1. Cross Border Coordination between Pakistan & Afghanistan September 26, 2007 POLIO ERADICATION INITIATIVE

2. Outline Introduction Risks and challenges Activities Impact The way forward

3. Introduction Current data shows sharing of virus between the two countries Large population movement across borders of Pakistan & Afghanistan Ongoing collaboration for synchronized vaccination activities & immediate information sharing Access issues in border areas lead to immunity gaps and active poliovirus circulation Technical Advisory Group held in April 2007 concluded that Pakistan & Afghanistan could become the next polio free countries

4. Risks and Challenges

5. Afghanistan & Pakistan isolates by genetic cluster & Type Jan-Aug 2007 Last Update: September 11, 2007 Case reported from Australia genetically related with NWFP/FATA viruses A - 3A A - 3D B - 4A B - 1C District Provincial Country Boundaries:

6. Sharing of polio viruses between Pakistan and Afghanistan 2006-07 A-3D B-1C A-3A B-1D B-4A A-3C A-3B 2007 cases District Provincial Boundaries:

7. Entry points of moving populations Established team (n=14) Planed to be established (n=5) I R A N I N D I A Entry points between Afghanistan & Pakistan

8. Across Border Movement HIGHLY MOBILE POPULATION MOVEMENT IN PAKISTAN WITH SURROUNDING PROVINCES OF AFGHANISTAN Nomads/Afghan Refugees Movement Seasonal Migrants 0.2 million children vaccinated from mobile populations in August 2007

9. Security Risk Areas & Polio Cases 2006 High Risk Variable Risk P1 Wild = 49 P3 Wild = 22 District Provincial Country Boundaries:

10. Security Risk Areas & Polio Cases 2007 High Risk Variable Risk Case reported from Australia genetically related with NWFP/FATA viruses P1 Wild = 10 P3 Wild = 11 P1 Wild = 01 District Provincial Country Boundaries:

11. SIA Coverage of under 6 months children < 95 %  95 % No Campaign May 07 Jan 07 Feb 07 Mar 07May 07Jun 07 Apr 07Aug 07 Consistently children below 6 months in areas bordering Afghanistan have sub optimal coverage District Provincial Boundaries:

12. < 0.5 % 0.5 % - < 1 % 1 % - < 1.5 % > 1.5 % Refusals proportion against total children covered in August 2007 round

13. Activities Increasing number of cross border vaccination posts and improving their performance Weekly sharing of information Inter-country program review meetings Cross border meetings at national and provincial levels Regular contact between provincial focal persons

14. Afghanistan & Pakistan Cross Border Meeting,Islamabad, December 1, 2006

15. Key steps for improving cross border coordination – ongoing activities Cross notifying AFP case standardized Permanent cross border vaccination posts Campaign schedule synchronized –Joint review of micro plans of bordering localities with clear demarcation done –Border areas covered on the same day (Day 3 of Afghanistan & Day1 of Pakistan) Regular sharing of information at the provincial levels has been encouraged –Weekly contact between WHO focal persons of both sides

16. Improve the quality of cross-border vaccination teams Working schedule; two shifts Teams to work 7days/week Children entering the country to be vaccinated normally (before gates are open children with the family waiting to be vaccinated) Cross check of children entering the country if found unvaccinated to be vaccinated by teams. Close supervision/monitoring of these check posts Visibility and recognition of the teams and better working environment for the teams

17. Improve the border coordination Regular monthly meeting on both sides of the border alternatively (needs multiple-entry visa for the staff)Regular monthly meeting on both sides of the border alternatively (needs multiple-entry visa for the staff) Joint SIAs micro-planningJoint SIAs micro-planning Mapping of the border villagesMapping of the border villages Swapping the supervisors on both side of the border in SIAsSwapping the supervisors on both side of the border in SIAs Special campaign conducted with type specific vaccine in the bordering areas (Dec 2006, July & Sep 2007)Special campaign conducted with type specific vaccine in the bordering areas (Dec 2006, July & Sep 2007) Regularly sharing of SIAs dataRegularly sharing of SIAs data

18. Strong Government support of both countries towards PEI

19. Option 2,PAK_AFG Border Mop Up Districts/Agencies –July 2007 Afghanistan Districts

20. Chaghai Zhob K Abdullah Wazir-S Wazir-N Kurram Khyber Nushki Mohmand Bajour Dlower Chitral Qamardin Bazar Norwrsik Mughol Kot (Zhob) (Mar-May coming, Sep-Nov going ) Arandu (Chitral) Nawa Pass Ghake Pass (Bajour) Atia Bazar (Mohmand) TurKham (Khyber) Treemangal Kharlachi (Kurram) Ghulam Khan (N-Waziristan) Angoor Adda (S-Waziristan) Shimpanda Allah Jirga Hamaya (Killa Saifullah) (Mar-May coming, Oct-Nov going) Anam Bosatn Karawan Raw Chamman (K Abdullah) Cross Border Movement in Districts/Agencies between Pakistan and Afghanistan Pishin K Saifullah Seasonal Workers Cross border movement Afghan Refugee Check Post Jilga (K Abdullah)

21. Impact

22. NIDsSNIDs Synchronized SIAs Pakistan & Afghanistan - 2007 AfghanistanPakistan 16-18 20-22 27-29 24-26 22-24 19-21 7-9 24-26 30 Oct -1 Nov 11-13 18-20 25-27 22-24 5-7 28-30 14-16 17-19 9-11 19-21

23. Nomads Crossed Sibi Check-post 9/Sep-9/Dec 2006 S #Districts Wise Nomads Settled# children <5 1Sibi2367 2Naseerabad2067 3Bolan1409 4Jacob Abad1272 5Sukkur844 6Jaffarabad672 7Shikarpur452 8Ghotki195 9Larkana112 10Shahdad kot91 11Khairpur82 12Jhal Magsi66 13Nawabshah59 14Rahim Yar Khan56 15Dera Bugti10 Total Nomads Crossed9754 Expected 10,000

24. Number Villages & target Population with Districts

26. Highly Mobile Population Movement in Southern Punjab In Southern Punjab Basically nomads and Afghan Refugees are coming from Loralai, Kohlu, Zhob, Musakhel (Balochistan), Peshawar, Dir and Swat (NWFP) and after staying they are moving toward Sindh, Mirpurkhas, Umerkot and Tando Allah Yaar Rivers District Boundaries Tehsil Boundaries Coming from DG Khan estimated population is 840(Nom*) / 6933(Afg**) stay for 1 month Coming from Rajanpur and further going to Sindh. When they return they follow same path. Security Compromised Areas Coming from Zhob Estimated population is 1000(Nom*) aprox. Staying for 2-4 months Coming from Bhawalpur Estimated population is 586(Nom*) aprox. Duration of stay is 1-5 months Nom* = Nomads Children < 5 years Afg** = Afghan Refugees Children < 5 years

27. Highly Mobile Population Movement in Southern Punjab In Southern Punjab Basically nomads and Afghan Refugees are coming from Loralai, Kohlu, Zhob, Musakhel (Balochistan), Peshawar, Dir and Swat (NWFP) and after staying they are moving toward Sindh, Mirpurkhas, Umerkot and Tando Allah Yaar Rivers District Boundaries Tehsil Boundaries Security Compromised Areas Nom* = Nomads Children < 5 years Afg** = Afghan Refugees Children < 5 years NWFP Coming from Kohlu, through Barkhan, DG Khan and B nagar than further going through MGarh to Bhawalpur their estimated population is 840(Nom*) / 6933(Afg**) stay for 1 month further go to Rajanpur and return from same way Coming from Rajanpur and further going to Sindh (Mirpurkhas, Umerkot, Tando Allah Yaar). When they return they follow same path. Estimated population is 3889(Nom*)/7000(Afg**) aprox. Staying for 2-3 months and go to Rajanpur Coming from Peshawar NWFP passing through Multan, MGarh, Lodhran estimated population is 1182 (Nom*)/4200(Afg**) aprox. Staying for 2-5 months especially April than go to Sadiqabad (RY Khan) Coming from Zhob Estimated population is 1000(Nom*) aprox. Staying for 3-6 months further moving from M garh, Multan to Bhawalpur Coming from Loralai, NWFP through DG Khan Estimated population is 586(Nom*) aprox. Duration of stay is 1-9 months Further take move to Sindh Umerkot Coming from Balochistan and NWFP Estimated population is 3889(Nom*)/7000(Afg**) aprox. Staying for 2-3 months and go to Rajanpur Coming from Loralai, NWFP through DG Khan Estimated population is 586(Nom*) aprox. Duration of stay is 1-9 months Further take move to Sindh Umerkot Coming from Kohlu, through Barkhan, DG Khan and Bnaga than further going through MGarh to Bhawalpur their estimated population is 840(Nom*)/ 6933(Afg**) stay for 1 month further go to Rajanpur and return from same way

28. Cross Border Coverage during 2007 MonthBalochistanNWFPTotal for the month Jan134933294646439 Feb118953217544070 Mar180924220360295 Apr194493472754176 May205613209652657 June202443677857022 July Data NA21351 Total103734232276336010

29. The way forward Continue excellent cross border coordination Joint risk analysis for highly mobile populations Increased activities in high risk border areas Locally appropriate communication strategies Advocacy for peace – days of tranquility

30. Thank You… Friendship Gate, Killa Abdullah