1. Strengthening Routine EPI through PEI Network TAG Meeting, 24-25, March,2011 Islamabad

2. Overview of National Routine EPI ProgramDr Zahra MohammedDr Rohullah

3. EPI Service Delivery Modality Routine EPI Vaccination through Fixed EPI clinics- 1210 Outreach Mobile PIRI (Periodic Intensification of Routine Immunization)- Child Health Weeks SIAs for Polio, measles, and TT

4. Coverage of various EPI Antigen (National)2008-10

5. % Districts with >80% Coverage of DPT-3& OPV-3 - 2008-10

6. Access Vs Utilization Nationally: Proportion Categories –2008-10 Cat1: >80% Coverage, <10% DOR; Cat2 : >80% Coverage , >10% DOR Cat3: <80% Coverage, <10% DOR; Cat4 : <80% Coverage , >10% DOR

8. More number of NNT cases

9. Most of the polio cases

10. More non-reporting districtsCategory 1 Category 2 Category 3 Category 4

11. Child Health Weeks- Accelerated RI Total 32 districts with DPT-HepB-Hib-3 coverage included Three rounds in each district done

12. Issues and Challenges Discrepancy between different sources of population data for planning purpose 15%-30% of populations have no access to HS/living in hard-to-reach areas/nomads/new illegal settlements/IDPs Poor monitoring of stakeholders (NGOs) Insecurity : a key problem for both access and utilization Poor outreach and mobile services

13. Way Forward Updating and strengthening of micro-plans in phase-wise manner ensuring its appropriate implementation Refresher training of vaccinators Strengthening of Cold Chain capacity following recommendation of EVM Ensuring that Polio Program structure devotes some percentage of the time and resources in strengthening routine immunization

14. PEI North

15. Strengthening Routine EPI is important strategy for PEI With decreasing number of SIAs, Increasing immunity gap among population particularly in most parts of the country without poliovirus circulation. Transmission and high risk zones : 2009 =9 2010 =8 2011 =8 Areas with no circulation: 2009 =6 2010 =4 2011 =2( first 6 months) Strengthening Routine immunization is the most effective way to maintain population immunity

16. Supporting routine EPI through PEI network Using AFP surveillance data to improve routine EPI services. Regular supervision of EPI fixed centers by PPO Supporting District EPI team in routine EPI district micro planning Including routine EPI activities during internal AFP surveillance review.

17. Median of routine EPI coverage in the vicinity of AFP cases

18. Area coverage survey from detailed AFP case review

19. Using AFP surveillance data to improve routine EPI services

20. Activity to improve routine EPI-2009,2010

21. PPO Observations in Fix centers No OPV in Fix Center No OPV for one month BCG no diluent NO gas for fridge 180 Vials expired

22. Including Routine EPI During AFP Surveillance review central region Out of 8 vaccination centers visited, vaccinator was found absent in 3 of the centers at the time of review. Knowledge of vaccinators in general was not adequate and the micro plan was not complete. Penta3 coverage (<60%) according to register Vaccine supply was more than the requirement (> 3 months supply) Drop out rate >10% On Job training was provided and feedback to PEMT and NGO

23. Conclusion With decreasing number of SIAs in non transmission zone, routine EPI is the only way to maintain population immunity. AFP surveillance was effectively used to improve routine EPI coverage in Northern region. Northern region experience is to be shared with other regions Strong coordination is required among partners to identify low routine EPI Pockets and plan to cover them accordingly.

24. Thank You