SPECIAL INITIATIVE REGARDING HEALTH SERVICES DELIVERY PRESENTED BY: DR. JANBAZ AFRIDI DD-EPI KHYBER PAKHTUKHWA EXPANDED PROGRAMME ON IMMUNIZATION

SPECIAL INITIATIVE FOR IMPROVING IMMUNIZATION  Government of Khyber Pakhtunkhwa has initiated Special Initiatives in the budget for improving the Mother and Child Health condition of poor and downtrodden of the province to achieve the MDGs 4 & 5.  Rs.200 & 300 Million have been allocated for Special Initiative for enhancing immunization coverage, ante natal care and encourage the skilled deliveries in the far flung and low performing districts. EXPANDED PROGRAMME ON IMMUNIZATION

SPECIAL INITIATIVE FOR IMPROVING IMMUNIZATION  To encourage the parents to get vaccinated their children against various childhood vaccine preventable diseases, Government of Khyber Pakhtunkhwa has allocated Rs Million in budget.  Rs.1000/child will be paid to parents on completion of the vaccination course of 15 months/ FIC( Fully Immunization Child).  Parents may be encouraged to retain the child Immunization Card  190,000 children will be beneficiaries of this initiative EXPANDED PROGRAMME ON IMMUNIZATION

OBJECTIVES OF THE INITIATIVE  To Improve the Immunization Coverage and reduce drop out of under 15 months  To reduce the diseases burden, disabilities and deaths in the target districts against EPI targeted diseases  To Control out breaks  To Reduce the neo Natal tetanus by immunizing the pregnant ladies EXPANDED PROGRAMME ON IMMUNIZATION

OBJECTIVES : CONTI…..  To Encourage ante natal care and to reduce the pregnancy complications which will reduce unwanted deaths in young mothers during her reproductive life/age  To Encourage the skilled deliveries in the public hospital  To Improve the birth registration EXPANDED PROGRAMME ON IMMUNIZATION

IMPLEMENTING DISTRICTS FOR IMMUNIZATION 1.Battagram2. Buner 3. Chitral4. Dir Lower 5. Dir Upper6. Hangu 7. Kohistan8. Lakki Marwat 9. Nowshera10. Shangla 11. Tank12. Torghar EXPANDED PROGRAMME ON IMMUNIZATION

CRITERIA FOR SELECTION OF DISTRICTS  Socio Economically backward  Low routine EPI coverage  High disease burden  In- accessible and hard to reach. EXPANDED PROGRAMME ON IMMUNIZATION

SELECTION CRITERIA FOR DISTRICTS Twelve Districts of Khyber Pakhtunkhwa are selected on the following grounds:  Districts having enough resources in terms of cold chain and human resource to utilize the incentives provided in the budget by the Provincial government.  Total average Measles II coverage is 46.4 and with this incentives it is expected to increase to target of 73 % EXPANDED PROGRAMME ON IMMUNIZATION

IMPLEMENTING DISTRICTS FOR IMMUNIZATION S NoDistrictNo of housesNo of UCsTotal Populatio n <1 year<2 yearMeasles II coverage Target coverage Q ReleaseFinancial Implication 1Battagram ,14215, ,427,200 2Buner ,14225, ,960,800 3.Chitral ,83516, ,479,900 4.Dir-U28 860,50530,40229, ,038,400 5.Dir-L ,067,57837,71836, ,596,800 6.Hangue ,12516,36215, ,374,200 7.Kohistan ,61124,89423, ,935,200 8.Lakki -M ,12825,86624, ,052,800 9.Nowshehr a ,360,800 10Shangla ,42122,80321, ,909, Tank ,518,25912,28111, ,353, T Ghar ,877,1069,2718, ,965,600 EXPANDED PROGRAMME ON IMMUNIZATION

EPI-District-Wise Target population and quarterly (Jan-Mar 2014) required budget for the financial year under Special Initiative Regarding Health Services Delivery S. No District Total Population <1 Year<2 Year Measles-II coverage Total allocation for Proposed Quarterly release for Social Mobilization (Jan- Mar 2014) Proposed Quarterly release for Monitoring (Jan-Mar 2014) Proposed Quarterly release to PPHI (Jan-Mar 2014) Proposed Quarterly release for Payment to parents (Jan- Mar 2014) Total Proposed release for quarter (Jan- Mar 2014) CurrentExpected % 1Battagram , ,427, ,106,800 3,238,050 2 Buner , ,476, ,119,200 5,250,450 3Chitral , ,960, ,240,200 3,396,450 4Nowshera , ,052, ,513,200 7,669,450 5Dir Lower , ,038, ,259,600 7,390,850 6Dir Upper , ,479, ,119,975 5,276,225 7Hangu , ,596, ,149,200 3,280,450 8Kohistan , ,374, ,593,550 3,724,800 9 Lakki Marwat , ,935, ,733,800 3,890,050 10Shangla , ,360, ,840,200 3,996, Tank , ,909, ,477,375 1,608,625 12Tor Ghar , ,353, ,338,300 1,469,550 Total: , ,191,400

Penta -3 & Measles 2, District wise coverage, 2013 EXPANDED PROGRAMME ON IMMUNIZATION

DISTRICT WISE DROP OUT, 2013 EXPANDED PROGRAMME ON IMMUNIZATION

DISTRIBUTION FORMULA  Total Allocated budget of the special initiative on EPI is 200 million and further distribution or allocation  Payment to parents190.0 Million  SM activities 6.0 Million  Monitoring 3.0 Million  Bank Charges 1.0 Million EXPANDED PROGRAMME ON IMMUNIZATION

MECHANISM TO ENSURE TRANSPARENCY  To Ensure the transparency and simplify the procedure for the money among the selected beneficiaries the following criteria is suggested.  Card/ Vouchers may be printed to facilitate the process after the completion of the successful course parents may be issued the vouchers by the respective vaccination center, and parents may receive the amounts on the same day in future after transfer of the money to the districts  The bank will release the payment on provision of Immunization card/voucher/Parents ID card.  Eligibility of the children completion of immunization of the children after 31 st December 2013 EXPANDED PROGRAMME ON IMMUNIZATION

MEANS OF DISBURSEMENT  Province released the check Rs to the districts and districts will release to the banks  The following means for disbursement can be utilized to the beneficiaries:  Bank s  Pakistan Post office  Easy Paisa  UBL Omni  Cash Payments Through Notified committee  Quarter release of the amount to the districts in advance EXPANDED PROGRAMME ON IMMUNIZATION

RESPONSIBILITIES  Provincial  Budgeting  Coordination and facilitation  Policy guidelines  Supervision, Monitoring and Evaluation  Provincial level Advocacy and Social Mobilization EXPANDED PROGRAMME ON IMMUNIZATION

ACTION TAKEN BY PROVINCIAL EPI  Three meetings conducted with DHOs of the concerned districts  Presentation to DGHS  Approval accorded by the honorable Secretary Health  Implementations will be started in the first week of February  Checks has been handover to the districts for the first quarter in this Final Planning meeting(29/02/2014)  Social Mobilization printed and dispatched to the districts  Provincial Inauguration request has been sent to the HCM EXPANDED PROGRAMME ON IMMUNIZATION

RESPONSIBILITIES  Districts  Preparation of FIC( Fully Immunized Children) list, facility based and district based  List of banks and its catchment Areas  Amounts disbursement in case of any other facility is not available  Preparation of districts Monitoring Plan  Preparation of Districts SM Plan  Notification of disbursement committees  Nomination of Focal person EXPANDED PROGRAMME ON IMMUNIZATION

BUDGET ALLOCATION FOR SM/MONITORING S NOSMMonitoring Provincial1.5 million1.2 million Districts4.5 million1.8 million EXPANDED PROGRAMME ON IMMUNIZATION

SOCIAL MOBILIZATION  Provincial inauguration  Press briefing at Provincial level.  Awareness/Orientation sessions with DHOs and EPI Coordinators and other stake Holders  Preparation of Banners, flyers and other IEC material  Involvement of other stake holders like PPHI & Education department etc  UNICEF has agreed to provide support in IEC Material later on  UNICEF has agreed to support the inaugurations at provincial level EXPANDED PROGRAMME ON IMMUNIZATION

SOCIAL MOBILIZATION  District inauguration followed by UCs inaugurations.  Press briefing at District level.  Awareness sessions in Schools and Madrassas,  To sensitize all health care providers (Medics & Paramedics of health facility)  All EPI technicians  LHWs & LHSs should be trained and sensitized to create awareness in the community through mothers counseling & compound dialogue  Involvement of PPHI at districts( Chitral, Dir Upper, Shangla, Nowshehra & Lakki Marwat) level EXPANDED PROGRAMME ON IMMUNIZATION

BUDGET FOR SOCIAL MOBILIZATION FIRST Q EXPANDED PROGRAMME ON IMMUNIZATION S.NoActivityCost allocationTotal for 3 Months/ District Total for 6 months for 12 districts 1District inauguration ( 12 ) 1.8million4.5 2UC inauguration ( 315 )/No of Health Facilities 3Provincial Press Briefing 4District Press Briefing 5Awareness sessions in Schools 6Awareness session for LHS/LHWs Paramedics 7Banners / Boards/ Flyers 8IEC Material 9PPHI for 5 districts125,000

EXPANDED PROGRAMME ON IMMUNIZATION

BANNER EXPANDED PROGRAMME ON IMMUNIZATION

FLAYER EXPANDED PROGRAMME ON IMMUNIZATION

POSTER EXPANDED PROGRAMME ON IMMUNIZATION

CALENDAR POSTER EXPANDED PROGRAMME ON IMMUNIZATION

MONITORING  Overall activities swill be supervised by HSH/DGHS Khyber Pakhtunkhwa and will be thoroughly monitored through special monitoring check list by Provincial committees split in 2 tiers  1, District Level : DHO,DDHO,EPI Coordinator,LHWs Coordinator, PH Coordinator, DHCSO, DSM PPHI and Partners staff  Provincial Level  HSH,DGHS,DHS KP,DDs /ADs of DGHS office, NP,PPHI and Partners.  First Monitoring visit has been done on 21th Feb 2014, by EPI Team(Dr. Farid, Dr. Rahim, Dr. Ishaq and Mr. Hanif) to Nowshehra EXPANDED PROGRAMME ON IMMUNIZATION

SPECIAL INITIATIVES FOR IMPROVING IMMUNIZATION GOVERNMENT KHYBER PAKHTUNKHWA MONITORING CHECK LIST  District ______________ Tehsil: ________________ Union council ______________  Name of Health facility _____________ Name of In-charge Health facility _______________ Designation of HF In-charge: __________________  Name of EPI technician________________________  Total Population of UC: __________­­­___ Target Under 1 Year: _____________  Total Number of Children Completed Measles 2 Vaccination: _____________  Total Number of Children received Incentives: _________________  Name of Bank/ BHU/ Easy Paisa/ other: ___________________________________________  Information of Clients Who Received Incentives EXPANDED PROGRAMME ON IMMUNIZATION S NoName of ChildFather NameNIC No. of FatherDate of Vaccination Completed Date of Incentives Received Verified YesNo

BUDGET FOR MONITORING EXPANDED PROGRAMME ON IMMUNIZATION S.NoMonitorsHonorarium per Month No of visitsTotal for 6 Months/ District Remarks 1DHO, DDHO, EPI Coordinator, DCNP, DSV 5000/per monitor 2/ per month by each monitor 1.8million 2Provincial Monitors. DGHS, DHS, DDs, ADs 10,000/mon th 1-2 visits per month1.2million 3Quarter reviewPresentation will be made by the districts on special initiative.3million UNICEF agreed to support this activity

CHALLENGES/WAY FORWARD  Poor compliance from the districts  Timely getting plans  Successful implementation of Special Initiative  Achievements of desiring targets  Transparent and timely disbursement of money to the beneficiaries Reduce drop out at district level  Achieving highest possible coverage  Reduce diseases burden, disabilities and deaths EXPANDED PROGRAMME ON IMMUNIZATION

THANKS EXPANDED PROGRAMME ON IMMUNIZATION