Kamagambo , Rongo District 14 Cases reported in 2013 in Dadaab & Hulugho Districts ; Onset of latest case 14 July 2 Cases cVDPV reported in 2012, June Dadaab District 1 environmental Sample positive for WPV1 Oct 2013
  65. 65. 4/27/2015 66 Outbreak following importation, 2004-08 Outbreak started 04 April 2008; Latest Case 27 April 2008 N=3
  66. 66. Somali Region WPV-1 Outbreak Affected Woredas from July 2014 up to January 14
  67. 67. • The total polio cases during the 2008-09 epidemic were 64 cases – 24 cases in 2008 – 40 cases in 2009 • The last polio case in South Sudan was on 27/6/2009 (Aweil West). • During the period June 2008 to December 2012 a number of 29 SIAs were conducted 2008 2009 19 Cases onset on 3rd Feb to 30th July 2009; in 3 Turkana districts 1 Case onset on 30th July 2011; Kamagambo , Rongo District History of polio out break in HOA – 2008-2009 Outbreak in SSD Exportation of the SSD outbreak to Kenya (2009)
  68. 68. Border Population at Risk • The cross border community and population at high risk for outbreak and transmission of infectious diseases including polio • Border communities share ecology, epidemiology, culture and values • Borders are only politically divided • Borders are likely to be – Hard to reach – Left out – Socio-economically disadvantaged • Borders are porous, free movement • People move for trade, pastures, health care, education, cultural reasons, recreation, migration, conflict and security reasons
  69. 69. Cross border meetings for polio eradication • 2012 Cross border meetings of Ethiopia, Somalia, South Sudan, Sudan and Kenya • Cross border meetings by CORE Group South Sudan with Ethiopia, Kenya, DRC, Uganda • Achievements: – Awareness and commitment of MOH, increased – Synchronized SIAs along the borders • Challenges: – Meeting was one time before SIA, no follow up – Action plan not implemented – No reporting, monitoring and evaluation – No plan to improve PEI efforts in border communities on ongoing basis
  70. 70. Source: http://kenya.iom.int/about-iom/iom-kenya-strategic-focus Major Migration Routes Strategic, irregular Multitude of factors o Political/Conflict o Environmental o Economic Monthly Updates
  71. 71. CORE Group in HoA • HOA regional secretariat in Nairobi • CGPP Project in Ethiopia since 2001 • CGPP Project in South Sudan since 2010 • CGPP in Kenya and Somalia – Kenya Border counties – Turkana, Marsabit, Wajir, Mandera, Garissa – Nairobi – Lower Juba, Gedo, Mudug in Somalia – CORE Group NGOs and National NGOs implement the project
  72. 72. Cross border initiative (CBI) for Polio Eradication • What is CBI – Understanding about border communities, border crossing points and transit hubs and addressing them for polio eradication internally as well as with border counterpart – Initiative at operational border health authority levels • Who are involved in CBI – National MOH – County government and health office – Local immigration and security authorities – Polio Partners and NGOs • Where is CBI institutionalized – Border between Kenya, Somalia, Ethiopia, South Sudan and Uganda
  73. 73. Goal and Objectives of CBI • Goal: Contribute to global eradication by improving population immunity in cross border communities and populations with effective AFP surveillance • Objectives: Improve cross border collaboration between health, administrative authority of border regions and the partners to – Improve PEI efforts in border communities and populations – Improve coverage and synchronization of SIAs at cross border points – Establish permanent vaccination points at major crossing points – Improve PEI efforts in transit hubs and routes – Improve communication and collaboration between border health offices
  74. 74. CORE Group CBI approach • Country internal approach – Situation assessment of polio eradication in border health facilities and populations – Polio eradication action plan for cross border communities and populations • Cross border joint approach – Identification of populations and areas for cross border collaborations – Joint action plan – Cross border health committee and TOR – Cross border planning and review meetings
  75. 75. Country internal approach • Situation assessment – Profiling of border communities, crossing points, transit hubs – Mapping of border communities, crossing points, transit hubs – Capacity assessment of border health facilities – Micro planning for SIA, RI, AFP Surveillance for border areas • Country action plan to address cross border issues for polio eradication – Action plan to support border health facility improve SIA coverage, Routine Immunization Coverage and AFP surveillance sensitivity – Cross border health committee members designated – Regular review and reporting on implementation of action plan
  76. 76. Show Table data – CBI tools
  77. 77. 1. List of Fixed posts, Villages, Markets, Nomadic/Pastoral camps and Border communities and crossing posts by health facility in a Location NB: List ALL villages in each location with their target populations. Also list markets, seasonal camps (pastoralists, nomadic, etc.), schools, transports stations, re 1 LIBOI Hc-SALAT MOHAMMED 1 DAMAJALEY DISPENSARY.-EVANS ARIAM 1 HAMEY DISPENSARY-SAMUEL CHEPSAIG 1 Health Facility (name) (Subsidiary) Health Facility (name) (Subsidiary) Health Facility (name) (Subsidiary) Health Facility (name) (Subsidiary 1.1 1.1 1.1 1.1 1 1.2 1.2 1 Village/Estate - Target populatioon 3484Village/Estate - Target population 925 Village/Estate - Target population 666 Village/Estate (Name/Target 1 Bula safaricom-190 1 Bula sheikh-75 1 Bula borehole-65 1 2 Bula makabul-210 2 Bula Tuhun-80 2 Bula banaan-70 2 3 Bula Sambule-220 3 Bula Daidei-90 3 Bula Primary-62 3 4 Bula Torotoro-210 4 Bula Hodhan-68 4 Bula labi-58 4 5 Bula Mohamed Zubeir-180 5 Bula Towfiq-74 5 Bula mosque-55 5 6 Bula Oji-90 6 Bula Primary-85 6 Bula camp-60 6 7 Bula Celtel-190 7 Bula Labatule-70 7 Bula Sheikh-52 7 8 Bula Sufi-215 8 8 Bula daidai-58 8 9 Bula Maseer-200 9 9 9 10 Bula Dana-230 10 10 10 11 Bula hursan-210 11 11 11 12 Bula Haji-174 12 12 12 13 13 13 13 14 14 14 14 15 15 15 15 16 16 16 16 Markets including supermarkets, transport stations, schools and religious places (Day and place): Markets (place & day) Markets (place & day) Markets (place & day) 1 Liboi Primary School 1 Damajaley market centre 1 Hamey market centre 1 2 Madina Academy 2 Damajaley Primary sch 2 Hamey Primary school 2 3 Liboi Airstrip 3 Damajaley mosque 3 Hamey animal watering point 3 4 Liboi Madrssa 4 Damajaley animal watering point 4 Hamey mosque 5 Liboi Mosque 5 5 6 Liboi KDF camp 6 6 7 Liboi Market centre 7 7 4 Seasonal Settlements Seasonal Settlements / Hard-Reach Seasonal Settlements / Hard-Reach Seasonal Settlements / Hard-R 1 Wardaklow-25 1 Abaq dam-10 1 Guba athey-28 1 2 Ali gabey-30 2 Gari gubane-12 2 Gadable-22 2 3 Welcadcad-30 3 Tarsis-18 3 3 4 4 Daryolle-13 4 4 5 5 Dobale dam-23 5 5 6 6 6 6 7 7 7 7 Hard to reach/high risk village/settlements Hard to reach/high risk village/settlements Har d to Hard to reach/high risk village/settlements H ar d Hard to reach/high risk village/settlements 1 Deg-elema-750 1 Magudo- 65 1 Deq-athey-70 1 2 Harhar-200 2 Aden santur-72 2 Homijo-65 2 3 Dat-quran-100 3 Ali dakane-60 3 3 4 Indatha Dam-30 4 Abdi sugow-110 4 4 5 5 5 5 6 6 6 6 7 7 7 7 Health Facility (name) (Responsible) Health Facility (name) (Responsible) Health Facility (name) (Responsible) Health Facility (name) (Responsible Mapping of villages
  78. 78. Bordering country(ies): KENYA/SOMALIA Bordering location/districts: LIBOI DIVISION/DADAAB SUB COUNTY DOBLEY/HOSUNGOW Date: 27/3/2015 Border country Name/area: Somali SN Name of border crossing/entry-exit points Name of village along the border crossing points Name of health facility that the crossing points belong to Is crossing point formal or informal? 1-Formal, 0- Informal Average number of people crossing the border in a day How will this crossing point be covered during SIA? (A static vaccination team, mobile vaccination team designated for cross border points, none) Name of border crossing/entry-exit points if different Name of village along crossing points in other side of border Name of health facility that the crossing points belong to in other side of border How will this crossing point be covered during SIA? (A static vaccination team, mobile vaccination team designated for cross border points, none) Comments Deg-elema Deg -elema Liboi Hc 0 60 Mobile Deg- elema Deg- elema None Coverage to be discussed with CB country/WHO Harhar Harhar Liboi Hc 1 150 Mobile Dobley Dobley Dobley hospital Coverage to be discussed with CB country/WHO Magudo Magudo Damajaley disp 0 Mobile Magudo Magudo None Coverage to be discussed with CB country/WHO Aden santuir Aden santur Damajaley disp 0 10 Mobile Aden santur Aden santur None Coverage to be discussed with CB country/WHO Ali Dakane Ali Dakane Damajaley disp 0 10 Mobile Ali Dakane Ali Dakane None Coverage to be discussed with CB country/WHO Abdi sugow Abdi sugow Damajaley disp 0 30 Mobile Abdi sugow Abdi sugow None Coverage to be discussed with CB country/WHO Deq-athey Deq-athey Hamey Disp 0 70 Mobile Deg-athey Deg-athey None Coverage to be discussed with CB country/WHO Harmujo Homijo Hamey Disp 0 25 Mobile Hosungow Hosungow None Coverage to be discussed with CB country/WHO Total 1.2. INTERNATIONAL CROSS BORDER PLAN - Border crosing points Kenyan villages covered by Kenyan teams are in Kenya's microplan. Other villages will be in border country's microplan KENYA Mapping of cross border communities
  79. 79. 1.1. INTERNATIONAL CROSS BORDER PLAN - Border communities Bordering country(ies): KENYA/SOMALIA Bordering location/districts: LIBOI /DAMAJALEY/HAMEY LOCATION Date: Border country NamSomalia Kenyan villages along border Name of Health Facility Target Pop. (Polio SIAs) Country covering Date of vaccinati on Border country's villages to be covered by Kenyan teams Border Health facility name Target Pop (Polio SIAs) Kenyan Team ID Date of vaccinati on OPV required (doses) LIBOI HEALTH CENTRE Deg-elema LIBOI HEALTH CENTRE Kenya 20/4/15 Deg-elema Harhaar LIBOI HEALTH CENTRE Kenya 20/4/16 Dobley Dat-quran LIBOI HEALTH CENTRE Kenya 21/4/15 DAMAJALEY DISPENSARY Magudo DAMAJALEY DISPENSARY Kenya 20/4/15 Aden santur DAMAJALEY DISPENSARY Kenya 20/4/16 Ali Dakane DAMAJALEY DISPENSARY Kenya 21/4/15 Abdi sugow DAMAJALEY DISPENSARY Kenya 21/4/16 Hosingow HAMEY DISPENSARY Deq-athey HAMEY DISPENSARY Kenya 20/4/15 Homijo HAMEY DISPENSARY Kenya 21/4/16 Total KENYA Kenyan villages covered by Kenyan teams are in Kenya's microplan. Other villages will be in border country's microplan Mapping of border crossing points
  80. 80. Cross border mapping
  81. 81. Social map of a border health facility
  82. 82. Profiling of border communities
  83. 83. Cross border joint approach • Cross border initiative operation guide • Joint action planning workshop • Review, reporting and documentation of cross border activities • Quarterly cross border health committee meetings • Regular information sharing between border county/district health office • Engagement of border immigration, security and other border stakeholders
  84. 84. Implementation • Monthly meeting of cross border health committees on each side • Joint quarterly meeting of cross border health committee • Semi-annual and annual review meetings • Implement and report on action plan – Synchronization of vaccination at border crossing points – Actions to improve AFP surveillance of border health facility catchment areas – Actions to improve routine immunization in border health facility catchment areas – Permanent vaccination points – Regular communication between parties
  85. 85. Progress to date (1) • Initiated in October 2014 as a process • Developed necessary assessment, planning and reporting tools • Microplanning for cross border issue at border health facility level initiated • Cross border Initiative Operation Guide developed • High level of commitment and support from MOH, County Health Office, Immigration and Security offices • High level of commitment from polio Partners – WHO and UNICEF and NGOs
  86. 86. CBI Progress (2) Country Dates of meeting Venue Countries attended Key objective Kenya September 22-23, 2014 Turkana Kenya, South Sudan, Uganda To map border points to cover in upcoming SIA and to have a joint action plan for synchronization of SIA Kenya October 29-30, 2014 Moyale Kenya and Ethiopia To map border points to cover in upcoming SIA and to have a joint action plan for synchronization of SIA Djibouti October 28 – 29 2014 Djibouti Djibouti, Yemen, Somalia, Ethiopia To review the implementation of recommendations of last workshop and plan for upcoming SIA in the region Kenya January 21, 2015 Moyale Kenya and Ethiopia Cross Border Health Committee meeting: To review cross border collaboration in last SIA, To review terms of reference for the committee South Sudan 8 cross border committees in 8 counties are functional South Sudan Permanent transit vaccination point established in Lotiimor, Nadapal, 2,042 children moving between countries were vaccinated in Aug-Dec 2014 South Sudan Vaccination teams in 20 border crossing points in 6 counties in Nov and Dec SIA 2014 vaccinated 11,242 children moving between countries
  87. 87. Plans ahead • Plan to expand – North Horr, Kenya between Kenya and Ethiopia – Mandera, Kenya between Kenya, Ethiopia and Somalia – South Central Zone, Somalia with Kenya • Provide field support to county health offices for CBI through Sub Grants to NGOs • Complete profiling and mapping of cross border communities, border crossing points and transit hubs. • Improve SIA coverage, Synchronization of campaigns, routine immunization , and improved AFP surveillances in border communities • Regular review and planning meetings on CBI internal and with cross border area • Improve communication between cross border health facility and authorities • Improve Polio Partners Collaboration on cross border initiative

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