SPECIAL INITIATIVE REGARDING HEALTH SERVICES DELIVERY PRESENTED BY: DR. JANBAZ AFRIDI DD-EPI KHYBER...

SPECIAL INITIATIVE REGARDING HEALTH SERVICES DELIVERY

PRESENTED BY: DR. JANBAZ AFRIDI

DD-EPI

KHYBER PAKHTUKHWA

EXPANDED PROGRAMME ON IMMUNIZATION

SPECIAL INITIATIVE FOR IMPROVING IMMUNIZATION

Government of Khyber Pakhtunkhwa has initiated Special Initiatives in the budget 2013-14 for improving the Mother and Child Health condition of poor and downtrodden of the province to achieve the MDGs 4 & 5.

Rs.200 & 300 Million have been allocated for Special Initiative for enhancing immunization coverage, ante natal care and encourage the skilled deliveries in the far flung and low performing districts.



SPECIAL INITIATIVE FOR IMPROVING IMMUNIZATION

To encourage the parents to get vaccinated their children against various childhood vaccine preventable diseases, Government of Khyber Pakhtunkhwa has allocated Rs.200.00 Million in 2013-14 budget.

Rs.1000/child will be paid to parents on completion of the vaccination course of 15 months/ FIC( Fully Immunization Child).

Parents may be encouraged to retain the child Immunization Card

190,000 children will be beneficiaries of this initiative


OBJECTIVES OF THE INITIATIVE

To Improve the Immunization Coverage and reduce drop out of under 15 months

To reduce the diseases burden, disabilities and deaths in the target districts against EPI targeted diseases

To Control out breaks

To Reduce the neo Natal tetanus by immunizing the pregnant ladies


OBJECTIVES : CONTI…..

To Encourage ante natal care and to reduce the pregnancy complications which will reduce unwanted deaths in young mothers during her reproductive life/age

To Encourage the skilled deliveries in the public hospital

To Improve the birth registration


IMPLEMENTING DISTRICTS FOR IMMUNIZATION

1. Battagram 2. Buner

3. Chitral 4. Dir Lower

5. Dir Upper 6. Hangu

7. Kohistan 8. Lakki Marwat

9. Nowshera 10. Shangla

11. Tank 12. Torghar


CRITERIA FOR SELECTION OF DISTRICTS

Socio Economically backward

Low routine EPI coverage

High disease burden

In- accessible and hard to reach .


SELECTION CRITERIA FOR DISTRICTS

Twelve Districts of Khyber Pakhtunkhwa are selected on the following

grounds:

Districts having enough resources in terms of cold chain and human

resource to utilize the incentives provided in the budget by the

Provincial government.

Total average Measles II coverage is 46.4 and with this incentives it is

expected to increase to target of 73 %


IMPLEMENTING DISTRICTS FOR IMMUNIZATIONS No

District No of houses

No of UCs Total Population

<1 year <2 year

Measles IIcoverage

Target coverage

Q Release Financial Implication

1 Battagram

73345 20 456889 16,142 15,534 64 80 3238050 12,427,200

2 Buner 68750 28 752816 16,142 25,596 69 80 5250450 12,960,800

3. Chitral 53733 24 476495 16,835 16,201 64 80 3396450 20,479,900

4. Dir-U 28 860,505 30,402 29,257 42 70 5276225 29,038,400

5. Dir-L 105651 37 1,067,578 37,718 36,298 63 80 7390850 12,596,800

6. Hangue 32937 19 463,125 16,362 15,746 66 80 3280450 14,374,200

7. Kohistan 27206 38 704,611 24,894 23,957 30 60 3724800 14,935,200

8. Lakki -M 60135 33 732,128 25,866 24,892 24 60 3890050 30,052,800

9. Nowshehra

147551 53 1149863

4024536025 68 80 7669450 15,360,800

10 Shangla 54137 28 645,421 22,803 21,944 48 70 3996450 5,909,500

11. Tank 27849 16 1,518,259 12,281 11,819 18 50 1608625 5,353,200

12. T Ghar 18985 15 1,877,106 9,271 8,922 36 60 1469660 193,965,600

EPI-District-Wise Target population and quarterly (Jan-Mar 2014) required budget for the financial year 2013-14 under Special Initiative Regarding Health Services Delivery

S. No DistrictTotal

Population<1 Year <2 Year

Measles-II coverage

Total allocation for 2013-14

Proposed Quarterly release

for Social Mobilization (Jan-

Mar 2014)

Proposed Quarterly release for Monitoring

(Jan-Mar 2014)

Proposed Quarterly

release to PPHI (Jan-Mar 2014)

Proposed Quarterly release for Payment to

parents (Jan-Mar 2014)

Total Proposed release for

quarter (Jan-Mar 2014)

Current Expected

% %

1 Battagram 456889 16142 15,534 64 80 12,427,200 93750 37500 3,106,800 3,238,050

2 Buner 752816 16142 25,596 69 80 20,476,800 93750 37500 5,119,200 5,250,450

3 Chitral 476495 16835 16,201 64 80 12,960,800 93750 37500 25000 3,240,200 3,396,450

4 Nowshera 1149863 40245 37,566 68 80 30,052,800 93750 37500 25000 7,513,200 7,669,450

5 Dir Lower 1067578 37718 36,298 63 80 29,038,400 93750 37500 7,259,600 7,390,850

6 Dir Upper 860505 30402 29,257 42 70 20,479,900 93750 37500 25000 5,119,975 5,276,225

7 Hangu 463125 16362 15,746 66 80 12,596,800 93750 37500 3,149,200 3,280,450

8 Kohistan 704611 24894 23,957 30 60 14,374,200 93750 37500 3,593,550 3,724,800

9 Lakki Marwat 732128 25866 24,892 24 60 14,935,200 93750 37500 25000 3,733,800 3,890,050

10 Shangla 645421 22803 21,944 48 70 15,360,800 93750 37500 25000 3,840,200 3,996,450

11 Tank 1518259 12281 11,819 18 50 5,909,500 93750 37500 1,477,375 1,608,625

12 Tor Ghar 1877106 9271 8,922 36 60 5,353,200 93750 37500 1,338,300 1,469,550

Total: 268961 267,732 193965600 1125000 450000 125000 48491400 50,191,400


Penta -3 & Measles 2, District wise coverage, 2013

Batag

ram

Bannu

Chitra

l

Dir up

per

Dir Lo

wer

Hangu

Kohistan

Lakk

i Mar

wat

Nowsh

era

Shan

gla

tank

Tor G

har

0102030405060708090

100

Penta 3Measles 2


DISTRICT WISE DROP OUT, 2013

Batag

ram

Bannu

Chitra

l

Dir up

per

Dir Lo

wer

Hangu

Kohistan

Lakk

i Mar

wat

Nowsh

era

Shan

gla

tank

Tor G

har

0

5

10

15

20

25

30

35

40

45

BCG- MeaslesPenta 1- Penta 3TT1-TT2


DISTRIBUTION FORMULA

Total Allocated budget of the special initiative on EPI is 200 million and further distribution or allocation

Payment to parents 190.0 MillionSM activities 6.0 MillionMonitoring 3.0 MillionBank Charges 1.0 Million


MECHANISM TO ENSURE TRANSPARENCY

To Ensure the transparency and simplify the procedure for the money among the selected beneficiaries the following criteria is suggested .

Card/ Vouchers may be printed to facilitate the process after the completion of the successful course parents may be issued the vouchers by the respective vaccination center, and parents may receive the amounts on the same day in future after transfer of the money to the districts

The bank will release the payment on provision of Immunization card/voucher/Parents ID card.

Eligibility of the children completion of immunization of the children after 31st December 2013


MEANS OF DISBURSEMENT

Province released the check Rs.50191400 to the districts and districts will release to the banks

The following means for disbursement can be utilized to the beneficiaries: Bank s Pakistan Post office Easy Paisa UBL Omni Cash Payments Through Notified committee Quarter release of the amount to the districts in advance


RESPONSIBILITIES

Provincial Budgeting Coordination and facilitationPolicy guidelines Supervision, Monitoring and EvaluationProvincial level Advocacy and Social Mobilization


ACTION TAKEN BY PROVINCIAL EPI

Three meetings conducted with DHOs of the concerned districts

Presentation to DGHS

Approval accorded by the honorable Secretary Health

Implementations will be started in the first week of February

Checks has been handover to the districts for the first quarter in this Final Planning meeting(29/02/2014)

Social Mobilization printed and dispatched to the districts

Provincial Inauguration request has been sent to the HCM


RESPONSIBILITIES

Districts Preparation of FIC( Fully Immunized Children) list , facility based and district based

List of banks and its catchment Areas Amounts disbursement in case of any other facility is not available Preparation of districts Monitoring Plan Preparation of Districts SM Plan Notification of disbursement committees Nomination of Focal person


BUDGET ALLOCATION FOR SM/MONITORING

S NO SM Monitoring Provincial 1.5 million 1.2 millionDistricts 4.5 million 1.8 million


SOCIAL MOBILIZATION

Provincial inaugurationPress briefing at Provincial level.Awareness/Orientation sessions with DHOs and EPI Coordinators and other stake Holders

Preparation of Banners , flyers and other IEC material Involvement of other stake holders like PPHI & Education department etc

UNICEF has agreed to provide support in IEC Material later on UNICEF has agreed to support the inaugurations at provincial level


SOCIAL MOBILIZATION

District inauguration followed by UCs inaugurations. Press briefing at District level.Awareness sessions in Schools and Madrassas , To sensitize all health care providers (Medics & Paramedics of health facility)

All EPI technicians LHWs & LHSs should be trained and sensitized to create awareness in the community through mothers counseling & compound dialogue

Involvement of PPHI at districts( Chitral, Dir Upper, Shangla, Nowshehra & Lakki Marwat) level


BUDGET FOR SOCIAL MOBILIZATION FIRST Q

S.No Activity Cost allocation Total for 3 Months/ District

Total for 6 months for 12 districts

1 District inauguration ( 12 ) 1.8million 4.52 UC inauguration ( 315 )/No of

Health Facilities

3 Provincial Press Briefing

4 District Press Briefing

5 Awareness sessions in Schools

6 Awareness session for LHS/LHWs Paramedics

7 Banners / Boards/ Flyers

8 IEC Material

9 PPHI for 5 districts 125,000


BANNER


FLAYER


POSTER


CALENDAR POSTER


MONITORING

Overall activities swill be supervised by HSH/DGHS Khyber Pakhtunkhwa and will be thoroughly monitored through special monitoring check list by Provincial committees split in 2 tiers

1, District Level : DHO,DDHO,EPI Coordinator,LHWs Coordinator, PH Coordinator, DHCSO, DSM PPHI and Partners staff

Provincial Level HSH,DGHS,DHS KP ,DDs /ADs of DGHS office, NP,PPHI and Partners.

First Monitoring visit has been done on 21th Feb 2014, by EPI Team(Dr. Farid, Dr. Rahim, Dr. Ishaq and Mr. Hanif) to Nowshehra


SPECIAL INITIATIVES FOR IMPROVING IMMUNIZATIONGOVERNMENT KHYBER PAKHTUNKHWA MONITORING CHECK LIST

District ______________ Tehsil: ________________ Union council ______________

Name of Health facility _____________ Name of In-charge Health facility _______________ Designation of HF In-charge: __________________

Name of EPI technician________________________

Total Population of UC: __________ ___ Target Under 1 Year: _____________

Total Number of Children Completed Measles 2 Vaccination: _____________

Total Number of Children received Incentives: _________________

Name of Bank/ BHU/ Easy Paisa/ other: ___________________________________________

Information of Clients Who Received Incentives

S No Name of Child Father Name

NIC No. of Father

Date of Vaccination Completed

Date of Incentives Received

Verified

Yes No


BUDGET FOR MONITORING

S.No

Monitors Honorarium per Month

No of visits Total for 6 Months/ District

Remarks

1 DHO, DDHO, EPI Coordinator, DCNP, DSV

5000/per monitor

2/ per month by each monitor

1.8million

2 Provincial Monitors. DGHS, DHS, DDs, ADs

10,000/month

1-2 visits per month

1.2million

3 Quarter review Presentation will be made by the districts on special initiative

.3million UNICEF agreed to support this activity


CHALLENGES/WAY FORWARD

Poor compliance from the districts Timely getting plans Successful implementation of Special Initiative Achievements of desiring targets Transparent and timely disbursement of money to the beneficiaries Reduce drop out at district level

Achieving highest possible coverage Reduce diseases burden, disabilities and deaths


THANKS

SPECIAL INITIATIVE REGARDING HEALTH SERVICES DELIVERY PRESENTED BY: DR. JANBAZ AFRIDI DD-EPI KHYBER...

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