Interventions in Southern Region
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Transcript of Interventions in Southern Region
Polio Eradication Initiative Afghanistan
Southern Region
Challenges, priorities and tactics 2011
TAG Meeting IslamabadMarch 24-25, 2011
Outline of Presentation• Challenges and steps taken
– Insecurity affecting accessibility to children, staff safety and leading to internal displacements
– Management issues affecting campaign quality – Higher risk of WPV transmission in 13 key districts– Cross border population movement
• Other steps taken in Southern region• Remaining challenges • Way forward/tactics 2011
• Summary
HilmandNimroz
Kandahar
Uruzgan
Zabul
RegGarmser
Dishu
Chahar Burja
Chakhansur
Day Kundi
Panjwayi
Nad Ali
Khash Rod
Maruf
Gizab
Washer
Daman
Chora
Spin Boldak
Baghran
Shorabak
Kijran
Arghistan
Naw Zad
Shahristan
Qalat
Maywand
NeshKajaki
Shah Wali Ko
Daychopan
Shamulzayi
Kang
Arghandab
Shinkay
DihrawudTirin Kot
Ghorak
Musa Qala Shahjoy
Khas Uruzgan
Atghar
Mizan
Shahidi Hass
Khakrez
Nahri Sarraj
Lashkar Gah
Zaranj
Tarnak Wa JaSangin
Kandahar
Naway i Bara
Region Target <5 Years
Southern Region 1298495
High Risk District 699928 (54%)
13 High Risk Districts of Southern Afghanistan
>90% of the cases in Afghanistan in the last 10 years are from South & almost 90% of these are from 13 HRD
Kandahar = 5Helmand = 5Urozgan = 3
19
95 3 3
9
28
15
25
34
19
105
10152025303540
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Num
ber o
f cas
es
Year
Security situationStarted worsening
Worsening security leading to increase in number of polio cases in Southern region
No.
of s
ecur
ity in
cide
nts
© UNDSS AFG - SR Security Incidents
0
100
200
300
400
500
600
700
Jan-03
May-03
Sep-03
Jan-04
May-04
Sep-04
Jan-05
May-05
Sep-05
Jan-06
May-06
Sep-06
Jan-07
May-07
Sep-07
Jan-08
May-08
Sep-08
Jan-09
May-09
Sep-09
Jan-10
May-10
Increase in security incidents
9941895929
89980
66652
66652228
1480718408 18330
92117
70000
33819 35804 36030 38616
3001922262
17047
0
20000
40000
60000
80000
100000
120000
No:
of i
nacc
essi
ble
Child
ren
No:
of i
nacc
essi
ble
Child
ren Helmand province
Kandahar province
NGOs Involvement
NGOs Involvement
Military operation
Panjwai and SW Kot military operation
Impact of BPHS NGOs involvement on No: of Children inaccessible in NGOs districts of each Helmand and Kandahar
Steps taken to improve accessibility and staff safety in Southern Region 2010
• Making NGOs responsible for campaign implementation in 10 districts (6 among them are high risk)
– Provincial manager recruited for the 2 main provinces
– Fulltime District manager for every NGOs district
• Access Negotiators hired where ever required
• Involving of local influential and elders
• Establishing transit posts for longer period on entry/exit of districts having conflict & accessibility issue– 6 transit posts (2 in HLD & 4 in KDR) with 16 Transit Teams,
working in two shifts– Cabins prepared with seating arrangements for their
facilitation and SM material displayed
• Updating micro plans of the areas with IDPs– Supervisors & teams selected from the community– Focused SM activities in areas having IDPs
Response to internally displacements due to insecurity in High priority districts Southern Region 2009-10
Transit teams coverage in Helmand and Kandahar province by month Southern Region from Feb 10 – Feb 2011
114,097 children vaccinated Feb 10 – Feb 2011
216,407 children vaccinated Feb 10 – Feb 2011
Since establishment 549,241 children vaccinated, out of which
264, 516 are from 10 HRD
Steps taken to improve campaigns in the 13 high risk districts (Southern Region)
• District Specific Plans developed in January were refined & completed in first week of August 2010 having communication as integral part
• Appointment of District Managers in the remaining 7 HR districts not with NGOs since September 2010
• Special training of all District Managers in October 2010 at Kandahar
• Advance payment in the 3 key provinces from October 2010 having the 13 priority districts
• Capacity building of District & cluster level supervisors by consultant company. Training materials also revised by this consultant company for volunteers.
• Revision of micro plans to make the workload reasonable and include some of the areas not part of micro plan. (8 DCs, 28 CSs and 136 teams added)
• Integration of communication plan in District Plans and also expansion of SM activities. (SM teams increased from 458 to 890)
Campaign quality issue as wellFM not allowed by AGE
Performance in High risk districts Mar 10 to Mar 2011 SIAs% coverage verified through Finger Marking in accessible areas
Adjusted Coverage (FM) in 5 HRD of Kandahar province by round Mar 2010 – Mar
2011
0
10
20
30
40
50
60
70
80
90
100
Kandahar Shahwalikot Maywand Panjwayi Spin Boldak
Mar-10 May Jun Jul Oct Nov Dec Jan Mar-11
Adjusted Coverage (FM) in 5 HRD of Helmand province by round Mar 2010 – Jan 2011
0
10
20
30
40
50
60
70
80
90
100
Bust Musa Qala Naw Zad Nad Ali Sangin
Mar-10 May Jun Jul Oct Nov Dec Jan Mar-11
Adjusted Coverage (FM) in 3 HRD of Uruzgan province by round Mar 2010 – Mar 2011
0
10
20
30
40
50
60
70
80
90
100
Tirin Kot Shahidi Hass Dihrawud
Mar-10 May Jun Jul Oct Nov Dec Jan Mar-11
Covering the target children on the move crossing border from Pakistan and Iran
• Special Campaigns– Mop-up in 5 Key districts of Kandahar in response to first P1
from Shahwalikot
– Small Scale targeted campaign in 4 districts of Helmand using tOPV to respond VDPV2 in September
– Three rounds of Accelerated Campaign to boost Routine EPI Coverage in Urban Slum areas of Kandahar
• Meetings with NGOs to review their district performance
Other Steps taken in Southern Region
Challenges• Deteriorating security situation and military operations
in the region mainly in Kandahar and Helmand continues to limit access to children
• Areas where finger marking is not allowed by AGE is still an issue, making independent monitoring (FM) more difficult
• Fatigue in staff and even community due to frequent campaigns
• Improving routine is becoming more challenging in the current security situation
Way Forward/Tactics 2011• Regular revision and monitoring implementation of
district specific plan• Availing windows of opportunity to carry out SIADs in
priority areas.• High risk cluster approach to further focus efforts in 13
high risk districts• Acceleration campaigns to improve routine
immunization in areas with low routine• Identifying/enlisting new partners having district based
networks
Way Forward/Tactics 2011• Quarterly review of NGOs performance
• Identifying reasons for Zero dose cases and response vaccination campaign
• Further strengthening coordination and expanding role of ICRC
• Special communication strategies intervention to have district specific SM plan
Summary• The program has effectively engaged various stake
holders to try to access the children in conflict affected areas
• Political commitment at the Regional and provincial level is high that needs to be translated into accountability and actions at the district level
• District specific plans for high risk districts are trying to resolve operational and quality issues hampering progress
• Insecurity remains the main risk to the program
Staff lost in the last few years
Dr. Shamsul Haq "Kakar"
36Regional
Polio officer Spin
Boldak14th Sep
2008Suicide Attack
Dr. Mamoon Tahiri
32POLIO
Technical Officer
Spin Boldak
Sep --2008
Suicide Attack
Abdul Jalil 24District
ManagerKDH City
April-- 2010
Gun shot
Mohammad Haneef
45District
CoordinatorShawalikot Apr-10 gunshot
Mohammad Nasim
20 Volunteer KDH CityMar --2010
Complex attack on
prison
Maihan Toor 42Cluster
SupervisorKhashrood
district Jun-09
Kidnaped and killed
Abdul Manan 37 DST Ataghar Apr-07Land Mine
Incident Type
TitleNameIncident
datePhoto
Incident place
Age
Thanks
CDC Polio Hero Award being given to the widow of Late Mehan Tore Cluster Supervisors Khashrod district of Nimroz province
Achievements • Almost 1.2 million target children reached every campaign (8
campaign in 2010)
• Almost 50% reduction in inaccessible children that was brought down from 134,500 in Dec 2009 to 69,700 in December 2010.
• Capacity building of local staff by training almost 10,000 personal in every polio campaign and around 1,000 health care providers on AFP surveillance in 2010
• Median dose of AFP cases age between 6-59 improved from 7 in 2009 to 8 in 2010
• Supported EPI activities in micro planning, capacity building, monitoring and supervision.
More than 44% reduction in number of polio cases in 2010 as compared to 2009
Line bar showing P1 & P3 circulation Southern region Jan 2008- Feb 11
2
0
1
0
1
3
2 2
5
6
0
1
3
1 1 1
2 2 2
0 0 0 0 0 0 0 0 0
1
0
1
4
1
2 2
1
0
1
0
1
0 0 0 0 0 0 0 0 0 0 0 0 0
1
2
3 3
4
3
6
4
2
0
1
0 0 0 0 0 0 0 001234567
WPV1 WPV312 months 9 months 11 months
Steps taken to improve accessibility and Staff Safety Southern Region Afghanistan
• Expanding Role of ICRC ,– Facilitating “Letter of support” by AGE Leadership at country and at local level
• Close coordination with ISAF to exchange information on dates and areas included in campaigns while also marinating program neutrality
• Few sessions conducted for Afghan National Army/Police to brief them on polio campaign process and their role with help of OCHA. Now the mentors are briefing ANA & ANP on polio during their trainings.
Trends of Inaccessibility of children Southern RegionHigh Risk Districts Vs rest of the districts From Jan 09- to Jan 2011
Military OperationsMaiwand/SW Kot/Panjwai
Accessible Area
Inaccessible 6/ 8 rounds
Inaccessible 3- 5/8 rounds
Inaccessible 1-2/8 rounds
(10) Nadali/Marja, Bust, Tirinkot, Maywand, Shahid Hasas, Shahwalikot, Kajaki, Chora, Arghandab,(9) Nauzad , Washir, Garamser, Gizab, BaghranReg (H)Sangin , Nahrisaraj , Shorawak (7) Panjwai , Sangeen, Mosa Qala Nawa, Shanki, Shamalzai, Deshou
No of times when > 10% children were missed
Insecurity leading to inaccessibility Inaccessibility by District- Southern region Jan - Dec 2010
≥
RegGarmserDishu
Chahar Burja
Chakhansur
Day Kundi
Panjwayi
Nad AliKhash Rod
Maruf
Gizab
Washer
Daman
Chora
Spin Boldak
Baghran
Shorabak
Kijran
Arghistan
Naw Zad
Shahristan
Qalat
Maywand
NeshKajaki
Shah Wali Ko
Daychopan
Shamulzayi
Kang
Arghandab
Shinkay
Dihrawud
Ghorak
Musa Qala
Khas Uruzgan
Atghar
Mizan
Shahidi Hass
Nahri Sarraj
Lashkar Gah
Zaranj
Kandahar
Trends of Zero Dose AFP case age 6-35 months by quarter 09-11; High risk VS rest of the districts in South region
Other 37 Dist13 Priority Dist
Data up to 20 Mar 2011
Cross Border vaccination Teams coverage by three CB Posts in Southern Region Jan 10 – Feb 2011
A total of 273,169 children Vaccinated from Jan 10 to Feb 2011
Pockets of refusal families in Key districts
• Refusal not a major problem – Issue is pockets of refusal families in certain areas –
• Boldak (3%) Kandahar city (0.4%) and 2 cases in 2009 from such families
• Steps taken to address the issue – District shura and elders were taken on board– Senior health staff like REMT, PPCO and PPOs personally visited the
refusals– Awareness sessions conducted in community – father of refusal helped– Selection of local social mobilizers and expansion of Social mobilization
activities– Awareness about vaccinating their children to all coming to health
facility – Involvement of other departments like education & communication etc– Use of local FM radio channels and BBC Pashtu service, Azadi and VOA
Issue is sustainability & new IDPs moving from the war affected areas
Num
ber o
f Ref
usal
Chi
ldre
nN
umbe
r of R
efus
al C
hild
ren
Trends of refusal in Boldak and Kandahar after concerted efforts My 09- Jan 2011
tOPV bOPV
Type of OPV used in 2010 - 2011 SIAs2010
HilmandNimroz
Kandahar
Uruzgan
Zabul
May Feb Mar Jun
RegGarmser
Dishu
Chahar Burja
Chakhansur
Day Kundi
Panjwayi
Nad Ali
Khash Rod
Washer
Maruf
Gizab
Daman
Chora
Spin Boldak
Baghran
Shorabak
Kijran
Naw Zad
Arghistan
Shahristan
Qalat
Maywand
NeshKajaki
Shah Wali Ko
Daychopan
Shamulzayi
Kang
Arghandab
Shinkay
Dihrawud
Ghorak
Musa Qala
Tirin Kot
Shahjoy
Khas Uruzgan
Atghar
Mizan
Shahidi Hass
Khakrez
Nahri Sarraj
Lashkar Gah
Zaranj
Tarnak Wa JaSangin
Kandahar
Naway i Bara
Arghandab
Reg
RegGarmser
Dishu
Chahar Burja
Chakhansur
Day Kundi
Panjwayi
Nad Ali
Khash Rod
Washer
Maruf
Gizab
Daman
Chora
Spin Boldak
Baghran
Shorabak
Kijran
Naw Zad
Arghistan
Shahristan
Qalat
Maywand
NeshKajaki
Shah Wali Ko
Daychopan
Shamulzayi
Kang
Arghandab
Shinkay
Dihrawud
Ghorak
Musa Qala
Tirin Kot
Shahjoy
Khas Uruzgan
Atghar
Mizan
Shahidi Hass
Khakrez
Nahri Sarraj
Lashkar Gah
Zaranj
Tarnak Wa JaSangin
Kandahar
Naway i Bara
Arghandab
Reg
RegGarmser
Dishu
Chahar Burja
Chakhansur
Day Kundi
Panjwayi
Nad Ali
Khash Rod
Washer
Maruf
Gizab
Daman
Chora
Spin Boldak
Baghran
Shorabak
Kijran
Naw Zad
Arghistan
Shahristan
Qalat
Maywand
NeshKajaki
Shah Wali Ko
Daychopan
Shamulzayi
Kang
Arghandab
Shinkay
Dihrawud
Ghorak
Musa Qala
Tirin Kot
Shahjoy
Khas Uruzgan
Atghar
Mizan
Shahidi Hass
Khakrez
Nahri Sarraj
Lashkar Gah
Zaranj
Tarnak Wa JaSangin
Kandahar
Naway i Bara
Arghandab
Reg
RegGarmser
Dishu
Chahar Burja
Chakhansur
Day Kundi
Panjwayi
Nad Ali
Khash Rod
Washer
Maruf
Gizab
Daman
Chora
Spin Boldak
Baghran
Shorabak
Kijran
Naw Zad
Arghistan
Shahristan
Qalat
Maywand
NeshKajaki
Shah Wali Ko
Daychopan
Shamulzayi
Kang
Arghandab
Shinkay
Dihrawud
Ghorak
Musa Qala
Tirin Kot
Shahjoy
Khas Uruzgan
Atghar
Mizan
Shahidi Hass
Khakrez
Nahri Sarraj
Lashkar Gah
Zaranj
Tarnak Wa JaSangin
Kandahar
Naway i Bara
Arghandab
Reg
RegGarmser
Dishu
Chahar Burja
Chakhansur
Day Kundi
Panjwayi
Nad Ali
Khash Rod
Washer
Maruf
Gizab
Daman
Chora
Spin Boldak
Baghran
Shorabak
Kijran
Naw Zad
Arghistan
Shahristan
Qalat
Maywand
NeshKajaki
Shah Wali Ko
Daychopan
Shamulzayi
Kang
Arghandab
Shinkay
Dihrawud
Ghorak
Musa Qala
Tirin Kot
Shahjoy
Khas Uruzgan
Atghar
Mizan
Shahidi Hass
Khakrez
Nahri Sarraj
Lashkar Gah
Zaranj
Tarnak Wa Ja
Sangin
Kandahar
Naway i Bara
Arghandab
Reg
June
RegGarmser
Dishu
Chahar Burja
Chakhansur
Day Kundi
Panjwayi
Nad Ali
Khash Rod
Washer
Maruf
Gizab
Daman
Chora
Spin Boldak
Baghran
Shorabak
Kijran
Naw Zad
Arghistan
Shahristan
Qalat
Maywand
NeshKajaki
Shah Wali Ko
Daychopan
Shamulzayi
Kang
Arghandab
Shinkay
Dihrawud
Ghorak
Musa Qala
Tirin Kot
Shahjoy
Khas Uruzgan
Atghar
Mizan
Shahidi Hass
Khakrez
Nahri Sarraj
Lashkar Gah
Zaranj
Tarnak Wa JaSangin
Kandahar
Naway i Bara
Arghandab
Reg
RegGarmser
Dishu
Chahar Burja
Chakhansur
Day Kundi
Panjwayi
Nad Ali
Khash Rod
Washer
Maruf
Gizab
Daman
Chora
Spin Boldak
Baghran
Shorabak
Kijran
Naw Zad
Arghistan
Shahristan
Qalat
Maywand
NeshKajaki
Shah Wali Ko
Daychopan
Shamulzayi
Kang
Arghandab
Shinkay
Dihrawud
Ghorak
Musa Qala
Tirin Kot
Shahjoy
Khas Uruzgan
Atghar
Mizan
Shahidi Hass
Khakrez
Nahri Sarraj
Lashkar Gah
Zaranj
Tarnak Wa JaSangin
Kandahar
Naway i Bara
Arghandab
Reg
July OctSep
RegGarmser
Dishu
Chahar Burja
Chakhansur
Day Kundi
Panjwayi
Nad Ali
Khash Rod
Washer
Maruf
Gizab
Daman
Chora
Spin Boldak
Baghran
Shorabak
Kijran
Naw Zad
Arghistan
Shahristan
Qalat
Maywand
NeshKajaki
Shah Wali Ko
Daychopan
Shamulzayi
Kang
Arghandab
Shinkay
Dihrawud
Ghorak
Musa Qala
Tirin Kot
Shahjoy
Khas Uruzgan
Atghar
Mizan
Shahidi Hass
Khakrez
Nahri Sarraj
Lashkar Gah
Zaranj
Tarnak Wa JaSangin
Kandahar
Naway i Bara
Arghandab
Reg
RegGarmserDishu
Chahar Burja
Chakhansur
Day Kundi
Panjwayi
Nad AliKhash Rod
Maruf
Gizab
Washer
Daman
Chora
Spin Boldak
Baghran
Shorabak
Kijran
Arghistan
Naw Zad
Shahristan
Qalat
Maywand
NeshKajaki
Shah Wali Ko
Daychopan
Shamulzayi
Kang
Arghandab
Shinkay
Dihrawud
Ghorak
Musa QalaShahjoy
Khas Uruzgan
Atghar
Mizan
Shahidi Hass
KhakrezNahri Sarraj
Lashkar Gah
Zaranj
Tarnak Wa Ja
Sangin
Kandahar
Naway i Bara
HilmandNimroz
Kandahar
Uruzgan
Zabul
RegGarmser
Dishu
Chahar Burja
Chakhansur
Day Kundi
Panjwayi
Nad Ali
Khash Rod
Washer
Maruf
Gizab
Daman
Chora
Spin Boldak
Baghran
Shorabak
Kijran
Naw Zad
Arghistan
Shahristan
Qalat
Maywand
NeshKajaki
Shah Wali Ko
Daychopan
Shamulzayi
Kang
Arghandab
Shinkay
Dihrawud
Ghorak
Musa Qala
Tirin Kot
Shahjoy
Khas Uruzgan
Atghar
Mizan
Shahidi Hass
Khakrez
Nahri Sarraj
Lashkar Gah
Zaranj
Tarnak Wa JaSangin
Kandahar
Naway i Bara
Arghandab
Reg
2011
DecNov
Feb Mar
RegGarmserDishu
Chahar Burja
Chakhansur
Day Kundi
Panjwayi
Nad AliKhash Rod
Maruf
Gizab
Washer
Daman
Chora
Spin Boldak
Baghran
Shorabak
Kijran
Arghistan
Naw Zad
Shahristan
Qalat
Maywand
NeshKajaki
Shah Wali Ko
Daychopan
Shamulzayi
Kang
Arghandab
Shinkay
Dihrawud
Ghorak
Musa Qala
Khas Uruzgan
Atghar
Mizan
Shahidi Hass
Nahri Sarraj
Lashkar Gah
Zaranj
Kandahar
Accessibility of districts to PPO Dec 2010 Southern region
RegGarmserDishu
Chahar Burja
Chakhansur
Day Kundi
Panjwayi
Nad AliKhash Rod
Maruf
Gizab
Washer
Daman
Chora
Spin Boldak
Baghran
Shorabak
Kijran
Arghistan
Naw Zad
Shahristan
Qalat
Maywand
NeshKajaki
Shah Wali Ko
Daychopan
Shamulzayi
Kang
Arghandab
Shinkay
Dihrawud
Ghorak
Musa Qala
Khas Uruzgan
Atghar
Mizan
Shahidi Hass
Nahri Sarraj
Lashkar Gah
Zaranj
Kandahar
Accessibility of districts to PPO Jul 2010 Southern region
80-100 % 50-79 % 10-49 % 0 - 10 % Accessibility
Shahwalikot , Reg , ShorawakKhakriz ,GhorakWashir , NawzadKhashrood
Khas UrozganShahid hasas GizabKijran
Khas UrozganShahid hasas GizabKijranGhorak
ShahwalikotMaywandKhakriz
RegGarmserDishu
Chahar Burja
Chakhansur
Day Kundi
Panjwayi
Nad AliKhash Rod
Maruf
Gizab
Washer
Daman
Chora
Spin Boldak
Baghran
Shorabak
Kijran
Arghistan
Naw Zad
Shahristan
Qalat
Maywand
NeshKajaki
Shah Wali Ko
Daychopan
Shamulzayi
Kang
Arghandab
Shinkay
Dihrawud
Ghorak
Musa Qala
Khas Uruzgan
Atghar
Mizan
Shahidi Hass
Nahri Sarraj
Lashkar Gah
Zaranj
Kandahar
FM Restricted areas<55 - 2021 - 4041 - 6061 - 8081 - 100
RegGarmserDishu
Chahar Burja
Chakhansur
Day Kundi
Panjwayi
Nad AliKhash Rod
Maruf
Gizab
Washer
Daman
Chora
Spin Boldak
Baghran
Shorabak
Kijran
Arghistan
Naw Zad
Shahristan
Qalat
Maywand
NeshKajaki
Shah Wali Ko
Daychopan
Shamulzayi
Kang
Arghandab
Shinkay
Dihrawud
Ghorak
Musa Qala
Khas Uruzgan
Atghar
Mizan
Shahidi Hass
Nahri Sarraj
Lashkar Gah
Zaranj
Kandahar
No Restriction
Areas restricted for Finger Markers use
As in Jul 2010 NIDs - Southern Region
Areas restricted for Finger Markers use As in Dec 2010 SNIDs - Southern Region