Polio National Emergency Action Plan for 2016-17

1. Polio eradication in
Afghanistan
NEAP 2016-2017
NEAP Workshop, Afghanistan
24 October 2016

2. 2
President
REOCs
National Polio
Focal Point
Presidential focal
point
Line Ministries Governors
Minister of Public
health
NEOC
All line
department of
MoPH
Changes in program management

3. NEAP 2016-17
• Goal:
– To stop WPV transmission in Afghanistan by the end of
December 2016, with no new wild poliovirus type 1 (WPV1)
cases from January 2017 onwards
• Strategic approach:
– Maintain programme neutrality and gain access to all
children with OPV, irrespective of the area where they
reside
– Implement alternate strategies, i.e. use Polio Plus
interventions and the PTT, particularly in inaccessible areas
– Focus on identified high-risk provinces and districts and
areas where children are persistently missed
– Underpin all strategies by ensuring strong household and
community engagement; and
– Enhance accountability of all stakeholders, at all levels

4. Targets and milestones
• 5 SIAs in the second half of 2016 and 5 in the first half of
2017:
– Reaching over 90% of children during each SIA
– >90% LQAS lots accepted at 80% and <5% missed children in
PCM
• One IPV-OPV SIA in all VHRDs by end Sept 2016
• Revise microplans of all VHRDs by the end Sept 2016
• Operationalize full-time ICN in all VHRDs by the end Sep 16
• Maintain NPAFP rate of >2 cases/100 000 with adequate
stool specimens collected from >80% of AFP cases in every
district across the country
• Implement the accountability framework: End August’16

5. NEAP 2016-17
• Continue strengthening polio governance and
management structure:
– EOC: Task team modality, weekly TCs
– Expansion of M&A officer to all 47 districts
– Provincial & district task force: Revise TOR
– Implement accountability framework from August
onwards
• High risk approach:
– Focus on 47 district and 5 high risk province
– District profile and specific plans for all VHRDs after each
SIA
– Districts in between VHRDs treated as high risk
– Revision in December 2016

6. High risk areas
New terminology
Revision in December 2016

7. District profile and
specific plan of action
• Profiling done for all VHRDs
• Specific issues identified and
action plan developed
• Updated after every
campaign
• Process supervised/ guided
by regional/national level
• Reviewed and tracked from
national level
District profile Updated 15-May-16 Fill in light blue cells
District details Number # High risk population groups Y/N Pop size Pattern
District name Shahwalikot 117,691 Nomads Yes 600
Mobile nomads
(stays for 5
months- (Nov-
Mar)
Geo-code (DCODE) 3306 4,708 Migrant labourers, Ailaks No -
LPD (1, 2) 1 23,538 IDPs No -
Province Kandahar 52,961 Others (specify) No -
Region South
Number # Number #
Epidemiology Number # 3 2
WPVs in 2015 1 1 2
WPVs in 2010-14 7 2 1
Compatibles in 2015 No 0 0
5 0
# Planned # Implemented
3 3
24 24
16 13
Number #
139
56/day
# adeq # inadeq
5 0
10 6 28
9 3
5
0
Number #
0
2
0
Number #
72 %
1,320 23%
12 17%
165 19%
o
#
76
93
69
9
Round 1 Round 2
# No
108
13
0
Date
District Polio Officers (DPOs)
District Communication Officers (DCOs)
# of districts same PPO covers
# of districts same PCO covers
M&A Officers
Routine immunization services provided in district
Number of Health Facilities providing RI services
RI sessions per month (total incl. fixed/outrech)
RI outreach sessions per month
NameRoutine immunization
BPHS NGO BARAN
Cluster Supervisors
SIA quality (trend)
7
5
6Intra-campaign Monitors (ICM)
Post-campaign Assessment (PCA) Monitors
28
- Team workload
(# of teams by work load category)
LQAS result (March 2016. if conducted) N/A
2.3.5.7.8.9.10.11.12.13.14.15.16.19.20.22.23.24.25.26.27
2.3.5.7.8.9.10.11.12.13.14.15.16.19.20.22.23.24.25.26.27
Clusters with inaccessibility (list)
Clusters with inaccessibility >6 months (list)
Clusters under AGE influence (list)
Clusters with limited supervision (list) - Refusal
- Others
Clusters with >5% missed children during last round (list)
2.3.4.9.10.11.13.15.17.20.21.23.27
SIA quality (last round)
Reason for missed children (last round)
- House not visited
- Child not available
Missed children (last 4 rounds)
March-16
February-16
January-16
December-15
AGE influence
0
Four Picnic teans are functioning in Dalla Band during revisit day (Friday)
Index case is resident of Maghdod village, Cluster # 7. Base on revised Micro plan and according
to the old SIAs. Micro-plan the area was belong to Cluster # 26. Maghdod hamlet has only 8
households harboring 24 families, and Its population is scattered. This area is fully under control
of AGEs, almost 2 months ago the Ambulance of the Shawalikot district was burned by unknown
people, also AGEs of the area do not allow mobile health services and RI outreach activities.
Implementation, Generally Majority of local people are farmers by occupation and very poor
and have no basic facilities of life. Nutritious status and education level of the index case village
is very poor. Illiteracy level is very high at the district level in general and at the index case area
in particular. The main sources of drinking water are streams, hand pumps and shallow wells,
Area sanitation is very poor, people use pit latrines and also have habit of open defecation
AFG/08/16/141- 2016 WPV case:
IPV campaigns conducted
Start date
% target
PCA coverage
% of clusters under AGE influence 75%
%
*Narrative description of WPV cases in 2015/16
Social mobilization
# of ICN
# of influencers
No
Special events (list incl. descption, timing/frequency)
Special sites (list incl. description, location)
Clusters with no ICN (list)
Gatherings held with community elders/ shuras, mullah imams. Sports events held.
Microplan analysis#
28
6725
Villages
Teams
139
Clusters
Schools
Houses
Vaccination Teams
400-600 children
>600 children
Total
<5 teams
5-6 teams
>6 teams
Supervisors
- Supervisor workload
(# of supervisors by work load category)
Team composition
(# of teams by composition)
15/12/2015
Alternative vaccination strategies
Permanent Polio Teams (PPT)
Permanent Transit Teams (PTT)
Cross-Border Teams (CBT)
Microplan field validation
Field validation of microplan completed
at least 1 female
none local
one local
both local
at least 1 CHW
Human resources
Surveillance
AFP cases in 2014-1016
Demography
Total population
<1 years
<5 years
<15 years
Health Facilities (HFs)
- Primary HFs
- Secondary HFs
- Tertiary HFs
- Private Clinics
Health services
3
Number #
3
1
1
1
Detailed narrative description below*
Category
Total
<400 children
Inaccessible children during SIAs (last 4 rounds)
Access and security
SIA Transit Teams
Nomads Teams
Communication Cluster Supervisors
District Coordinators
%
100%
1.1
HFs which are part of reporting network
- High priority (HP)
- Medium priority (MP)
- Low priority (LP)
Weekly reporting
- Timeliness of weekly report
AFP cases
Children inaccessible for >6 months
March-16
February-16
January-16
December-15
- AFP cases expected/year in 2016
- AFP cases with 0 dose (2014+2015)
- AFP cases reported in 2016
- AFP cases reported in 2015
- AFP cases reported in 2014
Microplan
0
28
0
2 ( I each secondary and high)
Number #
941

8. Jan-SNID Feb-SNIDs Apr-SNIDsMar-NIDs May-NIDs
SIA Schedule for July’16 to June’17
July, VHRD Aug , NID Oct, NID Dec, SNIDNov, SNID
Q3-Q4, 2016
Q1-Q2, 2017

9. IPV: SIAs
• Completing IPV SIAs in 9 districts of Kandahar (Sep/Oct)
Category VHR, no IPV in 2015-16 Areas inaccessible for >6 months
Districts Behsud, Jalalabad,
Qaysar, Jaranj,
Dehrawood, Trinkot,
Qalat, Bermel,
Laskargah, Musaqala,
Nade Ali, Nahre Saraj,
Kandahar, Kabul
Pachieragam, Kot, Achin, Mehtarlam,
Alingar, Watapur, Marawara, Dara-e-Pech,
Chapadara, Nari, Kunduz, Emamsaheb,
Qala-e-Zal, Chardarah, Aliabad, Khanabad,
Dasht-e-Archi, Kamdesh, Chora, Nad-e-Ali,
Zheray, Shahwalikot, Maywand, Reg,
Shorabak, Gardez, Pasaband
Target population 808,859 247,304
Doses required 970,631 296,765
Time period Q1 2017 As soon as access is gained

10. Open for discussion

11. Enhancing campaign quality
• Complete in remaining 10 VHRD by end of Q3
2016, 49 HRD by Q4 2017 and repeat in 47 VHRD
in Q1 2017
Revision of micro-plans
• Local, female and able to read/write, selected on
merit (AGE or Government controlled areas)
Improving team
selection
• Monitoring of training in VHRD; NEOC to track
attendance and quality
Improving the quality of
training
• Tracking performance of vaccinators and
supervisor of VHRD over the rounds
• Reward/sanction as per accountability framework
Monitoring and
performance
management
• Payment within 30 days of end of campaign;
tracking from National EOC. Phase wise expansion
of DDM
Ensuring timely
payment of FLW

12. Enhancing campaign quality
• Identification, training and deployment of
national/ regional level monitors for
pre/intra/post-campaign phase
National monitors
• Rationalized workload, monitoring by DC, tracking
performance over rounds
Improving
performance of
cluster supervisors
• Continue and strengthenRevisit strategy
• pre-campaign dashboard (review on 10/7/3/1
days before campaign
• Corrective actions as needed
Pre-campaign
• VHR districts: 1 ICM for every 5 supervisors, real
time data collection using IVR technology
• ICM data use, intra-campaign dashboards
Intra-campaign

13. Improved campaign monitoring
• PCM: 100% of clusters in VHRD and 50% in
others
• Expansion of all VHRD and HRD as feasible
Expanded scope
• Monitoring of PCM monitors (5% sample
cross checking)
• 10% surveyors and completed forms to be
cross checked
Ensuring quality
• Availability of data within 10 days of end of
campaign
• Use of mobile technology for real time data
flow
Data flow
• Detail field investigation and plan for
corrective action for areas with failed LQAS
lots and PCM with >3 missed children in one
team area
Corrective
action

14. Field investigation of areas with poor performance
• Detail investigation of each
failed lot in LQAS and PCA
with >3 missed children
• Identification of core issue
and action plan for
improvement
• Done by joint team from
provincial level
• Review and tracking from
national level
Detailed Investigation Form for failed lots in LQAS (failed at 80%) and/or >3 missed children in PCA
Instructions
Date of detailedinvestigation
Dr. Tahsil PEI and Dr.Matiullah PPO WHO
0 UNICEF
0 MoPH
Yes
Yes, dot mark is there ( S/Mworkingthree days before and duringcampaign)
weak revisit , Weak supervision of DC and C/S.
Plannedinterventions toimprove performance fornextcampaign
Selection of eligible volunteers, Focused on FLWtraining, updatingitinerary, increased S/Mactivities forconvince of family, focussed on dialy and 5th day revisit.
supportive supervision and monitoringaccordingto the plan.
Selection of new volunteers and supervisor, non eligible volunteers, hurriedly working, weak record of missed children, weak follow up of missed children, No commitment of C/S , Volunteers and S/M.
Child2:Reasonof missedchild(as percaregiver) Child was not at home
Child3:Reasonof missedchild(as percaregiver) Child as vaccinated but no fingermarked
Child4:Reasonof missedchild(as percaregiver)
Child5:Reasonof missedchild(as percaregiver)
Child6:Reasonof missedchild(as percaregiver)
Core issues identifiedforpoorperformance
Has the mobilizer(if present) beenpaidforthe lastcampaign?
Is there evidence of social mobilizationactivities inthe area? Please
elaborate.
Commentonawareness andacceptance of poliovaccine by
communityas well as bycaregivers of missedchild;if householdwas
refusing, please explainwhy.
Yes
Child1:Reasonof missedchild(as percaregiver) Child was not at home
Revisits (qualityof revisits duringandpost-campaign) Workingnot well
Qualityof supervision(was the areavisitedbysupervisor, ICMetc
duringthe campaign?)
Yes
Have vaccinators andsupervisorbeenpaidforlastcampaign? No
Teamcomposition(commentonwhetherteammembers are local,
has atleastone female etc.)
Local and Female
Training(commentonknowledge of team, whetherbothmembers
were trainedinlasttraining)
Yes
Teamworkload(commentonworkloadi.e. numberof childrentobe
covered, geographical challenges, etc.)
178/ day ( G1area)
Team# T5
Is the areaincludedinmicroplan Yes
Was the area/houses visitedbyteam. If no, give reasons why. Yes
Village Rahmatulul alamin
Name of area Tortank
Name of ClusterSupervisor Sadiqa
Province Helmand
District Bost
Cluster 29
Component Inputs/Comments
Dates of campaign April, SNIDs 2016
Region Southren
Members of investigationteam
1- Detailed field investigation to beconducted for all lots failed in LQAS (rejected at80%) and/or >3missed children in PCAin a subcluster(village) .
2- Investigation to beconducted within oneweek afteravailability of results.
3- Team fordetailed investigation to consists of WHO, UNICEF, and MoPH (whereapplicable).
4- Team to look into the reasons forchildren missed by visiting thehouseholds with missed children.
5- Investigation team to review composition, work load, and training status of concerned vaccination teams and also look into quality of supervision and microplanning.

15. Campaign review meetings
Pre campaign
• National, regional and
provincial levels
• 2-4 weeks prior to
campaign
• Dashboard
• At EOC10/7/3/1 day
before campaign
Intra campaign
• National, regional,
provincial and district
levels
• Standard matrix for
documentation
• Dashboard
• Core committee at
National level for
response
Post campaign
• National, regional,
provincial and district
levels
• 15 days after the end
of each campaign
• Dashboard
• Representation from
the National EOC in 5
HR provinces

16. Data flow
Data Source Timeline
Pre-campaign
1 Preparation of campaign EOC/PEMT 2 weeks, 1 week,
daily in last week
2 Coordination meeting EOC/PEMT 10 days before SIA
Intra-campaign
3 Administrative coverage EOC/PEMT Next day afternoon
4 ICM EOC/PEMT Next day afternoon
5 Evening meeting EOC/PEMT Next day afternoon
Post-campaign
6 Administrative coverage EOC/PEMT 10 days after SIA
7 PCM WHO 10 days after SIA
8 LQAS WHO 10 days after SIA
9 Out of house survey WHO 10 days after SIA
10 Compiled ICM data EOC/PEMT 10 days after SIA
11 Access data EOC/PEMT 10 days after SIA

17. Open for discussion

18. Accessibility status during recent SIA
Cat 1: Fully accessible
Cat 2: Partially accessible
Cat 3: Accessible with security challenges
Cat 4: Fully inaccessible
May NID
July SNID

19. Addressing inaccessibility
IPV and OPV from nearby health facility
Polio plus from nearby health facility
PTT at entry / exit points
3 rounds of SIADs (1 IPV) in newly
accessible
Cluster & village level mapping
Negotiations & community engagement
Areas inaccessible for vaccination
Areas with limited
access
Negotiations on quality of
campaign & independence
for monitoring
Remote monitoring
Use of neutral third party
Forum for providing
feedback

20. Complementary vaccination activities
• Assess and modify the number and
location as per need of the programme
and evolving accessibility situation
• Strengthen supervision and monitoring
with close tracking from National EOC
PTT and
CBT
• Review the performance of the existing
PPTs and modify as requiredPPT
• Special vaccination campaign for NomadsNomads
• Coordination with OCHA/UNHCR/IOM
through a task team
• Vaccination at UNHCR and IOM sites
• OPV & IPV
Returnee
refugees

21. Demand generation
• Communication plan as part of district specific
plan
• Full-time ICN operational in all VHR districts
Household and
community
engagement
• Mapping & engagement of key religious
leaders at local level building on NIUG platform
• Workshops with doctors, health workers &
other key stakeholders
Partnerships with
key influencers
• Regular media briefings & trainings and
interactions
• Development of awareness raising materials
for print & electronic media platforms
External relations
and partnerships
• Implement 2nd Harvard poll
• Third party monitoring of communication
interventions in VHR districts
Data collection and
evidence
generation

22. Monthly workflow of a full time social
mobiliser
Campaign
Week
Week.+1
Catching up
missed children
from campaign
Week.+/-2
Community
engagement
Polio+
Week.-1
Pre-Campaign
preparation;
Registry;
Awareness;
Shift to sustained engagement
 Focus on reducing
missed children
 Use of registers for
child registration,
follow up and
vaccination of missed
children after campaign
by ICN Network
 Tracking chronically
missed children
 Promoting a broader
package including
routine immunization
referral, hygiene and
sanitation and ANC in
between campaigns

23. Open for discussion

24. Surveillance
• Expansion to include newly opening health facilities
• Strengthen sensitization visits and monthly tele calls
Reporting network
• Review the existing ES sites
• Explore possible expansion to the areas surveyed in
2015
Environmental
surveillance
• Alternate mode/route of specimen shipment to RRL
as a contingency
Specimen
shipment
• Disaggregate data analysis by district and access
status to identify gaps and corrective actionData analysis

25. Cross border coordination
• Weekly communication between the focal points;
biannual face to face meetings and regular VCs
• Monthly meetings of concerned provincial teams
• Joint case response for cases at the borders

26. Evaluation
• NEAP progress review in Jan
and June 2017
Operational
• Surveillance review in June
2017
Surveillance
• In Kandahar in Q1 2017Serosurvey
• OPV doses in NPAFP cases
Population
immunity

27. RI strengthening
• 20% time on RI
• Training of program staff of RI
• Monitoring of sessions
• Support in training of FHWs
• Feedback on monitoring to BPHS NGOs
Operations
• Inclusion of RI in the message at key
stakeholders meetings
• Missed children tracking by ICN
• Tracking of newborn and mobilization
of parents for RI
Mobilization
Focus of intervention in VHRDs

28. Tashakkur/ Dera Manana

29. Open for discussion