measles catch-up campaign bangladesh & pakistan
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Measles Catch-up Campaign Bangladesh & Pakistan. Quamrul Hasan WHO - Pakistan. Sylhet. Rajshahi. Dhaka. Khulna. Barisal. Chittagong. Bangladesh Division: 6 District: 64 Sub district: 463 Union council: 4,451 City Corporation: 6 Municipality: 223 Area: 153,378 sq km - PowerPoint PPT PresentationTRANSCRIPT
Measles Catch-up CampaignBangladesh & Pakistan
Quamrul HasanWHO - Pakistan
Sylhet
Chittagong
Dhaka
Barisal
Rajshahi
Khulna
Phase 1 (01-18 March 07) 4 districts
Phase 2 (02-18 July 07) 6 districts
Phase 3A (20 Aug to 5 Sep 07) 28 districts
Phase 3B (27 Aug – 12 Sep 07) 12 districts
Phase 4 (12-28 Nov 07) 48 districts
Phase 5 (17 March- 02 April 08) 35 districts
Phase 1 (03-22 Sep 05) 2 districts + 1 City
Phase 2 (25 Feb-16 March 06) 62 districts + 5 City
Campaign Target & AchievementPakistan Bangladesh
Target age Phase 1: 09 months to less than 15 yrsPhase 2 to 5: 09 months to less than 13 yrs
09 months to less than 10 yrs
Phase wise target & achievement (administrative data)Target Achievement Coverage Target Achievement Coverage
Phase 1 2,571,536 2,511,837 98% 1,481,321 1,374,390 93%
Phase 2 1,219,364 1,282,232 105% 34,199,590 34,637,764 101%
Phase 3 6,890,603 6,906,376 100%
Phase 4 21,262,960 20,566,497 97%
Phase 5 34,123,305 35,315,375 103%
Total 66,076,768 66,582,317 101% 35,680,911 36,012,154 101%
Independent assessment
96% (Independent survey of phase 5 by education department with WHO assistance)
92% (RCA by independent local and international monitors)
Few facts & figuresPakistan Bangladesh
Skilled person 41,986 52,397
Non-skilled person/volunteer 64,733 762,192
1st line supervisors 6,994 9,505
Vaccine (doses) 81 million 44 million
AD syringes 81 million 44 million
Reconstitution syringes 8.1 million 4.4 million
Safety boxes 890,000 484,000
Campaign duration 2 to 2½ weeks 3 weeks
Actual campaign working days 15 days (18 days in ph 1) 12 days
Average cost per child (approx.) US$ 0.55 US$ 0.38
Political commitment & support
• Political commitment– Bangladesh:
• Enjoyed highest level political commitment
• Multi-sectoral involvement ensured
– Pakistan:• Phase 5 enjoyed better
administrative support• Local people’s representatives
extended excellent support
• Active participation and support from education department in both countries
Campaign preparation and microplanning
• Bangladesh– About 1 year uninterrupted preparation– Head count done in each and every schools and
community for accurate target setting– Repeated revision and refinement of microplan
• Pakistan– Short time of preparation in between repeated polio
campaign rounds– School target determined by head count– Community target set by estimation from census– Microplan prepared just few weeks before campaign
Cold chain
• Government in both countries provided handsome number of additional cold chain equipments from their own resources
• In Pakistan, additional cold chain equipments reached country during the 4th phase
• Shortage of power supply was a common challenge in both countries
Safe waste disposal• Safety box was used to
collect sharp waste in both campaign without any exception
• Burn and burry method was adopted in most instances in both countries
• Unsupervised disposal incomplete burning during the early days of campaign
Routine EPI during campaign
• Beside measles vaccination, health facility based fixed sites provided routine EPI service daily throughout the campaign days in both countries
• Routine EPI is mostly outreach based in both countries– Bangladesh: went uninterrupted according to
annual microplan– Pakistan: inconsistent scenario
Supervision and monitoring
• Limited capacity of 1st line supervisors for providing technical support to the vaccination team
• Use of common sense and pro-activeness missing• Regular evening meeting was held to monitor
daily progress
International monitors• Bangladesh– 12 monitors during Phase 1– 23 monitors during Phase 2
• Pakistan– 2 monitors during Phase 3– 3 monitors during Phase 4– 6 monitors during Phase 5
• Good number of well organized international monitors provide opportunity for mutual benefit
Challenges• Inadequacy of data– Number of schools and their students; especially non-
government schools of different categories, religious schools
– Accurate target– Daily progress and vaccine stock update during campaign– AEFI data
• Skilled manpower and their training• Vaccination in private posh schools• Nomadic population and other high risk group• Power shortage cold chain compromised • Vaccine and logistics management• Waste management• Time conflict with other priority programs
Lessons learned
Preparation
After setting strategy, adequate time is required: at least 1 year for Data collection regarding,
Effective available human resourcesCold chain inventoryExact target population in school and community by registrationSchool exam and vacation schedulePopulation distribution and its ethnic and cultural diversityLocal weather patternLocal important eventsSchedule of other important program activities
Local level sensitization through advocacy among service providers, clients and other stakeholders
Strategy
• School based immunization activity is easy if teachers, guardians and authorities are taken on board in advance
• Outreach center based immunization program is acceptable to the community
• Shifting center in a larger community rises access and acceptability
• On average vaccinating 150 – 200 children daily is an easy target for a skilled vaccinator
Political commitment, Leadership and Team spirit
• Highest level political commitment makes challenges easy
• Dynamic and effective leadership from government is crucial
• Political and top level administrative involvement may require for access to posh private schools
• Team spirit among the partners is the essence for micromanagement
Microplanning
Factual microplanning is the key to success
All relevant data to be ready beforehandActual site wise targetInventory of resources,
ManpowerCold chain equipmentsTransport Social and operational
mappingMicroplanning to be
reviewed and refined repeatedly for fine adjustment
Training• Maintaining quality and
consistency is difficult in multiple tire cascade training
• Using pool of provincial/regional master trainer may give better result
Supervision & monitoring
Medical doctors were the best choice as 1st line supervisorResponsibleEnthusiasticEarned confidence among
the team and the community
Daily evening review meeting helped inIdentification and
correction of problemMonitoring performance
Community participation
There are high demand for vaccination among the parents
Lack of awareness among community about benefits of vaccination is a false statement
Refusal is not a major issue
Teachers and students are great partners in child health
• Education department can play a vital role in promoting child health activities– Through participating– Creating community
awareness– Building trust
Vaccine & logistics management• Separate logistics unit for proper vaccine and logistics
management• A full time consultant may lead the unit• Separate storage facility for campaign vaccine and
logistics• Instead of hiring individual transportation, transport
firm with good capacity can be hired• Contingency plan for on road ice pack change• Pre arrangement of traffic clearance at ferry terminal,
city entry etc.• Continuous monitoring of all transporters from a
central control unit up to the terminal delivery level
Local initiativeInnovative idea adopted for
creating public awarenessEssay competition, letter writing
competition, sms competition etc. among school children
Distributing hand note on measles campaign during polio NID
Polio vaccine was given along with measles vaccine in previously inaccessible areas
Social mobilization and communication Top level advocacy for appropriate
sensitization Social mobilization by school teachers
and community/religious leaders gives good return at grass root level
Mosque announcement most effective
House to house visit important School students: good message
disseminator Scope of taking advantage of
nationwide media coverage is limited in multi-phased campaign
Appropriate material used in appropriate place best result
Selection of vaccine and syringes
• Avoid using vaccine from multiple manufacturer for a single phase of campaign
• AD syringes which are locked at 0.5 ml point are better choice
Plunger stops at 0.5 ml mark. Easy to use in campaign.
Plunger goes beyond 0.5 ml mark. Needs more skill for dose adjustment and prone to high vaccine wastage.
Recommendations for vaccine package and labeling
• Dark color vials are preferred option than transparent vials for protection from sunlight
• Both the vaccine vial and diluent ampoule label to be of similar color and graphic design
• Same name (either manufacturer or trade name) to be printed on both vaccine vial and diluent label using same font type and size
• Packing of vaccine vial and diluent must have same number of vials and ampoules