Time to invest in routine immunization

It was a unanimous agreement among participants of the annual review of the Expanded Programme of Immunization (EPI), Khyber Pakhtunkhwa (KP) Province, to invest in routine immunization and that investment in routine immunization will help not only put Pakistan on the right track for achieving the Millennium  Development Goal 4 but will also ensure eradication of polio on sustainable basis. The review was held in Islamabad on March 22-24, 2013.

Dr Janbaz Afridi, Deputy Director EPI, highlighted the issues faced by the programme in KP including complicated security situation, difficult terrain, burden of Afghan refugees since 1979 and Internally Displaced Persons (IDPs) since 5 years, absence of a uniform and sustained quality of  coverage in critical districts, reporting and data management problems, weak technical capacity at district level and late compliance from some of the districts, limited number of female EPI technicians and no legislation concerning immunization to ensure 100% coverage of the target population.

While discussing the way forward it was agreed that the World Immunization Week to be celebrated in the last week of April 2013 with the theme “Stop Measles Now” shall be used as an opportunity to strengthen routine immunization in the province. Furthermore, service structure of staff involved in routine immunization, training of EPI staff in vaccine management, data management, communication and M&E, involvement of paramedics in routine immunization, evaluation of Lady Health Workers involvement in routine immunization, involvement of private sector and CSOs in EPI and legislation to ensure 100% coverage of target population were some of the areas require to be focused for greater immunization coverage and strengthening of the routine immunization system in the province.

A brief introduction of the EVERY ONE campaign was presented with its purpose and strategic objectives with a focus on immunization. It was highlighted that not enough children in Pakistan receive childhood vaccinations and children in rural areas are 1.4 times less likely to be immunized than children in urban areas. Highlighting the importance of immunization among the masses it was shared that 20% of the people in Pakistan have no knowledge about immunization and 14% think it’s unnecessary. It was emphasized that parental attitudes & knowledge and the quality of communication and outreach strategies directly affects the parental knowledge & attitudes – many parents of unimmunised children lack information about routine immunisation programme.

The EVERY ONE Campaign demanded that the provincial government should allocate specific resources to scale up routine immunisation targeting uncovered areas and children from poorest wealth quintiles. For this purpose, a policy should be adopted to train and expand the scope of work of LHWs to administer routine immunisation. Similarly, for KP to progress towards achieving universal standard for number of vaccinators (one vaccinator per 5,000 people) it is imperative to introduce a policy and make budgetary allocation. Furthermore, donors’ commitment was requested for responding to the needs of the province for universal coverage of routine and new vaccines.

It was discussed during the review that specific existing initiatives can be used to strengthen routine immunisation such as investments in LHWs and vaccinators, specific initiatives to reach out to every union council of the district as currently 110 of 1040 union councils of the province have no fix EPI Centre for immunization. It was also an undisputed agreement that there is a need for widespread awareness among the communities and their empowerment to demand services and hold the EPI accountable.

Dr Roohullah representing the Director General of Health Services reassured provincial government’s commitment for strengthening the routine immunization system in the province. He further committed that all issues raised in the review will be seriously considered and addressed.

It was agreed that such reviews should be held regularly both at the provincial and district levels to be able to identify and remove weaknesses and strengthen the routine immunization system in the province including in the poor performing and hard to reach union councils and districts. Based on the findings of the review, the Deputy Director EPI and Provincial Coordinator of LHW Programme agreed to review the Terms of Reference of the LHWs and formally include responsibilities related to EPI as they are now permanent government servants. It was also agreed that joint advocacy efforts should be made by the civil society, donors and UN Agencies for legislation and increased budgetary allocation for immunization in the province. 

http://everyone.savethechildren.net/articles/time-invest-routine-immunization  

 

SUPERFOOD for Babies

There was a unanimous agreement among the participants and speakers of the launching ceremony of Save the Children’s Global Breastfeeding report, ‘SUPERFOOD FOR BABIES: How overcoming barriers to breastfeeding will save children’s lives’, that breastfeeding is the most effective and tested method to protect children from killer diseases as soon as they are born.  

“The lives of 95 babies could be saved every hour - 830,000 a year, if new mothers around the world breastfed immediately after giving birth”, said Dr. Qudsia Uzma, Director Health & Nutrition at Save the Children, while sharing the salient features of the report. She highlighted that if babies receive colostrum – the mother’s first milk – within an hour of birth, it will kick start the child’s immune system, making them three times more likely to survive. If the mother continues feeding for the next six months, then a child growing up in the developing world is up to 15 times less likely to die from killer diseases like pneumonia and diarrhea.

It was only four days ago that Pakistan witnessed the adoption of the local legislation by Sindh to address breastfeeding violations. Serendipity perhaps, but the timing of this development in terms of the revealing of the Report could not have been better.  

“It’s heartening to know that the Provincial Assembly in Sindh has adopted the Sindh Protection of Breastfeeding and Child Nutrition (Amendment) Act 2013. However, the real test is its implementation in letter and spirit”, noted Save the Children’s Deputy Country Director in Pakistan, Mr. Ghulam Qadri: “Despite the Protection of Breastfeeding and Child Nutrition Ordinance on statute books since 2002, its implementation has always remained a distant desire.”

The EVERY ONE Campaign in Pakistan also recently saw the induction of its second champion, Haroon Rashid.

 “I would like to take this opportunity to pledge that as a Campaign Ambassador for Save the Children’s EVERY ONE Campaign, I will do all that is possible in my capacity to take forward the cause of maternal, newborn and child health in Pakistan” the singer proclaimed at the launch,  where he was formally introduced as the Campaign Ambassador. “When I was approached to become an Ambassador, I didn’t hesitate to take the assignment up as this is a subject very close to my heart.”

“The teachings of Islam strongly endorse that mothers should breastfeed their children for two years and I congratulate Save the Children for taking up such an important subject related to infant mortality”, said Dr. Donya Aziz, Member National Assembly of Pakistan, who was also part of the panel. With her proclamation of taking up the matter of implementation of the Ordinance with the Minister for Capital Administration and Development Division (CADD), it was clear that Dr. Donya recognized the value of such an intervention to ensure that every infant is given the life-saving protection that breastfeeding can offer. Referring to the report’s recommendation about lack of adequate maternity legislation which makes breastfeeding and returning to work a challenge, Dr. Donya Aziz, promised that if provided with a bill about adequate maternity legislation, she will place it before the National Assembly of Pakistan and endeavour to help ensure that the law is adopted.

“Legislation alone is not going to change the situation as numerous bills already exist in Pakistan; it is the implementation of laws that demand attention”, said Dr. Sania Nistar, a prominent right to health advocate in Pakistan and founder of the organization Heartfile.

“Equity statistics at all levels shows fundamental distortions in Pakistan. The Breast Milk Substitute production industry has to be brought to the table. If they are part of the problem, they should also be part of the solution.”

Dr. Sania rounded up the entire event by underlining that breastfeeding can have an impact on the bottom line because it costs nothing, thereby having a large scale impact on the improvement of newborn and child health By concluding that Save the Children has touched the heart of the problem with the new report, we knew that a potential partnership with Heartfile could be in the making.