Measles%20Catch-up%20Campaign%20Bangladesh%20

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Measles Catch-up CampaignBangladesh Pakistan

• Quamrul Hasan
• WHO - Pakistan

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Bangladesh Division 6 District 64 Sub district
463 Union council 4,451 City Corporation
6 Municipality 223 Area 153,378 sq
km Population 140 million Population density
1,045/Km2
Pakistan Province 4 AJK District 134 Sub
district 474 Union council 6,806 Area 803,940
km2 Population 176 million Population density
206/km2
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Campaign Target Achievement
Pakistan Pakistan Pakistan Pakistan Pakistan Bangladesh Bangladesh Bangladesh
Target age Phase 1 09 months to less than 15 yrs Phase 2 to 5 09 months to less than 13 yrs Phase 1 09 months to less than 15 yrs Phase 2 to 5 09 months to less than 13 yrs Phase 1 09 months to less than 15 yrs Phase 2 to 5 09 months to less than 13 yrs Phase 1 09 months to less than 15 yrs Phase 2 to 5 09 months to less than 13 yrs Phase 1 09 months to less than 15 yrs Phase 2 to 5 09 months to less than 13 yrs 09 months to less than 10 yrs 09 months to less than 10 yrs 09 months to less than 10 yrs
Phase wise target achievement (administrative data) Phase wise target achievement (administrative data) Phase wise target achievement (administrative data) Phase wise target achievement (administrative data) Phase wise target achievement (administrative data) Phase wise target achievement (administrative data) Phase wise target achievement (administrative data) Phase wise target achievement (administrative data) Phase wise target achievement (administrative data)
Target Target Achievement Coverage Target Target Achievement Coverage
Phase 1 2,571,536 2,571,536 2,511,837 98 1,481,321 1,481,321 1,374,390 93
Phase 2 1,219,364 1,219,364 1,282,232 105 34,199,590 34,199,590 34,637,764 101
Phase 3 6,890,603 6,890,603 6,906,376 100
Phase 4 21,262,960 21,262,960 20,566,497 97
Phase 5 34,123,305 34,123,305 35,315,375 103
Total 66,076,768 66,076,768 66,582,317 101 35,680,911 35,680,911 36,012,154 101
Independent assessment Independent assessment Independent assessment Independent assessment Independent assessment Independent assessment Independent assessment Independent assessment Independent assessment
96 (Independent survey of phase 5 by education department with WHO assistance) 96 (Independent survey of phase 5 by education department with WHO assistance) 96 (Independent survey of phase 5 by education department with WHO assistance) 92 (RCA by independent local and international monitors) 92 (RCA by independent local and international monitors) 92 (RCA by independent local and international monitors) 92 (RCA by independent local and international monitors)
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Few facts figures
Pakistan 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
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Political commitment support

• Political commitment
• Bangladesh
• Enjoyed highest level political commitment
• Multi-sectoral involvement ensured
• Pakistan
• Phase 5 enjoyed better administrative support
• Local peoples representatives extended excellent
  support
• Active participation and support from education
  department in both countries

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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

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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

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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

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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

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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

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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

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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

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• Lessons learned

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Preparation

• After setting strategy, adequate time is
  required at least 1 year for
• Data collection regarding,
• Effective available human resources
• Cold chain inventory
• Exact target population in school and community
  by registration
• School exam and vacation schedule
• Population distribution and its ethnic and
  cultural diversity
• Local weather pattern
• Local important events
• Schedule of other important program activities
• Local level sensitization through advocacy among
  service providers, clients and other stakeholders

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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

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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

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Microplanning

• Factual microplanning is the key to success
• All relevant data to be ready beforehand
• Actual site wise target
• Inventory of resources,
• Manpower
• Cold chain equipments
• Transport
• Social and operational mapping
• Microplanning to be reviewed and refined
  repeatedly for fine adjustment

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Training

• Maintaining quality and consistency is difficult
  in multiple tire cascade training
• Using pool of provincial/regional master trainer
  may give better result

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Supervision monitoring

• Medical doctors were the best choice as 1st line
  supervisor
• Responsible
• Enthusiastic
• Earned confidence among the team and the
  community
• Daily evening review meeting helped in
• Identification and correction of problem
• Monitoring performance

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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

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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

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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

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Local initiative

• Innovative idea adopted for creating public
  awareness
• Essay 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

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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

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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.
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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

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