EMRO N Teleb SAGE April 2010 - WHO€¦ · PAK: 2008-2009 National target: 90% in all districts ORS Promotions De-Worming Vitamin A Nutrition Screening Polio Eradication TT Acceleratio

1

Report on EPI Situation in the EPI Situation in the EPI Situation in the EPI Situation in the EPI Situation in the EPI Situation in the EPI Situation in the EPI Situation in the

Eastern Mediterranean RegionEastern Mediterranean RegionEastern Mediterranean RegionEastern Mediterranean RegionEastern Mediterranean RegionEastern Mediterranean RegionEastern Mediterranean RegionEastern Mediterranean Region

Palestine

Bahrain

The Eastern Mediterranean Region The Eastern Mediterranean Region The Eastern Mediterranean Region The Eastern Mediterranean Region

GAVI eligible: 6 countries, 57% of LBGAVI eligible: 6 countries, 57% of LBGAVI eligible: 6 countries, 57% of LBGAVI eligible: 6 countries, 57% of LBLMIC: 8 countries, 36% of LBLMIC: 8 countries, 36% of LBLMIC: 8 countries, 36% of LBLMIC: 8 countries, 36% of LBHIC: 6 countries, 6% of LBHIC: 6 countries, 6% of LBHIC: 6 countries, 6% of LBHIC: 6 countries, 6% of LBUMIC: 2 countries, 1% of LBUMIC: 2 countries, 1% of LBUMIC: 2 countries, 1% of LBUMIC: 2 countries, 1% of LBPop: 555 MillionPop: 555 MillionPop: 555 MillionPop: 555 MillionLB: 16.4 MillionLB: 16.4 MillionLB: 16.4 MillionLB: 16.4 Million

2

The TargetsGlobal targets• Eradicate polio

• Eliminate MNT

By 2010,

• Reaching achieve at least 90% vaccination coverage at national level AND at least 80% in every district.

• Reduce measles mortality by 90% compared to 2000 level

By 2015:

• Reduce child mortality by 2/3 compared to 1990 taking MCV1 coverage as the indicator (MDG4)

• Reduce VPDs morbidity and mortality by 2/3 compared to 2000 (GIVS goal)

• Introduce new vaccines and reaching high level within 5 years

Regional Targets (in addition):

By 2010:• Eliminate Measles

By 2015: • HbS antigen prevalence

< 1% among <5 years children in all countries

OutlineOutlineOutlineOutlineOutlineOutlineOutlineOutline

• Reaching vaccination coverage 90/80 by 2010

– Progress in routine vaccination coverage in EMR

– Improving routine vaccination coverage in the difficult

and conflict-affected countries/areas

– Regional and national initiatives to scale up immunization programmes in the EMR

• Strengthening decision making process: NITAGs

• Vaccination week in the EMR

3

Reported vaccination coverage in the EMR, 2009

2.7 million infants missed DPT3 in 2008

1.9 M infants missed DPT3 in 2009

-1,600,000

-1,500,000

-1,400,000

-1,300,000

-1,200,000

-1,100,000

-1,000,000

-900,000

-800,000

-700,000

-600,000

-500,000

-400,000

-300,000

-200,000

-100,000

0

Pa

kis

tan

s. S

ud

an

N. S

ud

an

Afg

ha

nis

tan

Ira

q

So

ma

lia

Ye

me

n

Oth

ers

2.7 M in 1.9 M in 2008 1.9 M in 2009

DPT3 unvaccinated children in the EMR, progress 2008-2009

Challenges

Security situationFinancial constraints

4

Improving routine vaccination coverage in the Improving routine vaccination coverage in the

ConflictConflict--affected areasaffected areas

Of the Eastern Mediterranean RegionOf the Eastern Mediterranean Region

Palestine

Bahrain

Activities in the Conflict affected areas Activities in the Conflict affected areas Activities in the Conflict affected areas Activities in the Conflict affected areas

of the Eastern Mediterranean Region of the Eastern Mediterranean Region of the Eastern Mediterranean Region of the Eastern Mediterranean Region

REDChild health month 2009

PIRIRED

Child health DaysRED

RED Mobile teams/outreach

PIRIIntegrated PHC

intervention

RED

• RED: outreach, mobile teams• PIRI

PIRIRED

•Sustained high routine

coverage

5

Pakistan

• Population: >180 Million (country

report)

• Live Births: 6,499,679

• 37% of EMR birth cohort

• 46% of EMR DPT3 unvaccinated

children

Lower coverage in

2008

•Delayed

introduction of penta

vaccine

•Security situation

Accessibility risk inPakistan

Vaccination month

6

Punjab= > 55% of the population

2008National DPT3: 73%

2009National DPT3: 85%

PAK: 2008-2009National target: 90% in all districts

ORSPromotions

De-Worming

Vitamin ANutrition

Screening

PolioEradication

TTAcceleratio

n

Other antigens

Measles Follow up

CHDs in Somalia

RED approach

• Somaliland: 15 out of 19

districts

• Puntland: 23 out of 39

districts

• Central/South Zone:

preparation in progress

SomaliaPop: 8.3 M LB: 291,000

•DPT3: 6w-11 months•Measles: 9-59months•OPV: 0-59months •2 rounds/year (2 additional OPV NIDs)•Phased implementation

Polio free

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CHDs in Somalia: success factors

Main challenges:Main challenges:Main challenges:Main challenges:

Security situation

Financial constraints

Monitoring performance

Southern. Sudan

• RED approach

-state MOH+NGOs with WHO

support

• Acceleration campaigns:

– Multi antigen

– Target DPT:< 11 months

– State MOH+WHO

– Using WHO and GAVI ISS

funds

– Lack funding

• Accelerated Child Survival Initiative (ACSI)

– Lead by UNICEF

– Measles & Vit A, TT,

deworming

– <5 years

– Well funded

– MOH negotiate including

other antigens

?Coordination?

Pop: 9.7 Million

LB: 387,000

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S. Sudan: AchievementsS. Sudan: AchievementsS. Sudan: AchievementsS. Sudan: Achievements

2009• DPT3: 43%; • MCV1: 71%Main challenges:Main challenges:Main challenges:Main challenges:

Low capacity


(ISS GAVI funds)

Coordinating partners’

support

YemenPop: 23 M

LB: 829,375GNI $600

9

Yemen

• Intensifying RED

– Outreach/mobile

teams/

– Using GAVI ISS funds,

Loans

•Acceleration campaignsspecially in the conflict areas

• Integrated PHC

–Using HSS GAVI funds

Intervention

Integrated PHC packagePackage Age group

EPI BCG Polio 4 Penta. 3Measles 2 Pneumacoccos 3 Vit A 2 TT

<2years

15-45 y

IMCI ARI CDD Malaria Measles Malnutrition

anemia Treatment counseling

<5 years

RH/FP Counseling in maternal health FP materials STD

W 15-45 years

Nutrition Counseling in mother and infant and

young child nutrition, growth monitoring, micronutrient supplementation

<5 years

Mothers

Malaria Treatment, bed nets <5 years +pregnant w

TB Treatment DOTS, investigation All ages

Bilharzias Mass ttt, investigation sporadic ceases and ttt

6-18years, older

Surveillance All ages

Package Age group

EPI BCG Polio 4 Penta. 3Measles 2 Pneumacoccos 3 Vit A 2 TT

<2years

15-45 y

IMCI ARI CDD Malaria Measles Malnutrition

anemia Treatment counseling

<5 years

RH/FP Counseling in maternal health FP materials STD

W 15-45 years

Nutrition Counseling in mother and infant and

young child nutrition, growth monitoring, micronutrient supplementation

<5 years

Mothers

Malaria Treatment, bed nets <5 years +pregnant w

TB Treatment DOTS, investigation All ages

Bilharzias Mass ttt, investigation sporadic ceases and ttt

6-18years, older

Surveillance All ages

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Added value of the interventions in Yemen

Main challenges:Main challenges:Main challenges:Main challenges:


(GAVI funds)

Security situation

Other initiatives to scale up Other initiatives to scale up

immunization programmes in the immunization programmes in the

EMREMR

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Strengthening Strengthening

DecisionDecision--Making processMaking process

National Immunization National Immunization

Technical Advisory Groups Technical Advisory Groups

((NITAGsNITAGs))

Existence of Existence of NITAGsNITAGs by Region (2008)by Region (2008)

0

10

20

30

40

50

60

70

80

Percentage

of Countries

with NITAGs

GlobalWPRSEAREUREMRAMRAFR

60%73%70%72%59%65%32%

88/1468/117/1033/4613/2217/2611/34

Slide: Dr P. Duclos

12

Establishing/strengthening Establishing/strengthening NITAGsNITAGs: : Strategies:Strategies:

Technical

support &

information

sharing

Advocacy

and

partnership

Advocacy

and

partnership

StandardizationStandardization

Establishing/strengthening Establishing/strengthening NITAGsNITAGs: : Progress:Progress:

Technical

support &

information

sharing

Advocacy

and

partnership

Advocacy

and

partnership


•Regional Action Plan•Regional Guide•Tools and templates


13


Technical

support &

information

sharing

Advocacy

and

partnership

Advocacy

and

partnership




•EPI managers briefing•RD-MOH

communication•Video-conferences•SIVAC


communication•Video-conferences•SIVAC


Technical

support &

information

sharing

Advocacy

and

partnership

Advocacy

and

partnership





communication•Video-conferences•AMP/SIVAC


communication•Video-conferences•AMP/SIVAC

•In-country support•Chairpersons Briefing•emro.who.int/vpi/nitag

14

Establishing/strengthening Establishing/strengthening NITAGsNITAGs: :

Achievement:Achievement:

• End 2008: WHO/HQ survey:

– 13 (59%) of EMR countries

reported having NITAGs

• Meeting the criteria ?

• Currently:

– 4 NITAGs newly established

– 1 NITAG meet all criteria

– 13 NITAGs are being

strengthened

Opportunity for advocacy, communication, HE and Opportunity for advocacy, communication, HE and

increasing demand/utilizationincreasing demand/utilization

Vaccination Week in the Vaccination Week in the

Eastern Mediterranean RegionEastern Mediterranean Region

(VWEM)(VWEM)

15

Before 2010

• Few countries implement vaccination days/CHDs

• Synchronized in only one sub-region: the Maghrebian

Vaccination Days

2010 and Beyond

• Regional vaccination week

• Join American and European Regions

• Towards Global vaccination weeks

VWEM:VWEM:

Protecting more people against vaccine-preventable diseases

VWEM: Preparation and implementationVWEM: Preparation and implementation

Advocacy & Communication

• Country/EPI managers sensitization

• Draft Plan of Action

• RD communication with MOHs

• RD promotional video

• Regional Framework (document)

• VWEM Guide (document)

• Briefing of EPI managers

Phase IJan 09 – Oct 09

Assessment &Planning

Monitoring &Evaluation


• Visual identity, Slogan• promotional materials• Communication and media mobilization

• Technical support and monitoring of activities

• Regional Launching ceremony • Evaluation and lessons learned

(May – July)

• Visual identity, Slogan• promotional materials• Communication and media mobilization



(May – July)

Coordination, Technical

Support and implementation

Coordination, Technical

Support and implementation

Phase IINov 09 – July 10

Phase IINov 09 – July 10

First Year

Participation

22 countries 100%

First Year

Participation

22 countries 100%

16

Regional VWEM Plan of ActionRegional VWEM Plan of Action

Advocacy & Communication

• Country/EPI managers sensitization

• Draft Plan of Action

• Mobilize financial resources

• RD communication with MOHs

• RD promotional video

• Regional Framework (document)

• VWEM Guide (document)

Phase IJan 09 – Sept 09

Assessment &Planning



• Briefing for EPI Managers• Visual identity, Slogan, promotional materials

• Communication and media mobilization



(May – July)

• Briefing for EPI Managers• Visual identity, Slogan, promotional materials

• Communication and media mobilization



(May – July)

Coordination& Technical

support

Coordination& Technical

support

Phase IIOct 09 – July 10

Phase IIOct 09 – July 10

Regional Launching Ceremony

24 April Beirut, Lebanon

Visual identityVisual identity

17

Pamphlet, Roll up, Banner Pamphlet, Roll up, Banner

and give awayand give away

VWEM: WebsiteVWEM: Website

18

Conclusion

• A Region of major challenges,

specially the conflict-related

• Progress is remarkable

• Partner’s support is needed to

maintain the achievement and

overcome the challenges in the

needy countries

Acknowledgment

• Dr. Altaf Bosan, EPI manager, Pakistan

• Dr. Assegid Kebede, WHO, Somalia

• Dr. Osama Mere, WHO, Yemen

• Dr. Anthony Laku, EPI manager, S. Sudan

• Mr. Nahad Sadr-Azodi, VPI/EMRO

EMRO N Teleb SAGE April 2010 - WHO€¦ · PAK: 2008-2009 National target: 90% in all districts ORS Promotions De-Worming Vitamin A Nutrition Screening Polio Eradication TT Acceleratio

Documents