National Emergency Action Plan 2014 For Polio Eradication

Executive Summary Polio Eradication is a priority program for the country that is funded by the government, which means ultimately by the people of Pakistan! A national emergency has been declared by the Government of Pakistan to interrupt Polio transmission and achieve the goal of eradication.

Pakistan started 2013 with the hope of eradicating the poliovirus but the polio eradication initiative had a difficult year due to continued violence towards polio workers. Threats of violence caused limitation in access for vaccinators in some areas of FATA, Khyber Pakhtunkhwa and in Karachi. This resulted in an increase in the number of confirmed WPV cases from 58 in 2012 to 91 in 2013.

Additionally, 47 cases of circulating vaccine derived WPV type 2 (cVDPV2) were reported during the year. However, there have been several positive developments. The NEAP process continues to function and provide the basis for polio eradication in Pakistan. Most of Pakistan is polio free, WPV type-3 has not been detected in the last 18 months and outbreaks in non-endemic areas are being resolved effectively.

At the beginning of 2014, the country is at a critical juncture and intensified polio eradication activities in the next few months will determine if eradication is achieved this year. The programme relies on strong provincial administrative and political leadership, as well as the district and agency administrations.

Review of the NEAP 2013:

The 2014 revision of the NEAP builds on the experiences and lessons learnt in 2013, with a renewed sense of urgency to interrupt polio transmission in 2014. The review of last year’s NEAP was facilitated in a consultation meeting involving provincial Chief Secretaries alongside partner agencies, and the Secretary Ministry of National Health Services Regulation and Coordination. The meeting endorsed the salient features of the draft NEAP 2014 and made recommendations for additions.

The Goal of the National Emergency Action Plan 2014:

The goal of the NEAP is interrupt transmission of wild poliovirus in Pakistan by December 2014, focusing on first six months low transmission season of the year.

Elements of the NEAP:

Key elements of the NEAP 2014 and salient strategies are described in this section, some of which are enhancement of strategies already included in the NEAP 2013, and some of which are new approaches The following are the key elements of the Augmented NEAP 2013 that remain valid and in force:

• Polio continues to be a national emergency with international repercussions that must be urgently addressed through the engagement of all line departments of government in 8 eradicating polio

• Oversight at the national level continues through the national task force headed by the Prime Minister. In 2014, there will be a full time senior government official (additional secretary level) designated in the Prime Minister’s Polio Monitoring and Coordination Cell to oversee the implementation of the NEAP 2014. The Prime Minister’s focal person for polio eradication continues to lead programme coordination with the offices of the Prime Minister, President, and other relevant Ministries at the federal level.

• Oversight continues at the district level through the DPECs headed by the DC/DCO/PA, and at provincial level through provincial task forces, headed by the Chief Secretaries

• The highest emphasis continues to be on the implementation of activities at UC level

• Concentrated efforts continue to be on highest risk areas and populations to ensure that all children are reached with polio vaccine every immunization round.

• Routine immunization continues to be the backbone of polio eradication and is crucial for maintaining polio free status after the last polio case, and it will be monitored along with polio eradication activities • Implementation of a broad communications programme to engage communities and build demand for immunization at household level will continue.

• Close monitoring of programme performance will continue to identify problems, and design specific actions to address these problems.

• Special emphasis will remain on polio reservoirs, including development of individual integrated reservoir action plans, which encompass all aspects of operations, communications and security. There will be jointly agreed accountability mechanisms for these plans at the UPEC and DPEC levels.

New elements and special emphasis in NEAP 2014:

Key elements in NEAP 2014 are:

• Tracking of missed children with special focus on clusters. Analysis will be conducted to determine underlying causes to be addressed through appropriate and targeted strategies.
The analysis and the actions will be disaggregated down to UC level.

• Where appropriate utilize Short Interval Additional Dose Strategy (SIADs) to rapidly boost population immunity levels.

• Implementing special strategies for high risk populations such as Pashtun communities, nomads, brick kiln worker families, migrant and transit populations. Focus on implementing high risk population strategies nationwide to map, track and reach these populations consistently and effectively. Strengthen the transit strategy to ensure all the children on the move and those that reside in inaccessible areas are identified and vaccinated against polio

• Ensuring effective polio control/operations rooms at provincial level and district/agencies/town levels

• Strengthening monitoring and evaluation mechanisms

• Focusing on high risk UCs in implementing all new strategies (including polio plus for selective communities/areas) that improve quality of operations, communications and data.

• Strengthening partnerships at all levels to ensure every child is reached in FATA

• Enforcing zero tolerance for data misreporting/hiding and financial misappropriations

• Implementing the Direct Disbursement Mechanism (DDM)

• Strengthening cross border coordination with Afghanistan

• Improving vaccine management at provincial, district and sub-district levels to ensure efficient utilization of this important resource

• Optimizing the polio eradication operations for strengthening routine immunization

• Ensuring safety and security of the polio eradication workers will be critical to keep their confidence and hence the performance

Reviewing implementation status of NEAP:

The implementation status of the NEAP 2014 will be reviewed at various levels

• At the national level, the Prime Minister’s task force for polio eradication will meet every three months

• The National Control Room led by the Prime Minister’s Polio Monitoring and Coordination Cell will oversee the programme at the national level, with technical assistance of WHO, UNICEF and other key polio partners.

• At the provincial level, provincial task forces chaired by the Chief Secretaries (Additional Chief Secretary in FATA) review the programme performance after every SIA (preparation and results) and report to the Chief Ministers (Governor for FATA)

• The provincial control room will be established at the Chief Secretary’s office led by a senior officer (Additional Secretary level) and technically supported by the Provincial Technical Focal Person for NEAP and technical polio partners. At the district level, DPECs headed by the DCOs/DC/PA oversee the programme and report to their respective Commissioners and provincial task force

• The district polio control/operations rooms situated in the DC/DCO/PA offices will be responsible for overseeing the NEAP implementation and quality of the polio eradication activities at the district and UC levels. All the polio partners will work as ‘ONE POLIO TEAM’ under the flag of district control room under the leadership of DC/DCO/PA