21Sept22-Positive ES Landhi Investigation

Investigation WPV-1 Isolate Environmental site
Bakhtawar Village
Landhi Town – District Karachi Malir-Sindh Province
14-22 September 2022
1
Objectives of Mission
• Find gaps in Management oversight and accountability, ,
Surveillance, SIAs, Communication, EPI, PEI-EPI Synergy, ISD
• Design recommendations for the gaps observed
• Develop Action plan for implementation of recommendations
& follow up
Objectives of Investigation
• Background and Epidemiology
• Surveillance
• SIAs
• Communication
• Routine EPI-ISD-PEI/EPI Synergy
• Key findings
• Recommendations
• Way forward
Background and Epidemiology
Positive Environmental sample-Bakhtawar goth Landhi town-District Malir
• This is first Wild polio virus (WPV-1) positive Environmental sample (ES) from
Karachi Sindh province this year (collected 23 Aug 2022)
• Last WPV-1 positive ES isolated from Sindh was in July 2021 (Hyderabad) and
before that in May 2021 (Karachi Korangi)
• The last WPV-1 case detected from Sindh was in July 2020 from District
Jacobabad (UC Tajo Khoso) and before that detected in Jun 2020 from
District Malir, Landhi Town (UC1)
• The recent Polio campaign (NIDs) in District Malir was conducted between
15-21 Aug 2022
• EOC Sindh conducted Event Investigation between 14-22 Sept 2022
5
Source: Provincial Surv. Unit, Sindh
BAKHTAWAR GOTH Draining UCs Social Profile
Socio – economic Bifurcation Population Ethnicity

90% 120%
81%
80% 78%
75%
100%
70%
60%
60%
80%
50%
40% 60%
40%
30%
40%
22%
20% 19%
20%
10% 20%
5%
0% 0% 0%
0%
REHRI - 2 CATTLE COLONY - 3 MUZAFARABAD - 1 MUSLIMABAD - 2
BINQASIM LANDHI 0%
BINQASIM LANDHI
POSH MIDDLE SLUM
Data Source: PEI field staff
Profile of ES Collection Site – BAKHTAWAR GOTH
• Location: UC2 (Rehri) Binqasim Town,District Malir
LEGEND
• Method of ES collection: Grab and BMFS
Draining UCs
• Draining UCs: 04
UCs bordering with Draining UCs
TOWN UC NO UC NAME POP <15 YEARS
1 MUZAFARABAD-1 131829
LANDHI
2 MUSLIMABAD-2 104965
2 REHRI-2 133565
BINQASIM
3 CATTLE COLONY-3 106641
ES WPV-1 POSITIVITY TREND 2019-2022

• 2019: 75% Positive (except Jan, June & Dec)
• 2020: 75% positive (except June, Nov & Dec) QUAIDABAD UC-4
• 2021: 8% positive (once in Mar 2021)
(This was linked with ES Orangi nalla Karachi,Sindh collected
May 2020 with 99.22% homology, cluster YB3A)
• 2022: once in Aug 2022 (after 17 consecutive months)
• Last c-VDPV in ES was in Mar 2021
ES collection site Bakhtawar goth, UC Rehri Landhi Town

Environmental Sample Results, Karachi, Sindh; 2020 – 2022*
2020 2021 2022*
Division District Site Name Ma Ma
Jan Feb Mar Apr Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr Jun Jul Aug
y y
Sohrab Goth
East-Gadap Machhar Colony
Khamiso Goth
Chakora Nalla
East-Gulshan
Rashid Minhas)
KARACHI Keamari-Baldia M. Khan Colony
Keamari-SITE Orangi Nalla
Malir-Landhi Bakhtawar Goth
Korangi Korangi Nalla –Comp.**
Central-Liaquatabad Haji Mureed Goth
South-Saddar Hijrat Colony -PIDC Nalla
Sindh: last positive ES was in May 2021 from KORANGI

WPV1 Positive WPV1 Negative Under Process

Confirmed WPV1 Cases of District Malir 2013 – 2020
Year UC Name EPID Gender Age Ethnicity DOO R.I SIAs
2013 CATTLE COLONY - 3 SD/62/13/001 MALE 24 PASHTU 14-Jan-13 0 0
2013 REHRI - 2 SD/62/13/011 MALE 8 SINDHI 18-Oct-13 3 1

Draining UCs
2013 MUSLIMABAD - 2 SD/69/13/012 MALE 2 PASHTU 31-Dec-13 0 0
2014 MUZAFARABAD - 1 SD/69/14/008 MALE 12 PASHTU 6-Jun-14 0 0
2014 SHARAFI GOTH - 5 SD/69/14/012 MALE 12 PASHTU 8-Jul-14 2 6
2014 REHRI - 2 SD/62/14/009 MALE 20 PASHTU 30-Aug-14 1 7
2014 REHRI - 2 SD/62/14/011 MALE 8 SINDHI 22-Oct-14 0 4
2020 MUZAFARABAD - 1 SD/69/20/020 MALE 60 PASHTU 9-Jun-20 0 7
• Since 2013 – 8 WPV1 human cases have been reported from District Malir
• 88% (7/8) of the WPV1 cases reported from 4 draining Ucs
• 100% were male with average age of 18 months
• 75% (6/8) of the cases were from Priority-1 population (Pashtu speaking families)
• 62% had 0 R.I
• 38% had 0 SIA doses
• Note: Last c-VDPV case was in Nov2020 from UC-5 Binqasim Town
Surveillance
Surveillance Indicators Draining UCs District Malir, 2019-2022*
NP-AFP Stool Adequacy Detection Within 7 Days

20 100 97 97
100 93 95 94 100 90
16 86
15 80 80
10 60 60
10 8
6 40 40
5
20 20
0 0
2019 2020 2021 2022 2019 2020 2021 2022 0
2019 2020 2021 2022
EV Isolation SL Isolation Good AFP Rate

40 20 10
35
15 8
30 25 7/54
25 10 6
7 8
20
15 13 13 5 4
11 5
10 1 1.9
2 0.6 1.1
5 0 0.5
0 2019 2020 2021 2022 0
2019 2020 2021 2022 2019 2020 2021 2022
From draining Ucs: Cases reported 27 E-listed cases 45

Malir District AFP cases reported by Network & Health Facility type; 2019 - 2022*
AFP cases reported by Network AFP cases reported by HF Type Take away (2022):
• AFP cases reported from
2022 57 1 37 2022 41 4 19 31
Active sites are 57% and from
outside the network 37%
2021 63 2 47 2021 46 1 22 43
• AFP cases reported from
public sites are 41%, from
Community 31%,from
2020 47 4 30 2020 35 19 27
private sites 19% & from
IHCPs 4%
2019 87 8 28 2019 65 2 33 23 • 2 AFP cases were reported by

Community informants in
2022 from draining UCs
%
%
0%
0%
0%
0%
10
20
30
40
50
60
70
80
90
10
20
30
40
50
60
70
80
90
10
10
Active Site Zero Site Public Armed Pvt.
Outside Network IHCP Community
AFP & e-list cases reported & validated during investigations
Take away:
14
Reported Validated -6 AFP cases & 5 E-listed cases
12 were validated by the
1
investigation team
10
1
-In 2 AFP cases validated by FSO
1 the knowledge of investigating
8
person (DSO) about one
6
variable was found suboptimal
1 11 1 1 1 i.e: eligibility of child for RI IPV
9 1
4 8 dose
1 1
5 5 5 1 5
-In 2022 in District Malir 08 AFP
2
3
0
3
4 cases were validated by AC &
2 2
higher level supervisor (PSO)
0
LANDHI-5
REHRI-2
MUZAFARABAD-1
CATTLE COLONY-3
QUAIDABAD-4
CATTLE COLONY-3
QUAIDABAD-4
MUSLIMABAD-2
LANDHI-5
REHRI-2
MUSLIMABAD-2
MUZAFARABAD-1
AFP Cases elist Cases
Active site visits planned vs conducted in draining UCs (Jan – Aug
2022)
CATTLE COLONY-3 MUZAFARABAD-1 110%
102%
60 60
48 49 53
50 48
50
40 32 40
30 40
30
19 32
20 16
30
10 21
0 20
conducted
conducted
conducted
Planned
Planned
Planned
10 8
0
Planned conducted Planned conducted Planned conducted
DSO TSC Total DSO TSC Total
REHRI-2 113% MUSLIMABAD-2

30 60
90%
27 27
25 24 50 48
43
40
20 40
16
15 30
23
20
10 8 20
5 10 8
0
0 0
Planned conducted Planned conducted Planned conducted Planned conducted Planned conducted Planned conducted
DSO TSC Total DSO TSC Total
Surveillance Indicators of Draining UCs District Malir, 2022*
Expected AFP Cases Notified

Reported NPAFP Stool EV
Town UC Name AFP Cases within 7 SL
In Rate Adequacy Isolation
In 2022 2022 days
Landhi Muzaffarabad 2 09 15% 78% 88% 00 00
Landhi Muslimabad 2 08 13% 100% 100% 01 01
Bin Qasim Town Rehri 2 05 18% 100% 100% 04 00
Bin Qasim Town Cattle colony 2 05 18% 100% 100% 00 00

AFP Cases from Draining UCs District Malir, 2019-2022*
AFP Avera Late RI OPV SIAs Inadeq
Tow Fema Inv > RI OPV
UC Cas ge notifica < age <age uate Fate at 60 days if RP
n les 48 hrs zero
es age tion matched match
1 died (EPID-16 due to

02 03 post measles
02 02
UC-1 9 4 39M (Epid 0 (Epid (Epid 0 (Epid complication)
16,24) 16,24,29) 1with Residual paralysis
16,24) 16,24)
Landhi
(EPID-24,
Diagnosis PCM-2)
04 05
UC-2 8 5 30M 0 0 (23,42, (8.23,42, 0 0 NA
45,80) 45,80)
Binq UC-2 5 0 27M 0 0 01(34) 02(25,34) 0 0 NA

asim UC-3 5 2 18M 0 0 01(72) 01(72) 0 0 NA
Total 27 11 29 M 02 0 08 11 01 02
-For 2 late notification cases (Epid16,24) those who missed these cases were oriented
-For 2 lnadequate cases contact sampling was conducted timely

R.I Status of AFP Cases draining UCs, District Malir, 2022*
100%
90%
80%
2 1 2
70% 5 2
60% 4
50% 1
40%
30% 1
2 1 2
20%
1
2
10% 1
0%
0-4 m 5-11 m 12-23 m 24-35 m 36-47 m 48 - 59 m 60 & Above
0 dose 1-2 dose 3 dose

SIAs Immunization Status of AFP Cases draining UCs, District Malir, 2022*
100%
90%
1
80%
70%
60%
7
50% 1 5 4 1 4
40%
3
30%
20%
10%
1
0%
0-4 m 5-11 m 12-23 m 24-35 m 36-47 m 48 - 59 m 60 & Above
0 dose 1-2 dose 3 dose 4-6 dose 7 & Above

HSB of Reported AFP Cases from Draining UCs, 2022*
1st & 2nd
Town UC Name 1st Contact 2nd Contact Contact 3rd Contact 4th Contact Take away
• UC-1 (Muzafarabad)
LANDHI MUZAFFARABAD 5 (56%) 1 (11%) 6 (67%) 2 (22%) 1 (11%) Landhi Town
reporting from 1st
and 2nd contact is
LANDHI MUSLIMABAD 7 (88%) 1 (12%) 8 (100%) 0 0 not meeting bench
mark
BIN
REHRI 5(100%) 0 5(100%) 0 0
QASIM
BIN 5(100%)
CATTLE COLONY 5(100%) 0 0 0
QASIM
Total 27 AFP cases 22 (82%) 2 (7.4%) 24 (89.4%) 2 (7.4%) 1 (3.7%)
HSB bench mark for 1st contact is 75%, 2nd contact is 15% & 1st plus 2nd contact is 90%

List of UCs and Areas selected for 30 H-H cluster survey District Malir
Summary
Town UCs Areas Cluster taken by • Multidisciplinary team
Landhi-5 19-B Dr. Shabbir Ahmed, Aamir participated (FSO, PSO, DSOs,
TSCs, other provincial staff)
Landhi-5 Shah latif Town Dr. Shabbir, Dr. Tufail, Aamir
• All were trained on
Qaidabad-4 Qazafi Town Dr Sarwat,Dr Tufail methodology & tools prior to
Qaidabad-4 Zafar Town Dr Sarwat survey
BINQASIM Rehri-2 Bakhtawar Goth Dr. Sumera Ali
Rehri-2 Dubla Para Rehri Goth Dr. Sumera Ali • UCs selected were 6:
• 4 draining
Rehri-2 Lalabad Dr Sarwat • 2 adjoining UCs
Cattle Colony-3 Labour Square Dr. Bushra Farooqui
• Areas selected were biased
Cattle Colony-3 Railway Colony Dr. Bushra Farooqui
(by high-risk approach):
Muzaffarabd-1 Gulshan-E-Buneer Dr. Liaquat Ali • HRP (Eg: Priority-1 pop)
Muzaffarabd-1 Kachi Abadi Dr. Liaquat Ali • HR&MP
LANDHI
Muslimabad-2 Bilal Khadda Dr. Furnoor Zaidi
• Total 13 clusters were taken
Muslimabad-2 Swati Muhallah Dr. Furnoor Zaidi
Total 06 13 09
Draining UCs Adjoining to Draining UCs

30 Household cluster overview
TOTAL Take away
30 HH Cluster Variables • 398 households visited
Number Percentage
• 670 children were <5years
No. of UCs 6
• 176 (26.3%) were 6 to 23 M
No. of clusters taken 13 Routine Immunization (6-23M):
No. of Houses checked 398 • 107 (61%) received RI 3 doses of
OPV(recall)
Total Children Checked <5 Years 670
• 98 (56%) received RI IPV (recall)
Total Children Checked (age 6-23 Months) 176 26 % SIAs (<5Years):
Routine 3 OPV Doses coverage by recall (age 6-23 Months) 107 61 % • 628 (94%) vaccinated in Aug 2022
• 632 (94%) vaccinated in Jun 2022
Routine 3 OPV doses verified by EPI card (age 6-23 Months) 65 37%
• Predominantly reason for
IPV Administered (age 6 -23 Months) 98 56 % missed were NA
IPV Verified by EPI card (age 6 -23 Months) 82 47 % Travel history:
• 34 (9%) had household travel
SIAs OPV coverage last round Aug-2022 (Age 0-59 months) 628 94 %
• 18 (5%) had guests arrivals
SIAs OPV Coverage 2nd last round Jun-2022 (Age 0-59 months) 632 94 % • Non locals 23 (6%)
Travel history of Households 34 9% • No any AFP reported from 30 HH
clusters
Guests 18 5%
Non-Local Households(NL) 23 6%
No: of AFP cases found during cluster 0 0%
NL=AFG 4 (2 herat), Bahawalnagar 1, Jaffarabad 1, Jacobabad 5,Larkana 2 ,Kambar 5, Shikarpur 1, Sukkur 1, Dadu 1, MPK1, Thatta 1

UC wise 30 household coverage of children under five years of age in Jun & Aug 2022 SIAs
Take away
Jun & Aug 2022 SIAs coverage
UC-5 Binqasim Town:
100%
97%
97%
96%
96%
95%
95%
•
94%
82% coverage in Aug 2022
94%
94%
94%
93%
100%
92%
• main reason NA
82%
80% (IDPs arriving after SIAs Aug22)

• 92% in Jun 2022
60%
109/119 101/108 131/135 99/104 86/90 106/114 632/670 UC-4 Bin Qasim Town:
40%
97/119 101/108 130/135 99/104 90/90 111/114 628/670 • 94% in each Jun & Aug 22
• main reason Refusals
20%
UC-3 BinQasim Town:

0%
-5 l
hi -4 I-2 D-
1 AD Y-
3
ota
d ad HR B AB N T • 93% in Jun 2022
an b RE AR
A
OL
O
L id
a
F SL IM C • main reason Newborn
Qa AF U E
UZ M T TL
M CA
JUN, 2022 AUG, 2022

Reasons of Missed Children in SIAs Jun & Aug 2022 – 30 HH clusters
Reasons Missed Jun SNID 2022 Reasons Missed in Aug SNIDs 2022 Take away
100% 100%
1 1 Missed children:
6
1
80% 3 2 80% 3 2 17 • Jun 38 (5.7%)
• 50% Newborn(NE)
60% 19 60% 17 4 • 34% NA
4 4 6 1 1 1 6 • 16% Refusals
9 2
40% 2 40%
7
• Aug 42 (6.3%)
20% 20% 3 2
• 69% NA (40% IDPs)
2 13 1 12 • 17% Newborn(NE)
1 5 1
1 • 14% Refusals
0% 0%
-4
-4
I-2
-5
I -2
-1
-3
-5
-1
-3
AD
l
ta
ta
BD
BD
hi
NY
hi
NY
To
To
HR
HR
AB
ad
ad
nd
nd
LO
LO
RA
RA
RE
RE
ab
ab
LIM
La
La
CO
CO
FA
FA
id
id
US
Qa
Qa
AF
AF
LE
LE
M
UZ
UZ
TT
TT
M
M
CA
CA
NA NE R NA NE R NA-IDP

Routine Immunization Status by Recall (IPV and OPV doses) – 30 HH clusters
RI IPV (Received) RI OPV (Received)
100% 100%
Take away
5
8
• 176 children 6-23 M
80% 12 80% 13
17 98 107
• 98 (56%) received RI IPV
24 19 24
21 19 22
60% 60% 21 • 107 (61%) received
4 4 RI 3 OPV doses
40% 40%
16
2 23
19
78 14 6
20% 12 20% 4 9
14
9 8 3 12
46
4 4 3
0% 0%
AD
l
-5
-1
-4
I-2
-3
ta
L
AD
-3
-4
-5
-1
I-2
TA
NY
BD
hi
To
HR
NY
BD
hi
AB
ad
HR
AB
nd
ad
TO
nd
LO
RA
RE
LO
ab
LIM
RA
RE
ab
La
LIM
La
CO
FA
id
CO
FA
id
US
Qa
US
AF
Qa
LE
AF
LE
M
M
TT
UZ
TT
UZ
CA
CA
N Y 0 dose 1-2 dose 3 doses

Ethnic background – 30 HH clusters findings
Take away
100% 1 2 5
4 2 9
4 5 3 7
4 2 13 • Households visited: 398
1 4 13 • In draining Ucs Priority-1 pop:
3
12
14
• 155 (39%)
80%
• 58 (15%) Muzafarabad-1
34
4 • 49 (12%) Muslimabad-2
183
• 34 (9%) Rehri-2
60% • 14 (4%) Cattle colony-3
22
35
3 58
49 •
11 183 (46%) Priority-1
40%
39
• 13 (3.3%) Afghani
39
12 • 68 (17.1%) Sindhi
• 50 (12.6%) Balochi
20%
68 • 39 (9.8%) Punjabi
29
10 • 13 (3.3%) Hindko
18
• 9 (2.3%) Siraiki
50
3
5 2 • 7 (1.85) Urdu
2 1
0%
Landhi-5 Qaidabad - 4 REHRI-2 MUZAFFARABD- MUSLIMABAD CATTLE COLONY- Total • 5 (1.3%) Hazara
1 3
BALOCHI SINDHI PUNJABI PASHTO HINDKO AFGHANI URDU SIRAIKI HAZARA

Travel history of households with last 35 days– 30 HH clusters findings
100%
6 Take away
4
80%
6 1 7
1 34 (9%) had travel history
60% 2
1 1 5 5 • 14 (41.2%) Sindh
5
40% • 7 (21%) KPK
• 6 (18 %) Afghanistan(2 herat)
5 1 •
20% 14 5 (15%) Punjab
4 • 2 (6%) Balochistan
0%
-5 -4 I-2 -1 AD -3 tal Travel to infected Districts:
hi ad R D B N Y To
nd b RE
H AB A
L O
La a A R
LIM
aid F S CO • Peshawar 1 (Rehri 2)
Q Z AF M
U
TLE
M
U AT • Nowshera 1 (Landhi 2)
C
Sindh Punjab Balochistan KPK Afghanistan
Sindh Afghanistan Punjab Baluchistan KPK
Bahaw
Ucs Thatta Jacoba Shikar Hyder Larkan Dadu Afghan Herat Punjab alnaga Naseer Pishin BUNEE MANS KOHIS PESHA NOSH DIR Grand
bad pur abad a istan abad R HERA TAN WAR ERA Total
r
Total 1 4 5 2 1 1 4 2 4 1 1 1 1 2 1 1 1 1 34

Guests arrival history within last 35 days – 30 HH clusters findings
Take away
• 18 (4.5%) households
7
• 11 (61.1%) Sindh
6 • 6 (33.3%) KPK
1 • 1 (5.6%) Balochistan
5
1 • Peshawar-2(1 Muslimabad-2,1 Rehri-2)
4 • North Waziristan-1(1 Quaidabad-4)
1 • Swabi-2 (2 Muslimabad-2)
3 • Kohat-1 (1 Cattle colony-3)
1 1 • Jafferabad-1(1 Rehri-2)
2 4 2 • Larkana-3(1 Rehri-2,1 Quaidabad-4,
1 1 1 Landhi-5)
1 2 • Kambar-4 (4 Landhi5)
1 1 1 • Kashmore-1 (1 Rehri2)
0 • Khairpur-2 (2 Cattle colony-3)
CATTLE COLONY-3 Landhi-5 MUSLIMABAD Qaidabad - 4 REHRI-2 • Mirpurkhas-1 (1 Landhi-5)
BALOCHISTAN JAFFARABAD SINDH KAMBAR SINDH KASHMORE SINDH KHAIRPUR

SINDH LARKANA SINDH MIRPURKHAS KPK KOHAT KPK PESHAWAR
KPK SWABI KPK N-WAZIRISTAN

UC wise Health Seeking Behavior – 30 HH clusters findings
Take away
• From 384 responses:
HSB • 81 (21.1%) visits to informal health care
100% 3 providers (IHCPs)
4
8 • 303 (78.9%) visit to medical doctors (formal
18 81
22%
21
health care providers)
80% 27 35% • Significant health seeking behavior towards
44%
IHCPs found in:
• UC-5 (Landhi5) Binqasim town (44%)
60%
• UC-1 (Muzafarabad) Landhi town (35%)
51 67 • UC-2 (Rehri) Binqasim town (22%)
47
40% 64 303
39
35
20%
0%
l
i-5 -4 I -2 D-
1 AD -3 ta
d h d H R B B NY To
n ba RE A A
L O
La a AR L IM
aid F S CO
Q Z AF M
U
TL
E
U A T
M C
Formal Informal
30 HH cluster summary
• Assessed SIAs coverage last two rounds(<5years)*
• 628 (94%) vaccinated in Aug 2022
• 632 (94%) vaccinated in Jun 2022
• Assessed RI OPV (3 Doses) coverage (6-23M)
• 61% (by recall)
• 37% (by EPI card)
• Assessed RI IPV coverage (6-23M)
• 56% (by recall)
• 47% (by EPI card)
• Population movement
• 34 (9%) with travel history
• 18 (5%) with guests arrival
• 23 (6%) nonlocals
• High proportion of priority-1 population in SHRUCs,
• 97% Muzafarabad
• 80% Muslimabad
• Health Seeking behavior (HSB): Towards Informal health care providers(IHCPs) found was 81 (21%)
• UC-5 Binqasim town (44%)
• UC-1 Landhi (35%)
• UC-2 Binqasim (22%)
*Benchmark for assessed coverage (95%)

Assessed surveillance sites
• 1 recent AFP case found from Landhi UC2
• Bell’s Palsy case (from Social Security Hospital) cross notified to Korangi
• Trained doctors at health facility (of interviewed): 73% (22/30)
• Trained Para-medic staff at health facility (of interviewed): 73% (19/26)
• HF Focal Person not nominated: 5% (1/19) [BHU Jumma Himayati]
• HFs staff does not know the DSO: 16% (3/19) [Razia Medial center, KMC, Chasma Goth Dispensary]
• HFs staff does not know the DSC: 32% (6/19) [Razia Medial center, KMC, Chasma Goth Dispensary,
RHC Rehri Goth, Sina center, AKU dispensary]
• Unclear understanding of AFP Surveillance activities by health facility in-charge/ Focal
Person = 26% (5/19) [ISD Muzafarabad, SESSI circle dispensary, Star Ground Dispensary, Integrated services
Dispensary Muslimabad, Chasma Goth Dispensary]
• No feedback about the reported case or Lab result by Surveillance team: 53% (10/19)
[BHU Jumma Himayati, Aghakhan PHC, Razia Medial center , RHC Rehri Goth, KMC, Sina center, AKU dispensary, Star Ground
Dispensary, 25 bedded labour Sqaure and maternity home, Chasma Goth Dispensary]
In draining Ucs Active sites are 9 and Zero sites are 16)
Healthy children stool sampling
• 40 clusters were taken from 4 draining UCs
• South KP population was selected (2732)
• Samples collected per UC were:
• UC-1 Landhi (Muzaffarabad)-----18 samples (South KP population 1747)
• UC-2 Landhi (Muslimabad)-------8 samples (South KP population 732)
• UC-2 Binqasim (Rehri)-------------9 samples (South KP population 244 + HRMP Pop 1273)
• UC-3 Binqasim (Cattle colony)---5 samples (South KP population 09 + HRMP Pop 421)
• All samples were dispatched to Polio Lab on 23rd Sept22
• Lab results are awaited

Oversight & Accountability
DEOC FUNCTIONALITY CHECKLIST DEOC FUNCTIONALITY CHECKLIST
Name of District: DEOC Malir Filled by (Name & Designation): Dr Zamir Phul TSO NSTOP Sindh/Dr
Date
Furqan
filled:Nabil NSTOP Gujro 13-09-2022
Yes=1 ;
Sno DEOC EQUIPMENT AND DATA Partial=0.5; COMMENTS
• DEOC EQUIPMENT AND DATA

No=0
General:
Have sufficient space,cleanliness,records organized,data labelling, display boards,furniture,cup board,Files DEOC consist of 03 small room size 10 X 12
1 1
rack,water dispenser,attached clean wash room
2 Electronic Equipment available(Computers,Scanner,Printers,Telephone,Internet,multi media) 0.5 Telephone & Muti media was not present
• Telephone & Muti media was not present 3

Human Resources available(Lead senior officer from DC Eg:ADC-1,DHO/THO present,One person from DC
office & one from DHO Office,Computer operator,DHO office focal persons SIA, HRMP, Surveillance, EPI, IO,
NSTOP Officer, DHCSO,DSO)
0.5
No person from DC, DHO & computer operator deputed at DEOC
No NEAP, EPI ,Surveillance , Communication, training module or Book

4 Guidelines books & training Modules(NEAP books,SIAs,Surveillance,Routine EPI,Communication) 0
• No person from DC, DHO & computer operator deputed at DEOC

was available
5 Backup electricity (Generator or UPS) 0
6 DEOC staff coordination among each other,with DC,DHO,Talukas/Tehsils and UCs)& Follow ups 1
7 Evidence of District partners data quality validation(Eg: Covered NA,R,Covered Zero dose children) 1 Soft copy was present
• No NEAP, EPI ,Surveillance , Communication, training module or Book

DEOC SIAs Records Checklist:
DEOC SIAs Pre-campaign Data Checklist:
8 Resources plans(last 6 rounds) 1 Soft copy was present
1
was available
9 Count down of activities for campaign cycle with UC specific assignments for specific DEOC staff Soft copy was present
10 DPEC meeting minutes(SIA,Routine,Surveillance parts) and presentations for last 6 rounds 0.5 Routine & Surveillance part not present in DPEC PPT
11 Neap Reports(16,10 &5 days before campaign) highlighting suboptimal data(last 3 rounds) 1
12 Microplans for last 3 rounds 1 Only M.P summary sheets was available
13 District Social map with spot mapping of current high risk areas 0
• DEOC SIAs Pre-campaign Data Checklist:

14 Microplan Desk review checklists (at District & UC level) with compilations last 3 rounds 1
15 Microplan Field validation checklist (at District & UC level) with compilations last 3 rounds 1
16 Summaries of UPEC meeting minutes (last 6 rounds) 0
17 Communication Plans (for 3 rounds including current round) 1
18 Communication report (District level) for 3 rounds 1
• Routine & Surveillance part not present in DPEC PPT

19 Readiness Report 1
20 Contact Directory (District Management,DHMT,Supervisors,NGOs,Line department heads) 1
21 District level SIAs monitoring plan with all the tiers(Govt District management, DHMT, Supervisors, Partners) 1
• District Social map with spot mapping of current high-risk areas - not
DEOC SIAs Intra-campaign Data Checklist:
22 UC wise deployment data (First & last team) highlighting suboptimal data for 3 rounds 1 Soft copy was present
23 Issues,Corrective action & followup for 3 rounds 1 Soft copy was present
Administrative coverage data highlighting suboptimal data last 3 rounds 1
present
24 Soft copy was present
25 Clusters compilation highlighting suboptimal data 3 rounds(Partners,Supervisors) 1 Soft copy was present
26 Evening Meeting minutes with followups(Timely sharing with different levels) 1
27 Process indicators highlighting suboptimal data for 3 rounds NA
DEOC SIAs Post Campaign Data Checklist:
• DEOC Routine EPI Data Checklist:

28 Market Survey with suboptimal data for 6 rounds 1 Soft copy was present
29 LQAS with suboptimal data for 6 rounds 1 Soft copy was present
30 PCM with suboptimal data for 6 rounds 1 Soft copy was present
31 Sweeping reports for last 6 rounds 1 Availeable on online
32 Still missed children (SMC) data last 6 rounds 1 Soft copy was present
33 Zero dose children data last 6 rounds 1 Soft copy was present
• Routine EPI Microplan - not present 34

35
36
Persistent missed children(PMC) data last 6 rounds
Tally sheet Analysis compilation data last 3 rounds
SIAs gap Analysis & review meeting presentations last 6 rounds
1
1
1
Soft copy was present
Soft copy was present
37 Post campaign Review meeting minutes last 6 rounds 1 NIDs Aug. PCRM still not done at District level
• Vaccine & cold chain record - not present

Year wise separate file for Accountability actions reward & punishment (with Summary of Appreciation,
38 1
Explanation,Show cause, Transfer,Job termination,Job removal Letters)
39 Monthwise PTP (Seasonal) Coverage record two years comparison 1 Soft copy was present
DEOC Routine EPI Data Checklist:
• Compilation of Routine EPI checklists (District staff) - not present

40 Routine EPI Microplan 0
41 Routine EPI coverage report 1 Soft copy was present
42 Vaccine & cold chain record 0
43 Compilation of Routine EPI checklists (District staff) 0
44 District EPI review meeting minutes 0
• District EPI review meeting minutes - not present 45

46
DEOC Surveillance Data Checklist:
AFP Surveillance Indicators-District & Taluka wise for three years (Analysis & Displays)
Updated Line Lists (AFP ) for three years (Hard copies)
1
1
47 Confirm cases & Urgent cases Summaries & Detailed EPID Study 1
• Spot Map of confirmed Cases (human & environmental) for three

48 Cross notified AFP cases files (Case investigation forms) & Line list 1
49 Excluded cases line lists 1
50 Spot Map of confirmed Cases (human & environmental) for three years 0
51 Spot Map of AFP Cases for three years 1
years - not present 52

53
Spot Map of Active and Zero Sites with Surveillance network list
Monthly Plan Active Surveillance site visits District level (DSC/DSO& IO)
54 Compiled Surveillance reports Active surveillance,Zero sites(with Timeliness & Completeness) & VPDs
1
1
1
55 Health seeking behavior (HSB) data 1
56 Record of AFP Surveillance training plans and training reports 1
57 Minutes of Monthly District Surveillance review meetings 1
58 Minutes of Monthly District Review Committee(DRC)meeting minutes NA
Numerator 45.5
Denominator 56
Final score(%) 81
Interpretation: Pass
Interpretation: >75=Pass; 60-75=Needs improvement; <60% Fail
Supplementary Immunization Activities (SIAs)/Operations
HR Turnover in selective 6 UCs (Source: DDM Payment File)- CBV WORKERS DATA ONLY
#Team # New # New # New # New # New

UC- Name Member Member % Members % Member % Members % Member %
Turnover Turnover Turnover Turnover Turnover
s s Jan 22 Mar 22 s May 22 June 22 s Aug 22
Muzaffarabad 01 144 4 3% 2 1% 2 1% 4 3% 3 2%
Muslimabad 02 128 0 0% 0 0% 1 1% 8 6% 3 2%
Rehri Goth 02 92 1 1% 1 1% 1 1% 5 5% 4 4%
Quaidabad 04 87 1 1% 1 1% 3 3% 2 2% 1 1%
HRMP Observations
• District HRMP Profile is present and part of the micro plan.
• South KP Population is specially focused and incorporated in the microplan.
• Data errors found in the submitted sheets thus suggested to have a review by
UC/DEOC before submission.
Admin Coverages NIDs Aug 2022, Draining UCs District Malir
Total Still
Total Recorded Covered missed Total
UC Name Target Coverage Recorded Covered Recorded Covered Missed Total Total Still Still NA (#) Still Ref (#) among Children
NA NA% Ref Ref% Missed (#) approache
(%) Total (%) Target d (%)
(%)
CATTLE COLONY-3 18129 110 1776 94% 520 76% 2296 90% 227 104 123 1.25 111%
REHRI-2 22706 100 3622 95% 609 81% 4231 93% 307 191 116 1.35 101%
MUSLIMABAD-2 17844 97 3089 79% 1111 60% 4200 74% 1092 645 447 6.12 103%
MUZAFARABAD-1 22411 95 4256 79% 943 64% 5199 76% 1234 899 335 5.51 101%
TOTAL 81090 101 12743 87% 3183 70% 15926 83% 2860 1839 1021 3.56 104%
SMC 0.75% to <1.5% SMC <1.6-5% SMC >5%
EOC Dashboard as of 28th AUG 2022 09:00 AM

Summary of Data Quality Assessment
Process:
- Each UC was assessed against 17 variables for 2 teams and 2 area supervisors
- One day was randomly selected for one team of two separate area supervisors
- Tallysheet (Registration) V/s 2A form, 2A form V/s 2B form, 2B form V/s DEOC and DEOC V/s IDIMs were compared
Town UC Name % Score Major finings
• Difference in Guest children coverage and street children's coverages of Reg vs 2A.
• Difference in coverages of HRMP in Reg vs 2A, total doses given and used, still missed and same day
Landhi Muzaffarabad – 1 52% covered while no entry of total HH in DEOC vs IDMS
• 2B Form not available, Data entry into online sheet from 2A form
• Difference in coverages of HRMP in Reg vs 2A, total doses given and used and no entry of total HH in
Landhi Muslimabad – 2 545 DEOC vs IDMS
• 2B Form not available. Data entry into online sheet from 2A form
• Difference in HH vaccination, still missed, same day, guest children and zero dose in Reg vs 2A.
Binqasim Rehri – 2 54% • Difference in still missed and same day covered in 2A vs DSC
• Difference in recorded NA and Refusals and in total doses given tally sheet vs 2A.
Binqasim Cattle Colony – 3 50% • Difference in still missed while no entry of total HH in DEOC vs IDMS
• Difference in HH vaccination, still missed, same day, guest children and zero dose in Reg vs 2A.
Binqasim Quaidabad – 4 54% • Difference in HH vaccination, street children and no entry of total HH in DEOC vs IDIMS.
• Difference in recorded NA and Refusals and in total doses given tally sheet vs 2A.
Binqasim Landhi – 5 46% • 2B Form not available, Data entry into online sheet from 2A form
Implementation Status of DEOC Training Plan
Qualitative feedback for any
UC Name Assigned Officers as per Plan Feedback on EOC App monitor attending Training
Muzafarabad IO , NSTOP Officer, TFP None None
Muslimabad DDPO , TFP None None
Rehri Goth TFP None None
Cattle Colony TDSO YES Yes
Quaidabad NA None None
Landhi 5 TDSO None None
Name of UC Area Observations
None of the assigned UC was monitored by DEOC (District level staff)

except Cattle Colony supported by TDSO during FLWs training as per
Draining UCs Training Dashboard data of Training monitoring checklist.
FLW training attendance sheet was neither available at DEOC nor at
TSC for UC Cattle colony.
Training Need Assessment (TNA), a core component of FLW and

Non CBV UCs Training Need Supervisors training was not prepared at District Level for any of
Assessment
these UC
Microplan Desk Review Aug 22 – Qualitative Feedback
UC-1 Muzaffarabad UC-2 Muslimabad Cattle Colony Rehri
There is no concept of filling Extra components i.e UCMOs
Area Supervisor Farzana’s SMC
UC map was missing
and PMC data mismatched 2B form (calculation errors in supervision plan, List of still
day wise coverage) NAs
No AIC Level maps(20 AICs) # Schools mismatched with
Social mobilization plan was # Schools mismatched with
Nor were Team Route maps
available for field validation summary sheet
missing summary sheet
Summary sheets are filled Quality of area level maps

Area Supervisor Ishrat’s Team #35 Day 1 HRMP not
was not as per SOPs (Team
Microplan was missing mentioned on AS map incorrectly. wise, Day wise)
Area Supervisor Shazia’s dataArea Supervisor Rubina’s 2A Village and Hamlet list was
mismatched forms were missing not attached with 6 AICs
AS Salma’s PMC data
mismatched with 2A form The quality of UC level maps
and # schools and target was poor
mismatched
AS Raisa’s # schools and

target data mismatch with
summary sheet
Accountability/ Workload Rationalization/ SMC Validataion
UC- Name DEOC Core Team Frequency of # Meetings # Admin cases # Admin Cases # Pending
Functional Y/N Meetings held reported Jan -Aug Concluded Cases
UC-1 Muzaffarabad Y Need Base 22 18 4
2
UC-2 Muslimabad Y Need Base 19 19 0
UC-2 Rehri Goth Y Need Base 2 2 0
1
UC-4 Quaidabad Y Need Base 10 6 4
Major Findings
• Only two meeting for SHRUCs and one for HRUCs conducted in the last 11 months (Accountability)
• Delays in scheduling meeting with ADC-1 for admin cases core team meeting (at DEOC Part)
• Cattle Colony: Out of a total of 26 children Covered NA, 8 children were found uncovered (Fake Coverage)
• As per Area Incharge, Teams were replaced on Catch up days without any reason. Possibility of partial
teams' deployment in catch up days
• 100% Refusals coverage was found (n= 33/33)
• No child was found missed in 78 Locked & 0/0 Houses from 4 UCs
Compiled Coverage till September 16, 2022
UC wise Compilation Out break Response Coverages District Malir (Till Date: 16-Sep-22)
Still Defaulter IDPs STILL Covere STILL Covered Fixed Site

District Tehsil UC NAME Zero Covered s Coverag NA d REF Covered PMC OPV No of Guest
Zero Dose NA REF (in Vaccinated
Dose Coverage e SMC SMC Number) Coverage
MALIR BINQASIM REHRI-2 (CBV) 858 139 323 22 166 23 96 5 0 76 1
MALIR BINQASIM QUAIDABAD-4 (CBV) 593 147 242 37 292 28 128 11 6 80 5
MALIR BINQASIM CATTLE COLONY-3 231 40 127 8 109 0 88 7 3 0 0
MALIR BINQASIM LANDHI-5 698 62 10 9 433 5 614 18 4 0 0
MUZAFFARABAD-1
MALIR LANDHI 787 69 175 73 728 100 293 16 15 0 28
(CBV)
MALIR LANDHI MUSLIMABAD-2 647 69 214 75 554 127 395 24 8 176 39

(CBV)
Total 3814 526 1091 224 2282 283 1614 81 36 332 73

Communication
Methodologies for Communication Risk Assessment
1-Focused group discussions UC-Level/CBV/SMT FLWs and Community.

To assess the general perception about the Polio program, Polio vaccine, trust
on Polio Workers, and challenges for polio eradication.
2-Review of Communication plans
To evaluate communication activities and their impact.
3-Desk & field review of refusals profile/challenge mapping
To assess the quality of the Social profile/challenge and how it's been utilized
for developing a specific action plan
4-H-H clusters.
For Community risk assessment and assessment health seeking behavior.
5-Interviews with Key Managers at District Level/ Town Level/UC Level
To find out the area of improvement
Community Health Seeking behavior and Hygiene Condition
Source of Driking Water % Toilet Facility % Type of Health Facilities %
Health Seeking Behaviour %
7% 1% 0%
6% Public
9% 8%
26% Private
Pharmacist
41%
20%
Spiritual
Healers
65% 57%
74% I don’t take
85% him/her any
where
Piped Water Tube Well/Bore hole
Dig Well/Spring water Unprotected Dig Wel Flash Toilet Pit latrine Others Medical Doctor Paramedics Others
Rain/Surface Water Tanker/Cart Open Defecation Nurse/Informal Others
Others
Community know about campaign before Do you think OPV is effective % Knowledge about Multiple Doses Effectivity % Did the vaccinators come to your house %
start %
3% 3% 3%
10% 18%
14%
27% 5%
68%
77%
83%
90%
Verify Effective Somewhat Effective Yes No Not Sure Yes No Not Sure
Yes NO
Not Effective Not Sure
Key findings-Communication- Malir
KEY FINDINGS
• Poor Social data collection and monitoring mechanism for communication-

More than 20% of the social data mis-matched in the field
• Impact analysis of key Comm’s interventions at UC/DEOC level
• Lack of strategic approach for covering missed children-Multiple knocks with-

out proper plans creating fatigue and resistance in community
• Lack of coordination among different service providers and partners in

SHRUCs- Lack of Proper usage of HR and other resources in SHRUCs
Routine EPI-ISD-PEI/EPI Synergy
Fix Site’s Observations (1/2)
Functionality, Vaccines, logistics, CCE, Immunization Coverage
Indicator 50-Beded E.Disp. E.Disp. Bilal E.Disp. SINA PHC Aga BHU Juma
Hospital Muslim Colony, G.Bunair, Clinic, Khan, Himayeti, Cattle
Muslimabad abad Muslimabad Muzafarabad Rehri Rehri Col.
EPI Center functional
Functional CCE available
All Vaccines available
All logistics and syringes available
Vaccines kept in ILR properly as per

guidelines
Vaccine with unusable VVM 1 Vial of 15 Vials of
IPV OPV (SIAs) in
late stage 2
Temperature +2-8 inside ILR & Updated
temp. charts displayed
Safety boxes available and used as per Separate box for
guidelines syringes & vials
Updated Vaccination Coverage charts and
graphs
Accuracy ratio: (check for 1 vaccines in daily MR-1 (25/25) TT-1 Penta-3 (18/20) BCG (43/42) Penta-3 BCG IPV1 (51/51)
register & monthly report of last month) (19/19) (38/34) (76/75) IPV-2 (25/25)
Fix Site’s Observations (2/2)
MP, Outreach, ZD, AEFI
Indicator 50-Beded E.Disp. E.Disp. Bilal E.Disp. SINA Clinic, PHC Aga BHU Juma Himayeti,
Hospital Muslimabad Colony, G.Bunair, Rehri Khan, Cattle Col.
Muslimabad Muslimabad Muzafarabad Rehri
Quarterly UC RI Microplan Available Till Jan-

Feb.22
Monthly Outreach Plan duly
approved & signed by HF MO
Updated list of defaulter children Till 31st Jan Till Jul 22
available 22
List of ZD children of last SIA Till Mar 22
available SIA
If yes, how many ZD recorded & 54/235 11/87 51/173 1/65
covered SMT UC
EPI Center visited by supervisors & Issues not Issues not Issues not Issues not
issues identified identified identified identified identified
If yes, by whom? TSV, DEPI FP TSV of SHRUC TSV of SHRUC BY VPT VTP, TSV TSV
team
AEFI – forms available, Vaccinator Forms NA
know about AEFI and what to do in
case of AEFI reported
Indicator
Outreach Session’s Observations
Gul Ahmed Majeed Colony, Bilal Moosani 2, Rehri Lal Abad, Bhussa Mandi, Cattle Samoo Goth, Cattle
Area, Col-2, Muslimabad Rehri Col. Col.
Muslimabad
Updated outreach plan available
Session conducted as per Just an overall
outreach plan planning sheet
Vaccination site visible & No visibility No visibility No visibility No visibility No visibility No visibility
convenient
CHW/LHW available in session 3 CHWs SM available. CHWs Both CBV
engaged in R Supervisor
conversion activity
Updated Defaulters list available
ZD children list available 44/190 cov 11/47 cov 5/22 cov 0/24 from list. 0/32 from list
7 Unrecorded ZD 4 unrecorded ZD
covered covered
SVC with 4 cool packs 2 cool packs
half & warm
All antigens are available Except BCG
Date and time mentioned on
BCG, measles, IPV etc
Using safety box
AEFI forms available
Children vaccinated at time of 10 children at 10 children till 12.45 25 children till 2.45 14 children 10 children till 12.30 14 children till 1.55
visit 1.27 pm (7 ZD, 12 Defaulters) till 12.45
PEI-EPI Synergy:
• Lack of collaboration for outreach session’s planning and implementation
• (Joint) Monitoring and Supervision Plan not prepared/available for RI either by EPI or
PEI teams – thus monitoring of EPI activities not done properly (visit to EPI centers,
outreach, H-H clusters etc)
• Minutes of Monthly EPI review meetings suggests less participation of DEOC team (1/4
meetings) in 2022.
• Data sharing of ZD and defaulter children between CBVs network, Vaccination staff &
LHWs is not as desired
• Private sector (VPT, SINA, Agha Khan PHC etc) not utilized optimally - lists of ZD
children not provided to them, info for SIAs not shared. Their own staff is mobilizing
due & defaulter children.
• CHW’s Knowledge on EPI schedule need improvement (24 CHW’s group was asked
about EPI schedule for referring of due/defaulter children in ED G.Bunair but only few
know about RI schedule.
• Communication activities – not in structured way - resulting in low coverage of
defaulters and ZD children
• LHW’s network – less involved for RI coverage.
3. Integrated Service Delivery Basic Functionality Assessment
ISD Gulshan-e-Bunair UC ISD Muslimabad UC Muslimabad, ISD Bilal Dispensary UC
Indicators
Muzafarabad, Landhi Town Malir Landhi Town Malir Muslimabad, Landhi Town Malir
Birth registration availability
PHC services availability
MNCH services availability
Nutrition facility availability Not Applicable
EPI facility availability
Vaccinator availability
No. of registered pregnant women Marked in OPD register only
Marked in OPD register only 18
(Numbers)
Daily / Monthly OPD (Numbers) 1000+ on monthly basis 3000 + on monthly basis 200 to 250 daily
Attendance Register availability
MO availability
EPI vaccine availability status
EPI antigen wise coverage chart available
Zero dose children record / coverage
(numbers) 172/51 Till Mar 22 SIA 87/11
OPV corner established and functional Corner established during Campaign
During Crash Program (OR Plan
Outreach service
NA) No OR from this center No OR from this center
Pashtoon speaking social counselor
present
Observations
ISD Gulshan-e-Bunair, Muzafarabad
• HF MO Dr Waqas not doing OPD because he is working as UCMO
• WMO Dr Amna coming late 10:30 and going 12:30. LHV is doing OPD till 1:00 pm and lady
doctor coming on alternate day
• List of pregnant women not available (only marked in OPD register)
• List of Zero dose children not available.
ISD Muslimabad
• HF MO Dr Adil working as UCMO and also busy in health camps not giving proper time in ISD
ISD Bilal Colony Dispensary, Muslimabad

• Dr Basalat Hussain name mentioned as MO but Dr Tariq is working as MO and he is coming
late 11:00 am
• No lady doctor coming from last week
• List of pregnant women not available.
• No Children registration at the site
Key findings
Surveillance:
• HSB from 1st & 2nd contact in UC1 Landhi 67%
• Notified <7 days 88%
• Stool adequacy of UC-1 Landhi 78%
• Lab result feedbacks to Health care providers 53% (10/19)
• 9/11 Community informants visited were not IHCPs(Partner staff,TSV,Qualified doctors)
30 HH cluster:
• RI OPV 3 doses (6-23 M) 61% (107/176)
• RI IPV dose (6-23 M) 56% (98/176)
• SIAs Coverage < five years in SIAs in Aug 81% in Landhi 5
• Predominantly missed children are NA(69% in SIAs Aug22,40% IDPs)
• Health Facility staff does not know DSC 32% (6/19 HFs)
• Health Facility staff does not know DSO 16% (3/19 HFs)
• Health seeking towards IHCPs 21% (Bin qasim UC-5-44%, UC-2-22%,Landhi UC-1-35%)
Key findings
DEOC functionality:
• No computer operator from DHO/DC
• No guidelines books
• No records of RI microplan, vaccine and cold chain
• 19% (8/53) admin cases not decided in draining Ucs
• No Multimedia
SIAs:
• High turnover of HR 2%-6% in draining UCs
• Microplan shows missing components in SHRUCs (Maps,Hamlet list,HRMP data,
SMC/PMC data,Social mobilization plan)
• DQA shows data mismatch among different sources (Registration,Tallysheets,2A,Online sheets,DSC
data)
• No TNA analysis in draining UCs & 2 adjoining UCs
Key findings
SIAs (Continued):
• SMC > 0.75% in draining Ucs
• between 5% – 6% in SHRUCs draining Ucs
Communication:
• Perception of/knowledge about effectiveness of multiple doses 77%
• Poor social data collection and impact analysis
• Lack of strategic approach for covering missed children/repeated knocks at door steps
• Lack of coordination among different service providers and partners in SHRUCs
draining Ucs
Key findings
Routine EPI:
• EPI Centers: 7 visited
• 71% (5/7) had usable VVM
• 43% (3/7) had antigen coverage reporting accuracy
• 14% (1/7) had quarterly Microplan
• 14% (1/7) had outreach plan approved by HF medical officer
• 33% (2/6) had issues identified by the visiting monitor
• Outreach sessions: 6 visited
• 50% (3/6) had outreach plan available
• 100%(6/6) had visibility not up to mark
• 50% (3/6) had defaulters list available
Key findings
EPI/PEI Synergy:
• One out of four EPI review meetings held in 2022 had participation of DEOC team
• Nonavailability of Monitoring & supervision plan by EPI/PEI team
• Poor SMC,PMC,zero dose & RI defaulters children data sharing at various concerned levels
(CBV network, vaccination staff, LHWs, private sector)
• Poor knowledge of CHWs on EPI schedule in UC-1 Landhi(SHRUC)
Integrated Service Delivery: 3 ISD dispensaries visited
• 67% (2/3) had Birth registration
• 67% (2/3) had MNCH services (but partially)
• 67% (2/3) had updated Zero dose children record
Recommendations
Surveillance:
• Scale up orientation/trainings of Health care providers (particulary in SHRUCs)
• Scale up supervision of stool samples
• Providing Lab result feedbacks to Health care providers
• DSC/DSO to conduct thorough Active Surveillance visits,including joint visits
• Revision of Community informants lists including Informal health care providers
(starting with S/V-HRUCs)
Recommendations
DEOC functionality:
• Appointment of one computer operator from DHO/DC
• Making available guidelines books, RI microplan, vaccine and cold chain records
• Deciding 19% (8/53) admin cases in draining Ucs
SIAs:
• Adopting HR retention measures (Proper selection & work load distribution) particularly in
draining UCs
• Better oversight of DEOC on SIAs Microplanning, Data flow & Training need analysis
particularly in draining Ucs
• Decreasing still missed children by workload rationalization, improving supervision, social
mobilization and quality IPC trainings by SOPs
Recommendations
Communication:
• Develop communication plans based on social data. Scaling up targeted communication activities
• Enhance female engagement, especially from religious institutes, local health care providers & TBAs
• Engagement sessions with HR communities/stakeholders to emphasize on repeated vaccination
• Capacity building of staff on social analysis redo social profiling & do at least 15% Refusal profile
validation
• Improve challenge mapping
• Conduct quality training on Impact analysis Proper documentation of key Comm’s interventions &
conduct
• Having strategic approach for covering missed children/To prevent repeated knocks at door steps
• Coordination meetings among different service providers and partners (particularly in SHRUCs
draining Ucs) & develop joint integrated plans among all the service providers/partners with special
focus on Zero dose and PMCs refusals in SHRUCs
Recommendations
Routine EPI:
• Preparing & implementing quality EPI Microplans (jointly, involving Vaccinators, TSVs, AS CHW, LHSs)
• Preparing & implementing EPI outreach plan (jointly, involving Vaccinators, TSVs, AS CHW,
LHSs).Include all vaccinators in outreach activities (other than 1 Vaccinator/EPI center)
• Preparing & implementing EPI centers supervision & monitoring plans including DHMT,DEOC,LHW
program (focusing S/V-HRUCs by EPI Fp & DSV) .Include outreach sessions during field monitoring
• Track performance of vaccinator’s activities & monitoring status.Use of technology for same.
Accountability on poor performance
• Refresher training of EPI vaccinators & EPI Supervisors
• Making available RI Microplans, defaulters & zero dose RI list at all EPI centers & outreach sites & plan
to cover them
• Pre and post vaccination counselling by EPI vaccinators & Health care providers
• Special community mobilization for RI antigens to mobilize ZD & due/defaulters
• SMT UCs need special plan for accessing the ZD children as Vaccinators & UCCO are unable to find the
addresses
Recommendations
EPI/PEI Synergy:
• DEOC(PEI Staff) to be regular part of EPI review meetings
• EPI monitoring and supervision plan to include both EPI and PEI staff
• Making available SMC & PMC list at all EPI centers/outreach sites & plan to cover them
• Special community mobilization for SMC and PMCs
• Quality trainings of CHWs on EPI schedule & EPI referring of defaulters/due
• EPI to be integral part of daily evening review meetings during SIAs and PCRMs
Integrated Service Delivery:
• Implementation of all the activities as per ISD Action plan (Services,monitoring,staff capacity)
• To maintain Birth registration
• To maintain complete MNCH services
• To maintain updated Zero dose RI children record
Thank You
Back-Investigation Plan
Event Investigation & Response Plan [1/3]
Team /Person
S# Activity Activities Timeline Status
Responsible
NEOC /National Event
3 Level Meeting with NEOC ---
Manager
Coordination
1
& Planning
Prepare investigation plan and discuss with relevant
Dr Shabir Ahmed 12 Sep
members /DEOC
Review of Population Immunity (SIAs and R.I), Guest, Zero

Dose Recording & Coverages, PMC /SMC Refusal Clusters,
IDPs /HRMP Assigned DSOs 13 – 17 Sep
Include other relevant program components
ISD /Synergy
HR, management and accountability measures 13 – 17 Sep

HR turnover, Workload rationalization Dr Sundeep
2 Desk Review Review of AFP Surveillance Files, Line list, E-List, Cross
Notified cases, Meeting Minutes (DRC, DSRC & Trainings) 13 – 17 Sep
Assigned DSOs
Silent UCs, AFP Clustering, Cold chain and sample
validation, Validation of AFP cases
Social and demographic Analysis
Communication ( Challenges Mapping)
Population characteristics, Mr. Muhammad Amir & 13 – 17 Sep
movement and migration routes Comms member
Community social mapping and
determinants
Event Investigation & Response Plan [2/3]
Team /Person
S# Activity Activities Responsible Timeline Status
30 HH Clusters (Randomized among AS) – Separate clusters for

Assigned DSOs 13 – 17 Sep
HRMP /IDPs for SIAs and RI
Data Quality Assessment (Registration and Tallysheet) Dr Jawed Khan /Ms. 13 – 17 Sep
Sana
Validation of 0/0 & locked houses, Covered SMC, PMC, Zero dose Ops and Comms 13 – 17 Sep
Field
3 Visit of Active and Zero Reporting sites Assigned DSOs 13 – 17 Sep
Investigation
Communication Risk Assessment Comms 13 – 17 Sep
Validation of community engagement /Impact assessment Comms 13 – 17 Sep
Assessment of effectiveness of Influencers Comms 13 – 17 Sep
Oversight & DEOC functionality and accountability 13 – 17 Sep

4 NSTOP
Management
Development
Prepare final report and submit to PEOC /NEOC Event Manager
of Prepare action plan based on the investigation findings and Dr Shabir and Dr 19 Sep
5.
Investigation recommendations Sundeep
Report
Investigation Team Composition [3/3]
S.No Name of staff Designation Role in Investigation Specific Components
Dr Shabir Ahmed Oversee the investigation, distribute and assign tasks among members,
1 PSO/FSO Lead
Supported by Dr Tufail Report preparation, debrief to DEOC/DC and EOC
2 Mr. Jahanuddin Health Specialist Co-lead Communication /Media
3 Dr Jaishiri Mehraj Epidemiologist Member Data analysis
4 Dr Tariq Masood Consultant Member ISD /Synergy and EPI
5 Muhammad Amir HRMP Focal Person Member HRMP/IDP/PTP/Transit
6 Dr Sundeep PPEO Member Microplan, HR,
7 Dr Zameer Phul NSTOP TSO Member DEOC /UPEC Functionality
8 Dr Jawed Khan M.E Officer Member DQA /Monitoring processes and practices
9 Dr Zaid Bin Arif Training Officer Member Cold Chain Assessment
10 Ms. Sana M.E Officer Member DQA /DSC
11 Attaullah Training Officer Member Training processes and practices, monitoring
12 Sajjid Hussain Training Officer Member Training processes and practices, monitoring
13 Dr Furnoor /Dr Liaquat DSO Member Surveillance /30 HH clusters
14 Dr Sarwat DSO Member Surveillance /30 HH clusters
15 Dr Sumaira DSO Member Surveillance /30 HH clusters
16 Dr Bushra DSO Member Surveillance /30 HH clusters
Back up Surveillance
District Profile Malir
TOWN AREA POPULATION <15 YEARS POPULATION <5 YEARS
MALIR TOWN 123223 34637
BIN QASIM TOWN 342828 15968
GADAP TOWN 2635 SQ KM 108370 39588
LANDHI TOWN 330462 71121
Union Councils 904883 305035
TOTAL 2635 SQ KM 1809766 2010856
SURVEILLANCE INDICATORS 2020 2021 2022
Expected AFP Cases 59 59 30
Reported AFP Cases 85 112 85
N.P AFP rate 10.5 11 11.8
Adequacy 81 92 95
Last WPV1 reported 1 0 0
Last cVDPV2 reported 1 0 0
Silent UCs NA NA NA
ES site 1 1 1
Draining UCs 4 4 4
E-listed cases 23 28 55
Active & Zero Reporting sites 23+46=69 27+47=74 35+45=80
Informal & Formal HCPs - - Informal 152+formal 50=202
Active & Zero Sites by Taluka / Town, 2020-22
Active Sites Zero Reporting Site
Total Functional Health Care
Facilities in the District 2020 2021 2022 2020 2021 2022
Government 10 14 17 37 37 35
Private 13 13 18 09 10 10
Total 23 27 35 46 47 45
MALIR TOWN 04 04 08 04 04 03
Government 03 03 04 03 03 02
Private 01 01 04 01 01 01
BIN QASIM TOWN 11 11 12 22 22 21
Government 05 05 6 17 17 16
Private 06 06 6 5 5 5
GADAP TOWN 06 06 8 09 09 10
Government 3 3 4 07 07 07
Private 3 3 4 02 02 03
LANDHI TOWN 06 06 07 12 12 11
Government 02 03 03 10 10 09
Private 01 03 04 1 2 02
BAKHTAWAR GOTH Draining UCs Social Profile
Socio – economic Bifurcation Population Ethnicity

90% 120%
81%
80% 78%
75%
100%
70%
60%
60%
80%
50%
40% 60%
40%
30%
40%
22%
20% 19%
20%
10% 20%
5%
0% 0% 0%
0%
BINQASIM LANDHI 0%
BINQASIM LANDHI
POSH MIDDLE SLUM
Data Source: PEI field staff
Age categories and gender distribution – 30 HH clusters
Age groups - 30 HH clusters Gender - 30 HH clusters

100% 100%
Take away
80% 80%
• 47 (7.0%) were 0 to 5
45
53 69 59 73 49
55 350 months old,
85
87 74 72 76 447 • 176 (26.3%) were 6 to 23
60% 60%
months old and
• 447 (66.7%) were of 24 to
40% 40% 59 months old.
59 59
29 320
20% 27
38 21 30 176 20% 50 49 62 41 • 350 (52.2%) Male
31 • 320 (47.8%) Female
7 12 11 8 8 47
0% 1 0%
al
al
AD
AD
i- 5
i- 5
-4
I- 2
-3
I- 2
-3
-1
-4
-1
t
t
NY
NY
BD
BD
To
To
dh
dh
HR
HR
AB
AB
ad
ad
LO
LO
RA
RA
n
n
RE
RE
ab
ab
LIM
LIM
La
La
CO
CO
FA
FA
id
id
US
US
Qa
Qa
AF
AF
LE
LE
M
M
UZ
UZ
TT
TT
CA
CA
M
M
0-5 Months 6-23 Months 24- 59 Months Female Male
District wise household travel history in last 35 days– (30 HH cluster)
Sindh Afghanistan Punjab Baluchistan KPK
Jacoba Shikar Hyder Larkan Afgha Bahawa Naseer Pishi MANS KOHIST PESHA NOSHE Grand
Ucs Thatta Dadu Herat Punjab BUNEER DIR
bad pur abad a nistan lnagar abad n HERA AN WAR RA Total
Landhi-5 1 4 4 2 11
Qaidabad - 4 1 1
REHRI-2 2 2 4 1 1 2 1 1 14
MUZAFFARABD-1 1 1 2
MUSLIMABAD 1 1
CATTLE COLONY-3 3 1 1 5
Total 1 4 5 2 1 1 4 2 4 1 1 1 1 2 1 1 1 1 34
ES positive
Reasons of Missed Children in Jun & Aug SIAs 2022 in
draining UCs – 30 HH clusters
Reasons Missed Jun SNIDs 2022 Reasons Missed in Aug NIDs 2022 Take away
100% 100%
10% •
13% 16% 38 (5.7%) missed children
80% 43% 40% 80% 43% 40%
33%
0.404761904761905 reported in June 2022
SNIDs. Among total
60% 50% 0.772727272727273
60% 80%
missed 34% NA, 50%
100% 100% 75% 14% 20% 33% 14% Newborn and 16%
40%
90% 29%
40% 40%
refusals reported in Jun.
17%
43%
• 42 (6.3%) missed children
20% 20% 40%
29%
34%
23%
33% 29% reported in August SNIDs
20% 20%
13% 2022.
0% 0%
• Among total missed
al
AD
-5
-2
-1
-4
3
Y-
t
hi
children 29% NA, 17%

BD
I
To
HR
AB
ad
ON
nd
RA
RE
ab
LIM
OL
La
FA
Newborn and 14%

id
C
US
Qa
AF
LE
M
UZ
TT
refusals and 40% IDPs

CA
M
NA Newborn Ref NA Newborn Ref NA-IDP arrived after Aug SNIDs.

UC wise status of local and nonlocal households – 30 HH clusters
Local / Non Local Households
100% 3 4 23
90% 16
80%
70%
60%
50% 60 60 61
Take away
79 69 375
40% 46
• From 398 households,
30% only 23 (5.8%) were
20%
10% nonlocal households
0%
Landhi-5 Qaidabad - 4 REHRI-2 MUZAFFARABD- MUSLIMABAD CATTLE COLONY- Grand Total
• 17 were from other
1 3 districts of Sindh
Local Non Local • 04 from Afghanistan
• 01 from Punjab
Non Local Households • 01 from Balochistan
6
5 5 • None of the nonlocal
5
4 from south KP or other
3
2 2 2 infected districts
2
1 1 1 1 1 1 1
1
0
MIRPURKHAS
SHIKARPUR -IDP
AFGHANISTAN
LARKANA
THATTA
DADU
HEERAT-AFG
BAHAWALNAGAR
JACOBABAD
KAMBAR
SUKKUR
JAFFARABAD
AFGHANISTAN PUNJAB BALOCHIS SINDH

TAN
Bakhtawar Goth, ES Positive Profile 2020-2022*
Reporting Month Method Cluster Sequence Analysis Orphan Linked with
Aug-22 BMFS Pending Pending
99.22% with Adhoc ES Frontier Colony (Orangi Nalla) May 2020
Mar-21 BMFS YB3A Y ES-Karachi, May 2020
99.11% with Adhoc ES Bangali Para (Orangi Nalla) May 2020
99.11% with Adhoc ES Frontier Colony (Orangi Nalla) May 2020
Mar-21 GRAB YB3A N ES-Karachi, May 2020
99% with Adhoc ES Bangali Para (Orangi Nalla) May 2020
99.33% with Human case PAK/SD/52/20/032 Shikarpur, 2020 Human case Shikarpur
Oct-20 BMFS YB3A N
99.11% with Human case PAK/SD/55/19/159 Kambar, 2019 2020
99.33% with Human case PAK/SD/52/20/032 Shikarpur, 2020
Human case Shikarpur
Oct-20 GRAB YB3A 99.11% with Human case PAK/SD/55/19/159 Kambar, 2019 N
2020
100% with ES-BMFS Landhi Bakhtawar goth October 2020
99.22% with ES-BMFS Landhi Bakhtawar goth June 2020
Sep-20 GRAB YC2 98.45% with human case SD/69/20/020 Karachi-Landhi, 2020 N ES-Karachi, June 2020
100% with ES Landhi Bakhtawar goth Sept 2020
98.12% with ES Miani pumping station- Sukkur June 2020 SUKKUR ES-Sukkur, June 2020
Aug-20 GRAB YB3A Y
98% with ES Machar Colony –Gadap May 2020
99.33% with ES-BMFS Landhi Bakhtawar goth June 2020
Jul-20 GRAB YC2+YB3A 98.56% with human case SD/69/20/020 Karachi-Landhi, 2020 N ES-Karachi, June 2020
100% with ES-BMFS Landhi Bakhtawar goth July 2020
98.45% with ES-BMFS Sohrab goth – Gadap Oct 2019
Jun-20 GRAB YC2 Y ES-Karachi, Oct 2019
98.34% with ES-BMFS Sohrab goth – Gadap May 2019
99% with ES Landhi Bakhtawar goth Apr 2020
May-20 GRAB YB3A N ES-Karachi, Apr 2020
98.56% with ES-Jatak Killi & Takhthani, Quetta Mar 2020
99.55% with ES Machar Colony –Gadap Feb 2020
15-Apr-20 GRAB YB3A N ES-Karachi, Feb 2020
99.22% with ES Haji Mureed goth Liaqarabad Nov 2019
99.89% with ES Tulsidas Pumping Station, Hyderabad Jan 2020
17-Mar-20 GRAB YB3B 99.66% with ES Dhoke Dallal, Rawalpindi Feb 2020 N ES- Hyderabad Jan 2020
100% with ES Landhi Bakhtawar goth Mar 2020
99.55% with ES Landhi Bakhtawar goth Mar 2019
20-Feb-20 GRAB YB3A N ES-Karachi, Mar 2019
99.44% with ES Machar Colony –Gadap Jan 2019
99.89% with ES Orangi Nalla – Site Apr 2019
17-Jan-20 GRAB YB3A N ES-Karachi, Apr, 2019
99.77% with ES Rashid Minhas Rd, Giqbal Aug 2019
Environmental Sample Results, Sindh; 2020 – 2022*
2020 2021 2022*
Division District Site Name Ma Ma
Jan Feb Mar Apr Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr Jun Jul Aug
y y
Sohrab Goth
East-Gadap Machhar Colony
Khamiso Goth
Chakora Nalla
East-Gulshan
Rashid Minhas)
KARACHI Keamari-Baldia M. Khan Colony
Keamari-SITE Orangi Nalla

Malir-Landhi Bakhtawar Goth
Korangi Korangi Nalla –Comp.**
Central-Liaquatabad Haji Mureed Goth
South-Saddar Hijrat Colony -PIDC Nalla

Miani P. Station
SUKKUR Sukkur
Macca P. Station
Jacobabad Saddar P. Station
LARKANA
Kambar Massan Muhallah
Hyderabad Tulsidas P. Station**

HYDERABAD
Dadu Bago Road & Baqirabad
MIRPURKHAS Mirpurkhas Ring Road Puraan
**
Karachi: last positive ES in May 2021 from KORANGI
WPV1 Positive WPV1 Negative Under Process
Other Divisions: Last positive ES in July 2021 from HYDERABAD
Assessed Surveillance sites & Outside network
• Total sites visited = 25

• Active = 9
• Zero = 10
• Key Community Informant = 1(+11 by FSO=12)
• Outside network = 5
• Type of sites
• Public = 14
• Private = 7
• Informal Health Care provider = 4
Assessed Surveillance sites & Outside network
Outside
UCs Active Zero Site Key Informants Total
Network
Cattle Colony 2 3 5
Muslimabad 2 3 5
Muzafarabad 1 2 2 5
Quaidabad 1 1 2
Rehri Goth 3 1 1 3 8
Total 9 10 1 5 25
FSO findings
• Bilqees Sultan Hospital site (active, private)

• Zero reports not updated
• Age bracket for AFP definition unclear knowledge of doctors
• Selection of 9 community informants in UC1 & 2 Landhi was found
inappropriate
• 6 were UC partner staff (UCPO,UCOO)
• 1 was TSV
• 2 MBBS doctors
Non-Polio AFP Rate District Malir, 2019 – 2022*
16
15
15
14
13
12
12
11
10
9
8 8
8 8 7 7 8
7 7 7 7
7 6 6 6
6
5
5
4
3
2
1
0
MALIR BINQASIM TOWN GADAP LANDHI TOWN
2019 2020 2021 2022

Stool Adequacy District Malir, 2019 – 2022*
100
100 100 100 100 100 99 100
97 98 97 98
95 95
90
90 90
85
80
70
60
50
40
30
20
10
0
Malir Bin Qasim Town Gadap Landhi town
2019 2020 2021 2022

Detection within 7 Days, District Malir 2019 – 2022*
100
100 100 100 100 100 100 100 100 100
95 95
90 92 92
88 90 90
80
70
60
50
40
30
20
10
0
Malir Bin Qasim Town Gadap Landhi Town
2019 2020 2021 2022

R.I Status of AFP Cases District Malir, 2022*
100%
90%
1 2
80%
70%
4
60% 13 13 10 17
50% 2
4
40%
30%
1
20% 1
2 2 1
1
10% 1
1 2 2 2 3
0%
0-4 m 5-11 m 12-23 m 24-35 m 36-47 m 48 - 59 m 60 & Above
0 dose 1-2 dose 3 dose

HSB Data of AFP Cases District Malir, 2020 – 2022*
100 (Qualified) /Non qualified 2022
90 88
81
80
70
% 60 54
50 2020
2021 Non Qual-
40 34 ified
2022 Qualified 26%
30 74%
20 16
8 11
10
2 4 1 0
-
1st 2nd 3rd 4th 5th 6th 7th
YEAR 1st 2nd 3rd 4th 5th 6th 7th

2022 75 7 3 0
2021 91 18 2 1
2020 53 84 17
HSB of Reported AFP Cases from Draining UCs, District Malir 2022*
100
90
81
80
70
60
% 50
40
30
20
10 8 8
3
-
1st 2nd 3rd 4th 5th 6th 7th
YEAR 1st 2nd 3rd 4th 5th 6th 7th

2022 22 2 2 1
Ethnicity of AFP Cases in Draining UCs of District Malir, 2022*
25
21
20
15
13
#
10
7
5
5 4
3 3 3
2 2
1 1
0
SINDHI URDU BALOCHI PUSHTO SIRAIKI PUNJABI OTHER BRAVI HINDKO AFGHAN
2021 2022
Routine Immunization Status of AFP Cases - 2022*
UC Muzafarabad UC Muslimabad
100% 100%
80% 1 1 80% 2 1
60% 2 60%
1 1 1 1
40% 40% 1
20% 1 1 20% 1
1 1
0% 0%
0-4 m 5-11 m 12-23 24-35 36-47 48 - 59 60 & 0-4 m 5-11 m 12-23 24-35 36-47 48 - 59 60 &
m m m m Above m m m m Above
0 dose 1-2 dose 3 dose 0 dose 1-2 dose 3 dose
UC Rehri UC Cattle Colony

100% 100%
80% 1 80%
60% 60%
1 1 1 1 1 1 1 1
40% 40%
20% 1 20%
0% 0%
0-4 m 5-11 m 12-23 24-35 36-47 48 - 59 60 & 0-4 m 5-11 m 12-23 24-35 36-47 48 - 59 60 &
SIAs Immunization Status of AFP Cases - 2022*
UC Muzafarabad UC Muslimabad
80% 1 80%
2 1 1 3 4 2 1 1
40% 40%
1
0% 0%
0-4 m 5-11 m 12-23 24-35 36-47 48 - 59 60 & 0-4 m 5-11 m 12-23 24-35 36-47 48 - 59 60 &
4-6 dose 7 & Above 4-6 dose 7 & Above
UC Rehri UC Cattle Colony

80% 80%
1 1 1 2 1 1 1 1 1
40% 40%
0% 0%
0-4 m 5-11 m 12-23 24-35 36-47 48 - 59 60 & 0-4 m 5-11 m 12-23 24-35 36-47 48 - 59 60 &
4-6 dose 7 & Above 4-6 dose 7 & Above
Muzafarabad- Muslimabad- Rehri- Cattle Quaidabad -
Landhi-5 TOTAL
30 HH CLUSTER FINDINGS 1 2 2 Colony-3 4
n % n % n % n % n % n % n %
No of clusters taken 2 2 3 2 2 2 13
No of Houses checked 60 61 82 73 60 62 398
Total Children Checked <5 Yrs 104 90 135 114 108 119 670
Total Children Checked (age 6-23 Months) 21 20% 29 32% 38 28% 30 26% 27 25% 31 26% 176 26%
Routine 3 OPV Doses coverage by recall (age 6-23 Months) 8 38% 19 66% 24 63% 22 73% 21 78% 13 42% 107 61%
Routine 3 OPV doses verified by EPI card (age 6-23 Months) 3 14% 6 21% 17 45% 18 60% 16 59% 5 16% 65 37%
IPV Administered(age 6-23 Months) 5 24% 17 59% 24 63% 21 70% 19 70% 12 39% 98 56%
IPV Verified by EPI card(age 6-23 Months) 3 14% 5 17% 17 45% 18 60% 16 59% 5 16% 64 36%
SIAs OPV coverage last round Aug-2022 (Age 0-59 months) 99 95% 90 100% 130 96% 111 97% 101 94% 97 82% 628 94%
SIAs OPV Coverage 2nd last round -Jun-2022 (Age 0-59 months) 99 95% 86 96% 131 97% 106 93% 101 94% 109 92% 632 94%
Travel history of House holds 2 3% 1 2% 14 17% 5 7% 1 2% 11 18% 34 9%
Guests visited 0
0%
3
5%
4
5%
3
4%
2
3%
6
10%
18
5%
Non-Local 0 0% 0 0% 3 4% 4 5% 0 0% 16 26% 23 5%
No. AFP cases Found during Cluster 0 0 0 0 0 0 0

Spot mapping of 30 HH Cluster
CLUSTER UC’S AREAS
1. GULSHAN E BUNEER
MUZAFARABAD-1 2. KACHI ABADI
1. BILAL KHADA
MUSLIMABAD-2 2. SWATI MUHALLAH
1. BAKHTAWAR GOTH
REHRI-2 2. DUBLA PARA
3. LALABAD
1. LABOUR SQUARE
CATTLE COLONY-3 2. RAILWAY COLONY
1. QAZAFI TOWN
QUAIDABAD-4 2. ZAFAR TOWN
1. 19-B
LANDHI-5 2. SHAH LATIF TOWN
Healthy children stool sampling
Town UC Selected Name AS Samples South KP Pop Town UC Selected Name AS Samples South KP
Marvi 5 558 Shanza 3 136
Haleema 3 342 Hajra 2 97
Surraya 3 342 Binqasim 2 Amna Shah 2 96
Nusrat 2 200 Zareena 1 57
Landhi 01 Salma 1 98 Nazish 1 14
Tanzila 1 121 TOTAL OF UC 8 244
Shazia 1 92 Anila 2 8
Sonia 1 38 AS Madiha 1 7
Binqasim 3
Raisa 1 55 Misbah 1 6
TOTAL OF UC 18 1747 Sameena 1 0 +16 HRMP
Amna 4 471 TOTAL OF UC 5 21+16
Samrah 1 81
Landhi 02 Kosar 1 38
Farwa 1 36
Rukhsana 1 31
TOTAL OF UC 08 732
Modified Lab request form used
HCSS data to be collected:

1-Serial No:
2-UC:
3-AS Name:
4-Team Code:
5-South Kp pop:
6-HRMP pop:
7-House no:
8-Mohallah/village:
9-Name of child:
10-Fathers name:
11-Age:
12-No: of RI OPV:
13-No: of RI IPV:
14-No: of SIAs OPV:
15-Date last SIAs OPV:
16-Date of stool collection:
17-Cell no of AS:
18-HCSS house coordinates
19-cell number of father recorded
Back up-Oversight & Accountability
DEOC FUNCTIONALITY CHECKLIST
Name of District: DEOC Malir Filled by (Name & Designation): Dr Zamir Phul Date filled:
TSO NSTOP Sindh/Dr Furqan Nabil NSTOP Gujro 13-09-2022
Yes=1 ;
Sno DEOC EQUIPMENT AND DATA Partial=0.5; COMMENTS
No=0
General:
Have sufficient space,cleanliness,records organized,data labelling, display DEOC consist of 03 small room size 10 X 12
1 boards,furniture,cup board,Files rack,water dispenser,attached clean wash room 1
2 Electronic Equipment available(Computers,Scanner,Printers,Telephone,Internet,multi media) 0.5 Telephone & Muti media was not present
No person from DC, DHO & computer operator deputed at DEOC
Human Resources available(Lead senior officer from DC Eg:ADC-1,DHO/THO present,One
3 person from DC office & one from DHO Office,Computer operator,DHO office focal persons 0.5
SIA, HRMP, Surveillance, EPI, IO, NSTOP Officer, DHCSO,DSO)
Guidelines books & training Modules(NEAP books,SIAs,Surveillance,Routine

4
EPI,Communication) 0 No NEAP, EPI ,Surveillance , Communication, training module or
Book was available
5 Backup electricity (Generator or UPS) 0
DEOC staff coordination among each other,with DC,DHO,Talukas/Tehsils and UCs)& Follow
6 1
ups
Evidence of District partners data quality validation(Eg: Covered NA,R,Covered Zero dose
7 1
children) Soft copy was present
DEOC SIAs Records Checklist:
DEOC SIAs Pre-campaign Data Checklist:
8 Resources plans(last 6 rounds) 1 Soft copy was present
9
Count down of activities for campaign cycle with UC specific assignments for specific DEOC 1
staff Soft copy was present
10 DPEC meeting minutes(SIA,Routine,Surveillance parts) and presentations for last 6 rounds 0.5 Routine & Surveillance part not present in DPEC PPT
11 Neap Reports(16,10 &5 days before campaign) highlighting suboptimal data(last 3 rounds) 1
12 Microplans for last 3 rounds 1 Only M.P summary sheets was available
13 District Social map with spot mapping of current high risk areas 0
14 Microplan Desk review checklists (at District & UC level) with compilations last 3 rounds 1
15 Microplan Field validation checklist (at District & UC level) with compilations last 3 rounds 1
16 Summaries of UPEC meeting minutes (last 6 rounds) 0
17 Communication Plans (for 3 rounds including current round) 1
18 Communication report (District level) for 3 rounds 1
19 Readiness Report 1
20 Contact Directory (District Management,DHMT,Supervisors,NGOs,Line department heads) 1
21
District level SIAs monitoring plan with all the tiers(Govt District management, DHMT, 1
Supervisors, Partners)

DEOC SIAs Intra-campaign Data Checklist:
22 UC wise deployment data (First & last team) highlighting suboptimal data for 3 rounds 1 Soft copy was present
23 Issues,Corrective action & followup for 3 rounds 1 Soft copy was present
24 Administrative coverage data highlighting suboptimal data last 3 rounds 1 Soft copy was present
25 Clusters compilation highlighting suboptimal data 3 rounds(Partners,Supervisors) 1 Soft copy was present
26 Evening Meeting minutes with followups(Timely sharing with different levels) 1
DEOC SIAs Post Campaign Data Checklist:
28 Market Survey with suboptimal data for 6 rounds 1 Soft copy was present
29 LQAS with suboptimal data for 6 rounds 1 Soft copy was present
30 PCM with suboptimal data for 6 rounds 1 Soft copy was present
31 Sweeping reports for last 6 rounds 1 Availeable on online
32 Still missed children (SMC) data last 6 rounds 1 Soft copy was present
33 Zero dose children data last 6 rounds 1 Soft copy was present
34 Persistent missed children(PMC) data last 6 rounds 1 Soft copy was present
35 Tally sheet Analysis compilation data last 3 rounds 1 Soft copy was present
36 SIAs gap Analysis & review meeting presentations last 6 rounds 1
37 Post campaign Review meeting minutes last 6 rounds 1 NIDs Aug. PCRM still not done at District level
Year wise separate file for Accountability actions reward & punishment
38 (with Summary of Appreciation, Explanation,Show cause, Transfer,Job 1
termination,Job removal Letters)
39 Monthwise PTP (Seasonal) Coverage record two years comparison 1 Soft copy was present
DEOC Routine EPI Data Checklist:
40 Routine EPI Microplan 0
41 Routine EPI coverage report 1 Soft copy was present
42 Vaccine & cold chain record 0
43 Compilation of Routine EPI checklists (District staff) 0
44 District EPI review meeting minutes 0
DEOC Surveillance Data Checklist:
45 AFP Surveillance Indicators-District & Taluka wise for three years (Analysis & Displays) 1
46 Updated Line Lists (AFP ) for three years (Hard copies) 1
47 Confirm cases & Urgent cases Summaries & Detailed EPID Study 1
48 Cross notified AFP cases files (Case investigation forms) & Line list 1
49 Excluded cases line lists 1
50 Spot Map of confirmed Cases (human & environmental) for three years 0
51 Spot Map of AFP Cases for three years 1
52 Spot Map of Active and Zero Sites with Surveillance network list 1
53 Monthly Plan Active Surveillance site visits District level (DSC/DSO& IO) 1
54 Compiled Surveillance reports Active surveillance,Zero sites(with Timeliness & Completeness) 1

& VPDs
55 Health seeking behavior (HSB) data 1
56 Record of AFP Surveillance training plans and training reports 1
57 Minutes of Monthly District Surveillance review meetings 1
Numerator 45.5
Denominator 56
81
Interpretation: Pass
Final score(%)
Interpretation: >75=Pass; 60-75=Needs improvement; <60% Fail
Backup-Supplementary Immunization Activities (SIAs)/Operations
HR Turnover in selective 6 UCs (Source: DDM Payment File)- SMT WORKERS DATA ONLY
Breakup
UC Comparison of Total Workers % replacment
Replacment AIC Fixed Transit Mobile UCMO Total
Jan to Mar 165 4 4 0 46 0 54 33
CATTLE COLONY-3 Mar to May 189 4 6 0 71 0 81 43
(Target 18129) May to Jun 192 0 4 0 44 0 48 25
Jun to Aug 199 8 2 0 53 0 63 32
Jan to Mar 6 0 2 0 0 0 2 33
Mar to May 6 0 2 0 0 0 2 33
REHRI-2
May to Jun 5 0 0 0 0 0 0 0
Jun to Aug 7 0 2 0 0 0 2 29
Jan to Mar 19 0 2 4 0 2 8 42
Mar to May 19 0 4 6 0 0 10 53
MUSLIMABAD-2
May to Jun 18 0 4 4 0 0 8 44
Jun to Aug 18 0 4 4 0 0 8 44
Jan to Mar 10 0 2 2 0 2 6 60
Mar to May 8 0 0 2 0 0 2 25
MUZAFARABAD-1
May to Jun 11 0 4 4 0 0 8 73
Jun to Aug 10 0 4 2 0 0 6 60
Jan to Mar 324 6 2 0 44 2 54 17
LANDHI-5 Mar to May 391 10 4 4 119 7 144 37
(Target 50352) May to Jun 393 2 2 0 81 0 85 22
Jun to Aug 390 0 1 4 65 0 70 18
Jan to Mar 9 0 2 0 0 2 4 44
Mar to May 10 0 2 0 0 4 6 60
QUAIDABAD-4
May to Jun 7 0 0 0 0 0 0 0
Jun to Aug 9 0 4 0 0 0 4 44
UC Muzaffarabad
AIC name: Shumaila Anjum AIC name: Saima Hameed
UC name: Cattle Colony Team number: 48 Day: 3 Team number: 42 Day: 2
Tally DEOC Tally DEOC
Variables selected for assessed 2A vs 2B vs 2A vs 2A vs 2B vs 2A vs
sheet vs sheet vs
vs 2A 2B DEOC IDMS DSC vs 2A 2B DEOC IDMS DSC
Total household vaccination (Children vaccinated in HH-first visit)
100% 0% 0% 100% 100% 100% 0% 0% 100%
Total street vaccination by mobile team 75% 0% 0% 100% 100% 100% 0% 0% 100%
Total recorded NA 100% 0% 0% 100% 100% 100% 0% 0% 100%
Total recorded Refusals 0% 0% 0% 100% 0% 100% 0% 0% 100%
Total children vaccinated at school/Madrassa 0% 0% 0% 100% 0% 100% 0% 0% 100%
Total guest children vaccinated 67% 0% 0% 100% 100% 100% 0% 0% 100%
Total children from HRMP vaccinated 0% 0% 0% 100% 0% 100% 0% 0% 0%
Total dose given 100% 0% 0% 101% 100% 100% 0% 0% 98%
Total dose used 100% 0% 0% 101% 100% 100% 0% 0% 99%
Total Households on tally sheet? 100% 0% 0% 0% 100% 100% 0% 0% 100%
Total still missed children 100% 0% 0% 100% 100% 100% 0% 0% 100%
Total children covered the same day 100% 0% 0% 100% 100% 100% 0% 0% 100%
Total # of Recorded missed (A: front, B: Back of tally sheet) 100% 0% 0% 100% 100% 100% 0% 0% 100%
Zero dose for RI# or 0? 100% 0% 0% 100% 100% 100% 0% 0% 100%
AFP reported? 0% 0% 0% 0% 0% 100% 0% 0% 100%
Tally sheet signed by AIC ? 0, once , twice 0% 0% 0% 0% 100% 0% 0% 0% 100%
Team Total Score 99% 0% 0% 79% 100% 94% 0% 0% 94%
UC Total Score 52%
UC Muslimabad
AIC name: Reema Khan AIC name: Farzana
sheet vs sheet vs
100% 0% 0% 100% 100% 100% 0% 0% 100% 100%
Total street vaccination by mobile team 100% 0% 0% 100% 100% 0% 0% 0% 100% 0%
Total recorded NA 100% 0% 0% 100% 100% 100% 0% 0% 100% 100%
Total recorded Refusals 100% 0% 0% 100% 100% 100% 0% 0% 100% 100%
Total children vaccinated at school/Madrassa 0% 0% 0% 100% 0% 0% 0% 0% 100% 0%
Total guest children vaccinated 100% 0% 0% 100% 100% 0% 0% 0% 100% 0%
Total children from HRMP vaccinated 121% 0% 0% 100% 100% 87% 0% 0% 100% 100%
Total dose given 100% 0% 0% 100% 100% 100% 0% 0% 107% 100%
Total dose used 100% 0% 0% 100% 100% 100% 0% 0% 157% 100%
Total Households on tally sheet? 100% 0% 0% 0% 100% 100% 0% 0% 0% 100%
Total still missed children 100% 0% 0% 100% 100% 100% 0% 0% 100% 100%
Total children covered the same day 100% 0% 0% 100% 100% 100% 0% 0% 100% 100%
Total # of Recorded missed (A: front, B: Back of tally sheet) 100% 0% 0% 100% 100% 100% 0% 0% 100% 100%
Zero dose for RI# or 0? 100% 0% 0% 100% 100% 100% 0% 0% 100% 100%
AFP reported? 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%
Tally sheet signed by AIC ? 0, once , twice 200% 0% 0% 0% 50% 100% 0% 0% 0% 100%
Team Total Score 98% 0% 0% 80% 100% 99% 0% 0% 66% 100%
UC Total Score 54%
UC Rehri Goth
AIC name: Zarina Afreen AIC name: Razia
sheet vs sheet vs
97% 0% 0% 100% 100% 100% 0% 0% 100% 100%
Total dose given 100% 0% 0% 100% 100% 100% 0% 0% 100% 100%
Total dose used 100% 0% 0% 100% 100% 100% 0% 0% 100% 100%
AFP reported? 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%
Team Total Score 96% 0% 0% 72% 100% 97% 0% 0% 73% 99%
UC Total Score 54%
UC Cattle Colony
AIC name: Rubina AIC name: Hina
Tally Tally
Variables selected for assessed 2B vs DEOC vs 2B vs DEOC vs
sheet vs 2A vs 2B sheet vs 2A vs 2B
2A DEOC IDMS 2A DEOC IDMS
Total household vaccination (Children vaccinated in HH-first visit) 100% 0% 0% 100% 100% 0% 0% 100%
Total street vaccination by mobile team 100% 0% 0% 100% 0% 0% 0% 100%
Total recorded NA 0% 0% 0% 100% 114% 0% 0% 100%
Total recorded Refusals 0% 0% 0% 100% 75% 0% 0% 100%
Total children vaccinated at school/Madrassa 0% 0% 0% 100% 0% 0% 0% 100%
Total guest children vaccinated 0% 0% 0% 100% 100% 0% 0% 100%
Total children from HRMP vaccinated 0% 0% 0% 100% 0% 0% 0% 100%
Total dose given 133% 0% 0% 100% 100% 0% 0% 100%
Total dose used 100% 0% 0% 100% 100% 0% 0% 100%
Total Households on tally sheet? 100% 0% 0% 100% 100% 0% 0% 0%
Total still missed children 0% 0% 0% 98% 100% 0% 0% 100%
Total children covered the same day 0% 0% 0% 101% 100% 0% 0% 100%
Total # of Recorded missed (A: front, B: Back of tally sheet) 0% 0% 0% 100% 100% 0% 0% 100%
Zero dose for RI# or 0? 100% 0% 0% 100% 0% 0% 0% 100%
AFP reported? 0% 0% 0% 0% 0% 0% 0% 0%
Tally sheet signed by AIC ? 0, once , twice 100% 0% 0% 0% 100% 0% 0% 0%
Team Total Score 92% 0% 0% 100% 99% 0% 0% 74%
UC Total Score 50%
UC Landhi 5
AIC name: Shama Naz AIC name: Azra
Tally Tally
Variables selected for assessed 2B vs DEOC vs 2B vs DEOC vs
sheet vs 2A vs 2B sheet vs 2A vs 2B
2A DEOC IDMS 2A DEOC IDMS
Total household vaccination (Children vaccinated in HH-first visit) 100% 0% 0% 100% 100% 0% 0% 100%
Total street vaccination by mobile team 100% 0% 0% 100% 100% 0% 0% 100%
Total recorded NA 100% 0% 0% 100% 0% 0% 0% 100%
Total recorded Refusals 100% 0% 0% 100% 0% 0% 0% 100%
Total children vaccinated at school/Madrassa 100% 0% 0% 100% 0% 0% 0% 100%
Total guest children vaccinated 100% 0% 0% 100% 100% 0% 0% 100%
Total children from HRMP vaccinated 0% 0% 0% 100% 0% 0% 0% 100%
Total dose given 100% 0% 0% 100% 114% 0% 0% 100%
Total dose used 100% 0% 0% 100% 100% 0% 0% 100%
Total Households on tally sheet? 100% 0% 0% 100% 100% 0% 0% 100%
Total still missed children 100% 0% 0% 100% 100% 0% 0% 100%
Total children covered the same day 100% 0% 0% 100% 0% 0% 0% 100%
Total # of Recorded missed (A: front, B: Back of tally sheet) 100% 0% 0% 100% 100% 0% 0% 100%
Zero dose for RI# or 0? 100% 0% 0% 100% 0% 0% 0% 100%
AFP reported? 0% 0% 0% 0% 0% 0% 0% 0%
Tally sheet signed by AIC ? 0, once , twice 100% 0% 0% 0% 100% 0% 0% 0%
Team Total Score 100% 0% 0% 100% 96% 0% 0% 100%
UC Total Score 46%
UC Quaidabad
AIC name: Shabana Shaheen AIC name: Reshman
sheet vs sheet vs
95% 0% 0% 118% 100% 126% 0% 0% 100% 100%
Total dose given 100% 0% 0% 100% 100% 100% 0% 0% 100% 100%
Total dose used 100% 0% 0% 100% 100% 100% 0% 0% 100% 100%
AFP reported? 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%
Team Total Score 97% 0% 0% 71% 100% 96% 0% 0% 71% 100%
UC Total Score 54%
Recorded & Still Missed Jan – Aug 2022 (District Malir)
UC Type UCPO UCOO UCCO ALSM HHSM AIC CHW/TEAM
CBV/SMT 20 16 20 82 161 270 1702
Recorded Missed Children Still Missed Children

80000 12000
10579
69349
66359
65632
70000
62285
60824
10000
8707
53889
60000
52031
50765
48689
7441
8000
46072
50000
6513
6441
6099
40000 6000
4872
4066
4046
3835
30000
3395
3308
4000
3252
3189
2791
15460
14867
14752
20000 14328
13596
2000
10000
0 0
Jan Mar May Jun Aug Jan Mar May Jun Aug Jan Mar May Jun Aug Jan Mar May Jun Aug Jan Mar May Jun Aug Jan Mar May Jun Aug
Recorded Missed Recorded NA Recorded Refusal Still missed
Recorded Missed Still NA NA
Recorded Still Refusals
Recorded Refusal
Recorded & Still Missed Jan – Aug 2022 (UC Cattle Colony)
CBV 1 0 1 4 0 20 77

2500 250
2296
2240
227
2167
2164
212
2031
201
2000 200
1776
177
1649
1637
168
1617
155
1451
1500 150
128
125
123
104
103
1000 100
74
73
603
580
550
520
515
500 50
44
30
0 0
Recorded Missed Recorded NA Recorded Refusal Still Missed
Recorded Missed StillRecorded
NA NA Recorded Refusal
Still Refusals
Recorded & Still Missed Jan – Aug 2022 (UC Rehri)
CBV 1 4 1 4 0 22 87

4500 500
4231
449
3869
3791
4000 450
3622
3532
3367
3343
400
3248
3500 3137
350
2794
3000
311
307
301
300
258
2500
234
250
2000
192
191
200
153
148
148
1500
150
119
116
110
1000
100
81
609
502
454
448
395
500 50
0 0
Recorded Missed Recorded NA Recorded Refusal Still MissedMissed
Recorded Recorded
Still NA NA Still
Recorded Refusal
Refusals
Recorded & Still Missed Jan – Aug 2022 (UC Muslimabad)
CBV 2 3 1 6 6 16 128

4500 1400
4200
1273
4051
4000
3674
1200
1092
3312
3265
3500
3089
3006
2840 1000
3000
847
2558
809
2495
2500 800
645
2000 600
511
506
464
447
1500
386
1111
1045
400
336
319
834
1000
817
707
204
187
182
200
500
0 0
Recorded Missed Still NA
Recorded NA Recorded
Still Refusal
Refusals
Recorded & Still Missed Jan – Aug 2022 (UC Muzafarabad)
CBV 1 3 1 4 6 18 144

6000 1800
5199
1547
1600
4958
4923
5000
4554
1400
4256
4232
1234
4108
4053
1170
1095
4000 1200
3646
3510
1000
899
854
3000
800
647
2000 600
491
486
377
335
400
327
943
908
905
815
241
1000
722
159
156
200
0 0
Recorded Missed Still NA
Recorded NA Still Refusals
Recorded Refusal
ICM, PCM & LQAS Trend Jan – Aug 2022, Malir
% ICM % PCM % LQAS
100 97 97 100
94 93 92 100 97 97
90 92
92
90 90 90
80 80 80
70 70 70
60
60 60 60
50 50
50 50 50
40 40 40
30 30 30 25
20 20 20
10 10 10
0 0
0 0
Jan-22 Mar-22 May-22 Jun-22 Aug-22 Jan-22 Mar-22 May- Jun-22 Aug-22 Jan-22 Mar-22 May-22 Jun-22 Aug-22
22

% Missed Children found in Monitoring Jan – Aug 2022, Malir
% ICM % PCM % LQAS
100% 3 3 1 2 100% 100%

5 1
18 11 3 2 2
11 16 3
90% 90% 90% 5
6
37
80% 24 80% 3 80%
49 27
26 8
70% 70% 70% 9
4 6
60% 28 60% 60%
15 78
9 12 13
50% 27 50% 50% 13
40% 40% 40%

7 6
70 73
30% 71 30% 30%
12
66 5
20% 65 20% 20%
7 5
10% 10% 4 4 10% 5
3 1 15
1 1 1
0% 0% 0%
Jan Mar May Jun Aug Jan Mar May Jun Aug Jan Mar May Jun Aug
# NA# Ref # MC # MH
Missed Children Coverage
Activity
5th Sep-10th Sep
Missed Children Coverage Status – Cumulative up to (7 th Sep’22)
Targeted Cov Cov

Cov Targeted Cov Targeted Targeted Cov Targeted Cov
Targeted Slum of Slum of #of
District of Still Sick of Sick #of PMCs Slum of Slum Zero Dose of Zero
Still Ref Refusal Refusal PMCs
Ref Refusal Refusal Refusal PMCs PMCs PMC Dose PMC
Total Total Refusal
CENTRAL 7533 410 633 54 1856 225 2644 152 535 121 19 65
EAST 9914 306 689 66 2911 192 5044 53 1258 25 52 19
ERU GUJRO 1056 53 278 20 713 43 459 19 307 14 183 4
KAMARI 3986 232 579 52 3518 191 2091 97 1824 73 299 10
KORANGI 4725 211 486 35 737 27 2134 55 328 12 28 3
MALIR 3835 442 596 74 2492 283 2019 168 1274 105 210 82
SOUTH 2221 359 348 73 752 127 520 51 154 22 6 3
WEST 2775 109 688 57 1835 80 1370 21 771 17 226 5
Grand Total 36045 2122 4297 431 14814 1168 16281 616 6451 389 1023 191
Data Source: Online link as of 8 Sep-22, 9:30 am

Town Wise Admin Coverages NIDs Aug 2022, District Malir
Total Still
Total
Total Recorded Covered missed
Town Target Coverage Recorded Covered Recorded Covered Missed Total Total Still Still NA Still Ref among Children
NA NA% Ref Ref% Missed (#) (#) (#) approach
(%) Total (%) Target ed (%)
(%)
BINQASIM 183397 104 23862 93% 6370 78% 30232 90% 3163 1738 1425 1.72 106%
GADAP 51961 103 4181 93% 505 80% 4686 92% 375 276 99 0.72 104%
LANDHI 82311 98 13549 86% 5715 72% 19264 82% 3487 1878 1609 4.24 102%
MALIR 65776 100 12297 92% 2870 76% 15167 89% 1682 980 702 2.56 102%
Grand Total 383445 102 53889 91% 15460 75% 69349 87% 8707 4872 3835 2.27 104%

Communication Assessment-
Positive environmental sample Bakhtawar Nala
Malir
Key Findings FGDs With FLWs (SMT UCs)
(No Of Participants= 14)
 15/362 (4%) of UC-3 and 8/154 (5%) of UC-5 Landhi Town workers turn over in each campaign affect our work quality
in SMT UCs. New faces occur issues in interacting with families and indirectly refuse vaccination
 Multiple knocks/campaigns are the cause of community fatigue and increasing new refusals
 In the social profiling questionnaire community dislike answering about their tribes and caste
 UC-3 Landhi Town Railway Colony (Hindu basti) majority of the targeted children are NA as mothers take their
children early morning for bagging and return late evening
 Partially covered refusals is the key challenge to minimizing the refusal coverage.
 Capacity building and lack of interest in SMT UCs cause poor IPC skills of the teams due to which teams are not
probing properly and not recording proper data.
 Registration books should be provided in SMT UCs for proper use of record children
 Remaining PMCs are the challenge as some of them are also RI refusals and zero dose for OPV
Key Findings FGDs With FLWs (CBV UCs)
(No Of Participants= 30)
 73% (22/30) FLWs participants shared that multiple revisits on NA houses are converting into refusals, UC level staff
forcing the teams for revisiting despite the late arrival date given by the NA household
 Due to Medicines availability at EPI centers of ISD dispensaries community also demands medicine during EOA
activities
 Vital Vaccinators are forcing teams to record less zero dose children
 SMC refusals are converting into rigid refusals due to team’s visits during Friday prayer timings
 In front of chronic refusals sometimes influencers also suggest teams not to vaccinate the children if parents are not
willing.
 Special orientation of vaccinators at Fix Sites, ISDs, and EPI Centers for counseling of refusals
 Partially covered refusals is the key challenge to minimize the refusal coverage. School administration is not sensitizing
parents for vaccination
 During intra campaign HHSMs are showing AS’s refusals coverage as their own coverage during intra campaign
FGDs With Community
(No Of Participants= 35, 2 Session)
 Some of the mothers have misconception that OPV is the cause of infertility
 Majority of the refusals from priority-1 population are male dominant
 Mothers get confused for OPV administration because of negative rumors for polio
vaccination
 At ISD dispensaries medicines are not provided properly to the patients
 Private Schools administration isn’t cooperating with polio teams
 Community Suggested events for children at major private schools where parents should be
invited & to sensitize for polio vaccination
Interviews With Key Informants
The key informant interviews were conducted with DC, DDPO, IO, DCO/ERUCO of District Malir:
 24% (2/4) of key informants shared that there is poor management and poor accountability for follow-up
of missed children
 100% (4/4) of key informants shared Poor community support (community leaders do not support, etc) is
key challenge to minimize the still issued children specially PMC refusals
 75% (3/4) of key informants shared due to mobility of the population is the key challenge for high
number of missed children
 75% (3/4) of key informants shared that now still refusals are those who have been approached multiple
times with multiple strategies (relevant influencers engaged) but still they are refusing
 Now still refusals are those who have been approached multiple times with multiple strategies (relevant
influencers engaged) but still they are refusing
 Training capacity issues of FLWs and government accountable LHWs , LHS and UCMOs in communication
 Demanding refusals increased due to water and sanitation issues along with drinking water issues
 Lack of ISD services other than SHRUCs
COMMUNICATION ASSESSMENT DISTRICT MALIR
District Level Y N Remarks
1 Social profile of the district is available 1 0
1.1 Social profile of the district includes HR&MPs 1 0
1.2 Social profile of the district includes hard to reach areas NA NA
1.3 Social profile of the district includes list of influencers/ 1 0

religious leaders
2 Local issues-based communication plan/ strategy available 1 0
Human resource/structure (DHCSO, PSTF, other) available

3 to implement the communication plan/ strategy 1 0
3.1 Check if the human resource is local? 1 0
Check if the human resource is trained in relevant

3.2 disciplines especially social mobilization and IPC? 1 0
Total (%) 100% 0%

COMMUNICATION ASSESSMENT OF 6 UCs OF DISTRICT MALIR (1/2)
(4 Draining UCs and Two Bordering UCs)
UC/ Area level
# of Responses = 11 Y N Remarks
4 Does the Micro plan include social profile of the area 6 0
Does the Micro plan's social profile of the area include mapping of
4.1 6 0
HR&MPs
Does the Micro plan's social profile of the area include mapping of
4.2 NA NA
hard-to-reach areas
Does the Micro plan's social profile of the area include list of Influencers is available at district level but not
4.3 6 0
influencers identified incorporated in UC level Micro plan
Does the Micro plan's social profile of the area include list of
4.4 targeted schools available 6 0
Plans are available in micro plan but not specific

5 Does the micro plan include social mobilization plan 6 0
to UC challenges.
Are there special persons assigned in UC for communication and

6 social mobilization (SM/RSP/UCCO) 6 0
7 IEC Material received at the UC/ Area level 6 0 Only Banners
7.1 IEC Material used at the UC/ Area level N/A N/A
8 What type of communication material is being used 6 0 Banners Source: UC MP Desk Review And UCMO
COMMUNICATION ASSESSMENT OF 6 UCs OF DISTRICT MALIR (2/2)
(4 Draining UCs and Two Bordering UCs)
UC/ Area level Y N Remarks
Is the communication material/ messages developed suitable for the

9 NA NA
target population and the area (content, context and language )
10 Does the UPEC implement the social mobilization plan 6 0
11 Is the UPEC composition according to the NEAP standards 6 0
12 Community engagement sessions planned and conducted were as per 5 1

programme needs
13 Does the UC / area has maintained data on refusals 6 0
13.1 Refusals data is classified as reasons of refusals 6 0
14 Does the UC MO has plan for refusal conversion 6 0
15 Is the UCMO aware of the status of the still missed children 6 0
Total (%) 99% 1% Source: UC MP Desk Review And UC Level

Staff
Communication Assessment A - District Level Assessment
District Form A & B District Malir

N D Score
ERUCO/
Questions: What does s/he think are the main obstacles to reducing the number
DDPO
DCO
S#
DC
IO
of missed children in the village/settlement?
1 Limited financial resources 0 0 0 0 0 4 0%
2 Poor management, inadequate supervision, or poor accountability 0 0 1 1 2 4 50%
3 Inadequate/inappropriate IEC materials and messages 0 0 0 0 0 4 0%
4 Poor team performance 1 0 0 0 1 4 25%
5 Poor social mobilization performance 0 0 0 0 0 4 0%
6 Poor community support (community leaders do not support, etc) 1 1 1 1 4 4 100%
7 Inaccessibility (due to geographic complexity, security issues, etc 0 0 0 0 0 4 0%
8 Mobility of the population 1 1 1 0 3 4 75%
9 Others Specify: 1 1 1 0 3 4 75%

• 24% (2/4) of key informants shared that there is poor management and poor accountability for follow-up of missed children.
• 100% (4/4) of key informants shared Poor community support (community leaders do not support, etc) is key challenge to minimize the still issued children specially PMC refusals.
• 75% (3/4) of key informants shared due to mobility of the population is the key challenge for high number of missed children.
Others Specify:
• Now still refusals are those who have been approached multiple times with multiple strategies (relevant influencers engaged) but still they are refusing.
• Training capacity issues of FLWs and government accountable LHWs , LHS and UCMOs in communication.
• Demanding refusals increased due to water and sanitation issues along with drinking water issues.
• Lack of ISD services other than SHRUCs.
Source: Field Investigation
C. Community Risk Assessment Source: Field Investigation
Do people in this community accept routine

1 immunization services? 1- Yes 75% 2. Somewhat 20% 3. Not at all 5%
Do people in this community support polio

2 1- Yes 80% 2. Somewhat 15% 3. Not at all 5%
immunization services?
3 Is this community secure for polio workers? 1. Consistently 95%

2. Sometimes 5% 3. Insecure 0%
Secure insecure
How accessible is this community in terms of
geographic/residential characteristics (e.g. 2. Somewhat 3. Chronically
4 remote, no bridge over a river, scattered 1. Accessible 100%
accessible
0%
inaccessible
0%
settlement, slum, high rise etc.)?
Does the community have any special 2. Migrant 3. Internally
5 populations that are at increased risk of being 1. Nomadic 1% 20% 10% 4. Others 69%
missed by immunization services? workers Displaced
• Capacity issues of staff going for refusal coverage and is without planning.
• Community believe in western conspiracy & OPV cause infertility.
In your opinion, what are other local barriers • Majority of guest came from KPK refusal of vaccination.
• Community is reluctant provide any response to the influencer because they are irritated due to
6 or challenges to implementation of polio frequent visits of Teams
campaigns? • Rotary filter plant is not working from day one.
• Water and sanitation problem specially in TSCs.
• Proper training of staff especially on how to address PMC refusals/

• Doctors should be involved in communication activities to address the issues of community.
In your opinion, what could be done to • Systematic Engagement of relevant influencer in the field for refusal conversion.
7 overcome these barriers or challenges you • Filter plant should be handed over to community notables and they will support to run the plant
mentioned? properly.
• District administration and health office should pay attention to local genuine issues of community.
Refusal Profile Validation
Tribe Language Religious/Sect PMC Status
17% 3%
12%
48%
52%
83%
88%
97%
Matched Not Matched Matched Not Matched Matched Not Matched Matched Not Matched
Zero Dose Status PENTA III Status IPV Status
36% 34% 34%
64%
66% 66%
Matched Not Matched Matched Not Matched Matched Not Matched

Communication Action Plan- Malir
KEY FINDINGS RECOMMENDATIONS
• Re-do all the profiling and challenge mapping activity in District Malir
• Poor Social data collection and monitoring
mechanism for communication- More than • Refusal profile validation- at least 15% after each campaign by DEOCs/senior staff
20% of the social data mis-matched in the field • Proper usage of social data to develop communication plans accordingly
• Improve challenge mapping at UC & district level- Key challenges must be brought up at
Impact analysis of key Comm’s interventions at the District level to develop plans accordingly
• Should ensure documentation of all the key comm’s intervention with a proper mechanism
UC/DEOC level •
to assess the impact at UC/DEOC level
• Capacity building of staff on social analysis and data-based planning for refusal coverages
• Develop proper plans and extend social investigation mechanism for missed children
especially PMCs- Identification and engagement of new & relevant influencers – Strategic
• Lack of strategic approach for covering missed approach to engage administration
children-Multiple knocks with-out proper plans • Minimize multiple knocks- should sensitize FLWs/Comm’s team on how to approach missed
creating fatigue and resistance in community children/refusals
• Engagement sessions with HR communities/stakeholders to emphasize on repeated
vaccination- Enhance female engagement, especially from religious institutes, local health
care providers & TBAs
• Lack of coordination among different service • Develop joint integrated plans among all the service providers/partners (ISD, PEI, vital, EPI)
providers and partners in SHRUCs- Lack of • Systematic usage of human resource available- ensure proper accountability mechanism
Proper usage of HR and other resources in with clear roles and responsibilities
SHRUCs • Joint plan to improve RI services with special focus on Zero dose and PMCs refusals in
SHRUCs
Backup-Routine EPI-ISD-PEI/EPI Synergy
Status of EPI Centers and Vaccinators, District Malir
Town Number of TSVs Number of EPI Number of Remarks
Centers Vaccinators
Bin Qasim Town 1 24 49 43 Govt, 6 VPT
Landhi Town 2 (1 for SHRUCs) 14 29 18 Govt, 9 WHO, 2 VPT
Malir Town 1 6 13 11 Govt, 2 Private
Gadap Town 1 18 25 23 Govt, 2 Private
Total 5 62 116
Status of EPI Centers and Vaccinators in Draining UCs

Town Union Council Number of EPI Number of Remarks
Centers Vaccinators
Rehri 3 7 4 Govt 3 VPT
Bin Qasim Cattle Colony 4 8 7 Govt, 1 VPT
Quaidabad 3 5 5 Govt
Muzafarabad 4 8 2 Govt, 5 WHO, 1 VTP
Landhi
Muslimabad 6 11 6 Govt, 3 WHO, 2 VTP
Total 20 39
Synergy perspective
Detail Of District Malir Karachi
Number of Number of Number of Number of Number of
S.No Number of Name of Ucs District Town Remarks
Town UCs EPI Centres Supervisors Supervisors Vaccinators
UC-1, Ibrahim Hydri

UC-2, Rerhi
UC-3, Cattle colony 1-THO
1 Bin Qasim UC-4,
7 24 1-Focal 49 43 Govt & 6 Vital Pakistan
Town Qaidabad Person
UC-5, Landhi 1-TSV
UC-6, Gulshan-e-Hadeed
UC-7, Gahgar
UC-1, Muzzafarabad
116 Vaccinators 1-THO
Landhi UC-2, Muslimabad 1-Focal 1-Focal 18 Govt, 9 WHO, 2 Vital
2 Town Chorangi UC-3, Dawood 5 14 Person 29 Pakistan
UC- Person
1-DSV 2-TSV
4, Moinabad
UC-5, Sharafi Goth
UC-5, Jaffer Tayyar
3 Malir Town
UC-6,
Ghareebabad 4 6
1-THO
1-Focal 13 11 Govt, 2 Private
644 LHWs
UC-7, Ghazi Brohi Person
UC-8, Malir 1-TSV
Cantt
UC-1, Murad Memon 1-THO
4 Gadap UC-2, Darsano 3 18 1-Focal
25 23 Govt, 2 Private
Town Chano UC-3, Person 2-
Gadap TSV
Total 19 62 3 11 116 1 KMC,6 PVT
CHWs
Town UC NAME UCMO UCPO UCOO UCCO ALSM AS HHSM Team
(Members)
Landhi Muzafarabad-1 3 2 3 1 6 18 72 72 144
Landhi Muslimabad-2 2 2 3 1 6 16 64 64 128
Binqasim Rehri-2 2 1
Binqasim Cattle colony-3 2 1
56840 CHW11 Teams
4
4
23
20
0
0
92
77
92
154
Binqasim Quaidabad-4 2 1 3 1 5 22 0 82 82
Binqasim Landhi-5 5 1 0 1 6 45 0 181 362
Recommendations – EPI, Synergy, ISD (1/2)
• Implementation of PEI-EPI Synergy framework with letter and spirit.
• Bottom-up approach to prepare EPI quarterly microplans/outreach plans jointly, involving Vaccinators,
TSVs, AS CHW, LHSs)
• District EPI FP and DSV to enhance supportive supervision in draining UCs (not merely by TSVs)
• Joint monitoring and supportive supervision plan by DHMT & DEOC team (including LHWs program)
prioritizing S/VHRUCs
• Accountability – need to be on place to track the performance. Support of technology is available, need to
be utilized – both for Vaccinator’s activities as well as monitoring & supervision status.
• Active participation of PEI colleagues in monthly EPI review meetings.
• EPI to be integral part of daily evening review meetings during SIAs and PCRMs
• Provision of copies of microplans, outreach plans, list of defaulters, ZD, SMCs, PMCs to all fix & OR sites
• Coverage of ZD children, SMCs and PMCs to be addressed together with coverage of due and defaulter’s
children – this will benefit both the programs and shall enhance the coverage.
• 5-8 days crash programs are not the long-term solutions. Need of the hour is to implement and monitor
the outreach sessions planned Vs conducted on regular basis.
• Rationalization of Vaccinators with involvement of all Vaccinators in outreach activities (other than 1
Vaccinator/EPI center)
Recommendations – EPI, Synergy, ISD (2/2)
• Detailed training of CHW’s on EPI schedule especially for referring of due/defaulter children
• Special community mobilization for RI antigens to mobilize ZD, SMC and PMCs
• Improvised mechanism of data sharing of ZD and defaulter children between CBVs network, LHWs and
Vaccination staff.
• Leveraging the resources of private sector (VPT, SINA, Agha Khan PHC and others) – sharing ZD lists, info for
SIAs & provision of FMs etc.
• Policy decision on provision of analgesics/antipyretic to ZD/defaulter children
• SMT UCs need special plan for accessing the ZD children as Vaccinators & UCCO are unable to find the
addresses
Integrated Service Delivery

• Implementation of all the services as per ISD Action plan
• Monitoring & supervision as per ISD Action plan to track the performance.
• Supervision & monitoring mechanism from DEOC & DHMT, not merely by the SHRUCs team
• Staff Capacity building for record keeping.

21Sept22-Positive ES Landhi Investigation

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21Sept22-Positive ES Landhi Investigation

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Investigation WPV-1 Isolate Environmental site

14-22 September 2022

Socio – economic Bifurcation Population Ethnicity

ES WPV-1 POSITIVITY TREND 2019-2022

Source: Provincial Surv. Unit, Sindh

East-Gadap Machhar Colony

KARACHI Keamari-Baldia M. Khan Colony

Keamari-SITE Orangi Nalla

Malir-Landhi Bakhtawar Goth

Korangi Korangi Nalla –Comp.**

Central-Liaquatabad Haji Mureed Goth

South-Saddar Hijrat Colony -PIDC Nalla

Sindh: last positive ES was in May 2021 from KORANGI

Source: Provincial Surv. Unit, Sindh

2013 REHRI - 2 SD/62/13/011 MALE 8 SINDHI 18-Oct-13 3 1

2014 MUZAFARABAD - 1 SD/69/14/008 MALE 12 PASHTU 6-Jun-14 0 0

2014 SHARAFI GOTH - 5 SD/69/14/012 MALE 12 PASHTU 8-Jul-14 2 6

2014 REHRI - 2 SD/62/14/009 MALE 20 PASHTU 30-Aug-14 1 7

2014 REHRI - 2 SD/62/14/011 MALE 8 SINDHI 22-Oct-14 0 4

2020 MUZAFARABAD - 1 SD/69/20/020 MALE 60 PASHTU 9-Jun-20 0 7

NP-AFP Stool Adequacy Detection Within 7 Days

EV Isolation SL Isolation Good AFP Rate

From draining Ucs: Cases reported 27 E-listed cases 45

2019 87 8 28 2019 65 2 33 23 • 2 AFP cases were reported by

REHRI-2 113% MUSLIMABAD-2

Expected AFP Cases Notified

Landhi Muzaffarabad 2 09 15% 78% 88% 00 00

Landhi Muslimabad 2 08 13% 100% 100% 01 01

Bin Qasim Town Rehri 2 05 18% 100% 100% 04 00

Bin Qasim Town Cattle colony 2 05 18% 100% 100% 00 00

1 died (EPID-16 due to

Binq UC-2 5 0 27M 0 0 01(34) 02(25,34) 0 0 NA

Source: Provincial Surv. Unit, Sindh

0 dose 1-2 dose 3 dose

Source: Provincial Surv. Unit, Sindh

0 dose 1-2 dose 3 dose 4-6 dose 7 & Above

Source: Provincial Surv. Unit, Sindh

Total 27 AFP cases 22 (82%) 2 (7.4%) 24 (89.4%) 2 (7.4%) 1 (3.7%)

Source: Provincial Surv. Unit, Sindh

Draining UCs Adjoining to Draining UCs

Source: Provincial Surv. Unit, Sindh

80% (IDPs arriving after SIAs Aug22)

UC-3 BinQasim Town:

Source: Provincial Surv. Unit, Sindh

Source: Provincial Surv. Unit, Sindh

N Y 0 dose 1-2 dose 3 doses

BALOCHI SINDHI PUNJABI PASHTO HINDKO AFGHANI URDU SIRAIKI HAZARA

Source: Provincial Surv. Unit, Sindh

Sindh Afghanistan Punjab Baluchistan KPK

Source: Provincial Surv. Unit, Sindh

BALOCHISTAN JAFFARABAD SINDH KAMBAR SINDH KASHMORE SINDH KHAIRPUR

Source: Provincial Surv. Unit, Sindh

Source: Provincial Surv. Unit, Sindh

Source: Provincial Surv. Unit, Sindh

• DEOC EQUIPMENT AND DATA

• Telephone & Muti media was not present 3

No NEAP, EPI ,Surveillance , Communication, training module or Book

• No person from DC, DHO & computer operator deputed at DEOC

• No NEAP, EPI ,Surveillance , Communication, training module or Book

• DEOC SIAs Pre-campaign Data Checklist:

• Routine & Surveillance part not present in DPEC PPT

• DEOC Routine EPI Data Checklist:

• Routine EPI Microplan - not present 34

• Vaccine & cold chain record - not present

EOC Dashboard as of 28th AUG 2022 09:00 AM