Sehat ka Insaf

02 February and 20 April, 2014

Report of the First 7 Rounds

Updated on: 19 March, 2014 Peshawar, the capital of Khyber Pakhtunkhwa province is home to four million people, and the main urban center of northwest Pakistan. The city acts as a major transit hub; every day hundreds of thousands of people move in and out creating an environment conducive to the spread of the poliovirus across the country. As much of the population of the area moves through Peshawar, the city has become an amplifier of the poliovirus. According to the World Health Organization (WHO), Peshawar is considered the largest reservoir of poliovirus in the world. Many children paralyzed by polio in Pakistan and Afghanistan were infected by the virus genetically linked Peshawar. Samples of sewage water collected from different locations in Peshawar over the last four years have persistently shown presence of the highly contagious wild poliovirus. The prevailing security situation in Peshawar had seriously affected the quality of polio campaigns in the city and was resulting in inconsistent coverage at UC level that was insufficient to interrupt the poliovirus. A repeated, high quality vaccination campaign accompanied by strong monitoring and awareness raising was inaugurated on 23rd January 2014 by Imran Khan, Chairman of the Pakistan Tehreek-e-Insaf (PTI).The political leadership in KP province has strongly backed the initiative. PTI is committed to improving the health of the children of Peshawar by providing an integrated child health package together. The package includes routine immunization against the nine vaccine-preventable childhood diseases such as measles, pneumonia, meningitis, hepatitis B, tetanus, pertussis (whooping cough), diphtheria, polio and tuberculosis. Undertaken by the Health Department in collaboration with the police, administration and education departments of the Government of KP, Sehat ka Insaf aims to build a stronger health system in Peshawar, bringing together immunization, improved sanitation, and nutrition and health services; and to interrupt and stop transmission of poliovirus in Peshawar.

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Sehat ka Insaf is an innovative health initiative that utilizes the existing infrastructure of the polio eradication program. The initiative targets 754,000 children under the age of five in 97 Union Councils of Peshawar.

Success of Sehat ka Insaf in Numbers

Medical camps offering free medicine and checkups in areas where there are no government health facilities available. Doctors at medical camps diagnose and treat children free of cost; that includes quality medication. According to an estimate, almost 3,500 people are benefitting from these medical camps regularly. Four medical camps are held twice each week for the last seven weeks, meaning that thousands of patients have already been treated for various diseases. 500,000 Invitations to vaccination delivered door to door as part of the largest ever health education campaign in the history of Pakistan. The invitations invite parents towards 100% free immunization against nine vaccine-preventable diseases at local health facilities in Peshawar. This has been done in accordance with the local culture of sut or invitation. An excellent response has been seen to the activity as 50 fixed EPI vaccination centers in the District have reported a clear increase in the number of families that visited the centers to immunize their children. Distribution of 250,000 health education materials highlighting the importance of routine immunization and prevalent diseases like dengue fever, hepatitis and sanitation. 25,000 hygiene kits have been distributed to under-served and unhygienic households in Larama, Shaheen Muslim Town 1, Shaheen Muslim Town 2, Akhunabad and Gulbahar. This was done through a transparent system involving door to door distribution of coupons by Insaf Sehat Razakars. 11,000 Insaf Sehat Razakars, including PTI Tabdeeli Razakars, independent volunteers, health department employees and teachers are involved in delivering the campaign door-to-door to 350,000 households in District Peshawar. These Sehat Razakars were trained and equipped with health education material for distribution. The capacity building was done by the partner organizations. Unprecedented security arrangements were made that includes police force mobilization from various districts of KP. A total of 5,777 security personnel ensured state of the art security for Insaf Sehat Razakars. By the grace of the Almighty, not a single major security related incident involving Insaf Sehat Razakars has been reported till date, and the credit for this goes to the Peshawar Police.

In the upcoming rounds

2.2 million water cleaning aqua-tablets will be distributed door-to-door to 220,000 households in the high risk UCs of Peshawar. Vitamin A will be administered to children (between the ages of 6 months to 5 years) of Peshawar to help improve immunity and nutrition. Clearing of garbage and replacing sewage pipes in selected neighborhoods that includes Shaheen Muslim Town I and II and Larama is about to begin. It may be highlighted that the sewage from Larama and Shaheen Muslim Town revealed presence of wild poliovirus in more than 90% samples taken in the last 04 years.

Sehat ka Insaf: the winning combination

Sehat Ka Insaf program is a complete child healthcare package for the children of Peshawar using the existing infrastructure of the polio eradication initiative to enhance the efficiency and quality of the childhood vaccination. Sehat ka Insaf is the first ever mass scale immunization drive that is being conducted in a single day within 7-9 hours. This is being done to minimize the exposure of Insaf Sehat Razakars to terrorism and targeted attacks. Prior to Sehat ka Insaf, half of children reported absent were found to be attending school. To address this problem, Sehat ka Insaf is carried out on weekends.

Public Response
The public response to the first ever one day mass immunization campaign has been enthusiastic. Insaf Sehat Razakars are playing an important role in presenting the broader health package for children in Peshawar. Because of the high visibility campaign supporting these rounds, Sehat Ka Insaf is now recognized by all communities in Peshawar. Many children were brought to health facilities for routine immunization as a result of raised awareness from the distributed invitation cards. Despite the fact that thousands of motorcyclists are barred from bike-riding on the day of the campaign, not a single incident of public outrage has been reported against this inconvenience. This shows the acceptance of Sehat ka Insaf and the success of its communications strategy.

Sehat ka Insaf strikes

The Sehat ka Insaf model has struck a vital blow to the stubborn poliovirus present in the sewage of Shaheen Muslim Town. The sewage sample results showed no presence of poliovirus (samples are collected and evaluated independently by WHO for various cities of the country including Peshawar). This was a breakthrough after a long gap of 20 months as previous polio campaigns had failed to get a negative sewage sample from the densely populated Shaheen Muslim Town.

Verticality in Health systems and Sehat ka Insaf

The Sehat ka Insaf model is creating a unique opportunity to achieve convergence of the Expanded Programme of Immunization (EPI) and the Polio Eradication Initiative (PEI) within a strengthened health system. This is a vital step to put an end to the verticality of the health systems as two of the largest public health sector initiatives are now working together.

Local recognition
Following Sehat ka Insaf, Karachi has also adopted the one-day innovative model and has conducted three rounds till date. Similar to Peshawar, the model has proven excellent for the Sindh government as no attack has taken place on health teams in Karachi.

Global recognition
The Director General of the WHO, Dr. Margaret Chan has termed Sehat ka Insaf a huge success. In addition, Sir Liam Donaldson of the highly influential Independent Monitoring Board (IMB) called Sehat ka Insaf a firm and intelligently designed initiative. Th e Chairman of Bill and Melinda Gates Foundation, Mr. Bill Gates personally called to congratulate Chairman Pakistan Tehreek-e-Insaf, Mr. Imran Khan on the success of this innovative model. Mr. Bill Gates is currently one of the biggest donors of the global polio eradication initiative.

Startling Success of Sehat ka Insaf roundscoverage trends upwards

First round (2nd February, 2014) Total target population: 440,512 Total target households: NA Children vaccinated: 365,625 Success percentage: 83% Second round (9th February, 2014) Total target population: 5,24,585 Total target households: NA Children vaccinated: 4,57,583 Children recorded as absent: 22,624 Success percentage: 87.2% Third round (15th February, 2014) Total target population: 6,35,675 Total target households: 2,98,619 Children vaccinated: 5,47,093 Children recorded as absent: 30,410 Success percentage: 86.06% Fourth round (22nd February, 2014) Total target population: 6,35,675 Total target households: 2,98,619 Children vaccinated: 5,60,881 Children recorded as absent: 28,392 Success percentage: 88.2% Fifth round (1st March, 2014): Total target population: 6,96,408 Total target households: 3,40,043 Children vaccinated: 6,68,871 Children recorded as absent: 33,526 Success percentage: 96.01% Sixth round (9th March 2014) Total target population: 6,83,605 Total target households: 3,39,186 Children vaccinated: 6,59,833 Children recorded as absent: 29,126 Success percentage: 96.5% Seventh round (15th March, 2014) Total target population: 6,90,473 Total target households: 3,38,640 Children vaccinated: 6,60,085 Children recorded as absent: 22,000 Success percentage: 95.6%

Breakup of Expenses
The total financial support committed to the provincial government from UNICEF and WHO is Rs. 124 million for the complete duration of Sehat ka Insaf. This includes breakfast, lunchboxes and mobilization of 4000 policemen. The amount also covers the mass media campaign. The items distributed during the campaign are being contributed and procured through the international donor agencies according to their mandate and their vendors. The KP government is open to transparency. All records and official correspondence with WHO and UNICEF according to rules of business are available.