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Topic of presentation: “EPI IN PAKISTAN; A SUCCESS OR A FAILURE ?”

PRESENTERS:
FARHEEN ZAFAR BUTT SABA AHMED

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PROGRAMME OVERVIEW AIM:
EPI was launched in 1987. It aims at protecting children by immunizing them against Child hood tuberculosis Poliomyelitis Diphtheria Pertussis Measles & Tetanus
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Aim continues….

AND also protecting their mothers against tetanus.

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PROGRAMME OBJECTIVES
Reduction of mortality and morbidity resulting from 7 EPI target diseases by immunizing children of age 0-11 months and women of child bearing age. 90% routine immunization coverage of all EPI antigens by 2012. Interruption of polio virus transmission by 2010.
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“Program objectives “continues….

Elimination of neonatal tetanus by 2015 Reduction of measles mortality by 90% by 2010. Reduction of diphtheria ,pertussis and childhood T.B. to a maximum level. Control of other diseases by introducing new vaccines in EPI as and when they are available using EPI as a spearhead for promoting other PHC activities and finally integrating EPI into primary health care

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EPI SCHEDULE:
ROUTINE IMMUNIZATION SCHEDULE: BCG & OVP 0 dose are given at birth, DPT, HBV & OVP at 6, 10 and 14 weeks Measles vaccine at the age of 9 months. The pregnant ladies and child bearing age ladies are provided immunization against TT.

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EPI schedule continues…

THE SCHEDULE OF VACCINATION OF PREGNANT WOMEN AND LADIES OF CHILD BEARING AGE IS:

TT 1 at first contact, TT 2 at least 4 weeks after 1st dose, TT 3 at least 6 months after 2nd dose, TT 4 at least 1 year after 3rd dose and TT 5 at least one year after 4th dose)

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Program Responsibilities at Federal level Overall planning guidance, support , monitoring and evaluation Coordination with International Agencies Purchase of vaccines/syringes and supply to provinces Mid-level Managers Training
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Program Responsibilities at Provincial level Implementation Collection of vaccines/syringes/needles from the Federal EPI Cell for further distribution to the districts Repair and maintenance of equipment Monitoring, evaluation and reporting Supervision at all EPI service delivery level Training of all EPI workers except Mid-level Managers
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Evaluation of EPI success:

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%age of children immunized in each province (up to 2006)
ANTIGEN BCG DPT3 MEASLES
FULLY

PUNJAB

SINDH

NWFP

BALOCHISTAN

89.9 82.6 80.2 76.2

84.2 66.5 63.6 59.8

74.3 61.3 57.6 52.0

59.0 40.2 40.9 32.0
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IMMUNIZED

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ANTIGEN

AJK

FATA

FANA

BCG DPT3 MEASLES

95.5 91.1 88.70

53.4 37.4 32.0 25.6

86.9 66.5 70.60 59.6

FUULY 84.0 IMMUNIZED

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EVALUATION RESULTS:
The trend of graphs shown in previous slides; indicates that EPI in Pakistan has been quite successful. Where as there is a room for improvement.

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Recent additions in EPI targets:

meningitis Surveillance The Federal EPI has established Sentinel sites at several tertiary care hospitals in the country to see the disease burden of Bacterial Meningitis in the country which will facilitate the EPI Program for the introduction of Hib vaccine in the country. High levels of advocacy achieved through involvements of politicians, religious leaders and community elders using Inter Personal Communication (IPC), Print and Electronic media tools. The federal Government ensured required funding for the routine programme. EPI Diseases Surveillance system established

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Combination tetravalent vaccine Introduction of Combination tetravalent vaccine (DPT + HepB) from 2008. This will eliminate the coverage difference between DPT3 and Hep B 3.

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HURDLES IN ATTAING 100% RESULTS:

The course of vaccine is not completed.

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In complete or last minute planning at federal and provincial level.

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IDEAS FOR IMPROVEMENT:

How to improve?
BY: • Developing integrated social mobilization /communication plans for EPI at all levels. • Developing more responsibility and resources for social mobilization to provinces and districts for Facilitating local strategies. • Holding more frequent meetings among partners.

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How to improve the communication strategy General • Focus messages on reaching every child every round, e.g. search for the missed children beginning • Strengthen EPI communication, especially between PEI rounds.

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Mass media • Extend mass media broadcasting before and after rounds. • Work more creatively with PTV and build their capacity to plan and produce effective spots. • Improve the use of BBC, VOA and other international networks. • Place spots on cable TV channels. • Explore synergies with neighboring country mass media channels.
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Other channels • Place the ‘every child, every time message’ on such as balloons, matchboxes, poster, stickers on vehicles, product labels focusing on the “every child, every time” message. • Distribute calling card to closed homes. • Employ special communication strategy for reaching hard-to-reach groups e.g. elites: glossy and special interest magazines, airlines, supermarkets, paediatricians, Rotary and Lions Clubs, hairdressers, housing co-operatives, GSM networks, ISPs, internet cafes, taxi drivers, colleges, etc. • Involve pre-schools (securing prior permission from parents).

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Using electronic media can be a good source of generating awareness about EPI among lay men.

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REFRENCES:
WHO/UNICEF Review of National Immunization Coverage19802003 Pakistan PEI/EPI Communication Review Report By Mike Favin, Robert Tyabji and Susan Mackay Islamabad, 22 July 2001
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