1. Nation-wide Measles/Polio SIAs in Afghanistan, 2012

2. Background The action have been prompted by the nation wide measles outbreak in 2012. Three folds increase in the number of cases as compared with 2011 High mortality rates in initial phases (before response) Double number of outbreaks almost in all provinces

3. Age-distribution of measles,2008-2011

4. Mapping of cases/outbreaks, Jan-June 2012 SIA Dates

5. Nation-wide Measles/Polio Follow up SIAs in Afghanistan, 2012 SIA Dates  7-12 July 2012 (1 st phase)  1-6 December 2012 (2 nd phase)  18-22 November (Mop-up measles campaign in 16 districts) Target age group  9M-10Y for measles  0-10Y for OPV Target population (#) for Measles  5,616,580 (for Measles SIAs 1 st phase)  4,279,589 (for measles SIAs 2 nd phase)  106,500 (for measles mop-up campaign in 16 districts)  10,002,669 – total target Population reached (#)  6,025,203 (Measles reported – 1 st phase)  4,755,519 (Measles reported – 2 nd phase)  98,778 (measles reported coverage of measles mop-up campaign)  10,879,500 – total number of children vaccinated with measles Coverage (%) achieved  106% (measles reported coverage), 93% (PCS result) – 1 st phase  111% (measles reported coverage), 96% (PCA result)- 2 nd phase  National coverage (all 34 provinces) based on Post Campaign Assessment (PCA) – 94%

6. 3rd Nation-wide Measles/Polio Follow up SIAs in Afghanistan, 2012 Number of immunization posts  1497 (fixed centers) Number of vaccination teams  17,219 (outreach/mobile teams) Total # of health workers, volunteers, supervisors, monitors and evaluators were engaged in measles SIAs  71, 872. Other Interventions (number reached and % coverage if available)  In addition to measles vaccine, OPV was included into measles SIAs. Total # of children 0-10Y received OPV: 11,679,211 (92%) children aged 0-10Y have received a full dose of OPV. Major national/local partners  WHO,UNICEF, MOPH and all Health NGOs Resources utilization Cost/Child immunized  So far, around $12 million spend

8. Challenges/Constraints Poor quality of district micro-plans (some provinces) Weak strategy for remote and high-risk areas Weak communication & social mobilization strategies Shortage of trained health workers Difficulty in reaching all children in problematic provinces (Kandahar, Helmand, Farah, Zabul, Uruzgan, Badghis, Ghor, Kunar and Nooristan, Paktika, Paktya and khost); 54 districts underperformed Shortage of cold chain equipment Over-reporting

9. Lessons learned Early preparation and proper micro-planning is the key Inaccurate denominator resulted in in-adequate micro- planning including incorrect estimation of vaccine/supplies, human resource need and fund in many instances. Timely inventory of cold chain equipment is vital for adequate handling of vaccine and preventing shortage of vaccines at service delivery levels In advance identification of trained health workers and volunteers helps to timely conduct training courses Visiting all households for referring of children to the vaccination sites and adequate daily monitoring /reporting helps taking timely actions during the implementation

10. Future Plan Local measles campaigns should be conducted in partially covered districts to reach the un- reached children and supplement declining routine immunization coverage Conduct measles mop-up campaign in the districts that could not achieve 90% coverage for measles Implement RED strategy in all districts less than 60% coverage for EPI.

11. ProvincesProblematic districts ( <90% SIAs coverage, <80% routine coverage, without EPI services) in need for Mop-up measles campaign, in 2013 Kandahar Maroof, Arghistan, Shorabak, Reg, Nesh, Ghorak, Khakrez, Shah wali kot Helmand Khan Nshin, Sangin, Gramser, Deshu, Washer, Nawa Barakzai, Nawzad, Baghran, Kajaki, Farah Poor Chaman, Gulistan, Bakwa, Bala Blook, Khaki Safid, Lash wa Joien Zabul Daychopan, Mizan,Tarnak Wa Jaldak, ShinkayAtghar, Shamulzayi Uruzgan Chora, Shahid Hassas, Dihrawud Badghis Qadis, Jawand, Ghor Saghar, Tayawara, Pasaband, Tulak, Shahrak Kunar Mrawara, Nari, Chapa Dara, Nurgal Nooristan Kamdesh, Waygal, Mandol, Mandol, wama Paktika Gomal, Omna, Barmal,, Gayan, Neka Paktya Shwak, Zoormat Khost Musa Khael, Sabari Badakhshan Darwaz, Jurm,

12. Provinces Districts ( <90% SIAs coverage, <60% routine coverage) in need for Mop-up measles +pulse immunization campaign, in 2013 Additional districts coming from median coverage Kandahar Maroof, Arghistan, Shorabak, Reg, Nesh, Ghorak, Khakrez, Shah wali kotShah Wali Kot, Maroof Helmand Khanshin (Reg), Sangin, Gramser, Deshu, Washer, Nawa Barakzai, Nawzad, Baghran, Kajaki, Nahri Saraj, Musa Kala, Nad Ali, Nawa Barakzai, Sangin, Gramser, Washer Farah Poor Chaman, Gulistan, Bakwa, Bala Blook, Khaki Safid, Lash wa Joien Zabul Daychopan, Mizan,Tarnak Wa Jaldak, Shinkay Atghar, Shamulzayi Uruzgan Chora, Shahid Hassas, Dihrawud Badghis Qadis, Jawand,Qala I Now, Mugur Ghor Saghar, Tayawara, Pasaband, Tulak, ShahrakLal Wa Sarjangal Kunar Mrawara, Nari, Chapa Dara, NurgalPech Nooristan Kamdesh, Waygal, Mandol, WamaNungaram, Du Ab, Paktika Gomal, Omna, Barmal,, Gayan, NekaWor Manay Paktya Shwak, ZoormatJadran, Jani Khel, Jaji Ayoub, Khost Musa Khael, SabariKalandar Badakhshan Darwaz, Jurm,Khwahan, Ragh, Kohistan

14. Thank You