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Comprehensive Multi-Plan Immunization Program Of Comprehensive multi-Plan Immunization Program of Khyber Pakhtunkhwa List of figures Comprehensive multi-Plan | Immunization Program of Khyber Pakhtunkhwa List of Acronyms AD Auto-destruct AEFI Adverse Events Following Immunization AFP Acute Flaccid Paralysis BCG Bacillus Calmette-Guerin BHU Basic Health Unit BPS Basic Pay Scale CD Civil Dispensary cMYP Comprehensive Multi-year Plan DGHS Director General Health Services DHO District Health Officer DHQH District Headquarters Hospital DTP Diphtheria Pertussis Tetanus DQS Data Quality Self-Assessment DSV District Superintendent Vaccination EPI Expanded Program on Immunization EVM Effective Vaccine Management FMT Female Medical Technician FTE Full Time Equivalent GAVI Global Alliance for Vaccines and Immunization GDP Gross Domestic Product GGE General Government Expenditure GGHE General Government Health Expenditure GHE Government Health Expenditure HMIS Health Management Information System HR Human Resources HSRU Health Sector Reform Unit ICC Inter-agency Coordinating Committee IEC Information, Education and Communication ILR Ice-Lined Refrigerator IP Immunization Practices IPV Inactivated Polio Vaccine JICA Japan International Cooperation Agency 2 Comprehensive multi-Plan | Immunization Program of Khyber Pakhtunkhwa KAP Knowledge, Attitude and Practice KM Kilometer LHS Lady Health Supervisor LHV Lady Health Visitor LHW Lady Health Worker M&E Monitoring and Evaluation MCHC Maternal and Child Health Center MDG Millennium Development Goal MIS Management Information System MLM Mid-Line Manager MMR Measles, Mumps, and Rubella MNCH Maternal Neonatal and Child Health MT Medical Technician NIPS National Institute of Population Studies OPV Oral Polio Vaccine PITAG Provincial Immunization Technical Advisory Group P&D Planning and Development PC-1 Planning Commission Performa No.1 PCV-10 Pneumococcal Conjugate Vaccine - 10 PEI Polio Eradication Initiative PKR Pakistani Rupee POL Patrol Oil Lubricants PSDP Public Service Development Program RHC Rural Health Center SH Secretary Health SIA Supplementary Immunization Activity SIS Skilled Immunization Staff SOPs Standard Operating Procedures SWOT Strengths, Weaknesses, Opportunities and Threats THE Total Health Expenditure THQH Tehsil Headquarters Hospital TPV Third Party Validation TT Tetanus Toxoid 3 Comprehensive multi-Plan | Immunization Program of Khyber Pakhtunkhwa UC Union Council UNICE United Nations Children's Fund F USD United States Dollar VPD Vaccine Preventable Disease WHO World Health Organization 4 Comprehensive multi-Plan | Immunization Program of Khyber Pakhtunkhwa Executive Summary Immunization System Analysis Current Immunization Status Immunization prioritized under Health Sector Strategy 82% immunization coverage 70% DTP3 coverage 2010-17 53% Fully immunized Strong Political Commitment DPT1 – DPT3 drop out being 11% Only 46% of districts with above 80% of DPT3 coverage Province specific target setting of all RI 96% polio SIA coverage Poor oversight and Monitoring systems Very low turnover of vaccinators Strong political commitment Well established PIU with qualified technical staff for Salaries of EPI service delivery staff on Recurrent surveillance, monitoring and evaluation and cold chain budget staff Functional AFP surveillance system management Aging and insufficient cold chain equipment LHWs involvement in RI activities Health System Constraints Incremental budget planning No practice of developing annual health plans Health department’s contribution to revenue generation remained 0.08% Fragmented health information system No HR policy for human resource management of the health department Lack of coordination between vertical health programs Security risks and poor law& Order situations Baseline In Total Immunization Expenditures 21,210,243 Campaigns 4,979,795 Routine Immunization only 16,230,448 per capita $ 0.63 per DTP3 child $ 27.12 % Vaccines and supplies 5 43% % Government funding ExecutiveComprehensive Summary multi: Comprehensive-Plan | Immunization multi-Plan Program, 2014- 2018of Khyber | Expanded Pakhtunkhwa Programme on Immunization, KhyberPakhtunkhwa Immunization Priorities Goals &Objectives 2014-18 Increasing immunization coverage and reducing vaccine preventable disease associated morbidity and mortality To increase coverage of fully immunized from 53% to 80% in Increasing the share of immunization services through outreach services and fixed EPI centers all districts by 2018 Expanding tending the reach of immunization services to To enhance Penta3 from 70% to 90% in all districts by 2018 marginalized populations and security compromised areas To increase TT2+ coverage from 56% to 80% by 2018 in all Strengthening and upgrading cold chain and logistics districts Introducing new vaccines (IPV/Rotavirus) To increase measles coverage from 58% to 80% Polio eradication Increase the proportion of population protected at birth Strengthening VPD Surveillance from neonatal tetanus from 56% to 80% Programme Monitoring Framework Priority Immunization Strategies Indicator 2012 Enhancing programme staff capacities in policy, planning 2018 and guidelines/SOP development DTP3 coverage Introduce mechanisms of accountability through third party 70% 90% monitoring Measles 1 coverage 58% Increase the number of skilled immunization staff 80% Upgrade/maintain adequate cold chain equipment PCV-10 coverage 0 Develop and implement evidence based communication 90% strategies % of children fully immunized 47% 80% % of districts that have at or above 80% DTP3 coverage 52% 90% Dropout rate - % point difference between DTP1 and DTP3 coverage 10% 7% Partnerships & Sustainability Strategy Health and Development Impacts Enhance efficient utilization of human resources by Improve child survival through contribution to achievement developing synergies with other health initiatives of MDG Goal 5 Minimize wastage of resources under immunization Reduced disability in the community associated with program vaccine preventable disease (Polio) Advocacy for ensuring financial sustainability of Contribute to poverty reduction goals through reduction of immunization program preventable hospitalization for childhood illnesses Introduce mechanisms of accountability through third party monitoring Cost and Financing projections 2014, 2015, 2016, 2017, 2018 Total Resources Required 66,573,771 71,366,278 83,553,150 84,098,539 81,145,668 per capita 1 , 1, 2, 2, 2 Total Secure Financing 63,853,429 55,992,582 14,663,937 16,840,934 15,325,660 Funding Gap $2,720,342 $15,373,696 $68,889,213 $67,257,605 $65,820,008 Total probable Financing 106,120 10,378,681 63,803,102 62,543,804 61,230,295 Funding Gap 2,614,222 4,995,016 5,086,111 4,713,801 4,589,7136 Comprehensive multi-Plan | Immunization Program of Khyber Pakhtunkhwa Executive Summary Situation Analysis Khyber Pakhtunkhwa (KP), one of the four provinces of Pakistan is among the least developed and crisis prone province in Pakistan. KP province accounts for 10 percent area of Pakistan with 13 percent of population residing in seven administrative divisions. About 69 percent of population lives in the rural areas, above national average size of 4.8 members per household compared to national average of 3.8, low literacy rate of 49 percent, less than 50 percent of population is having access to tap water connections, and high unemployment rates of 8.5 percent1. Its relative underperformance is due to low levels of growth, socio-economic development and absence of public services in comparison to other provinces of Pakistan. This province is also affected by geo-political developments (militancy) and devastations of mother-nature (earthquake 2005 and floods 2010); all calling for continued scaling-up of public interventions and investment to not only improve quality of life but, also, unlock economic potentials. The Khyber Pakhtunkhwa, has four administrative sub-regions– Hazara, Malakand, Central and Southern––that together contain 25 districts. The regions are further constituted of 25 districts, 72 tehsils and 1,040 union councils. Based upon 1998 census the projected population of KP for 2012 is estimated at 25,929,799. The population of districts ranges from 0.2 million to above 2 million (average of 0.7 million) with Thorghar and Peshawar being smallest and largest in terms of population respectively. The Province continues to establish new districts and union councils. In Khyber Pakhtunkhwa, as in other parts of the country, the quality of health services is often poor, resulting in a waste of both government and household resources and providing a low impact on health outcomes. Women and children are particularly disadvantaged by socioeconomic and cultural barriers with estimates of only 30% of women and children having access to medical care.2 The total fertility rate is high (3.9) and the CPR (28.1)3 is not rising fast enough to achieve MDG goals. The situation is further compounded by high maternal and infant mortality rates (58)4 and insufficient services. Public as well as private services focus on curative care, with little attention to promotive, preventive care and rehabilitative care. Health facilities are underutilized due to shortages of staff and supplies. Chronic staff shortages and non-availability of essential medicines is common. In the CIET survey (2004), only 9% of the patients who had used a government facility had received all the prescribed medicines.5 The health outcomes in KP present a challenging picture showing improvements
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