HOPE’S One Day Orientation on Routine Immunization At HOPE/MCHIP Office, District Sanghar

HOPE, an educational and health  NGO in Pakistan , organized a  one day orientation on Routine Immunization at HOPE/Mchip Office, District Sanghar. The activity began with recitation of the verses of Holy Quran .After which Dr.Muzaffer Samoo Acting District Coordinator MCHIP, began with welcome remarks and talked about the Genesis of this Routine Immunization Orientation.

One Day Orientation on Routine Immunization

At HOPE/MCHIP Office, District Sanghar

Date &Time	20- 11- 201510:30  AM
Venue	HOPE Office,  A-10, Gate No-1, Main Nawabshah Road,  adjacentThe Smart School. Sanghar, SINDH
Subject	One day Orientation on Routine Immunization at HOPE/MCHIP Office, District Sanghar
Managed by	Mr. Irfan& Mr. SohailArain
Organized By	Health Oriented Preventive Education  (HOPE)
Facilitated By	Mr. LalaAftab (Immunization Officer JSI/MCHIP)
Reported By	Dr. S. M. Ashfaque Ahmad(District Coordinator) HOPE, MCHIP Project , Sanghar

                     

Dr. MuzafferHussainSamoo Acting District Coordinator MCHIP  briefed  following points/Agenda for this orientation.

1. Introduction of Participants.
2. Welcome Note
3. Objective of the Routine Immunization

1. Define supportive supervision and discuss its role in improving immunization services.
2. Outline major steps essential to supportive supervision.

6. Practice tools that can be used for supportive supervision

                       

Introduction

MNCH Services Component 2 of USAID/Pakistan’s Maternal and Child Health (MCH) Program implemented by MCHIP/Jhpiego in USAID target districts in Sindh is contributing to achieve improvement in maternal and newborn health through improved quality of MNCH service delivery. One of the objectives of program is to promote routine immunization and enhance immunization coverage and quality among target population through adopting modified “Reach Every Union Strategy”, strengthen linkages between Expanded Program on Immunization (EPI), Lady Health Worker (LHW) Program, stake holders like Peoples Primary Healthcare Initiative (PPHI) and partners (WHO, UNICEF etc) and enhance coverage through registering the target population in selected districts. In current year MCHIP is planning to improve quality and coverage of immunization of target population (Children 0-23 months, pregnant women and Child Bearing age women) in all USAID focus districts mainly through registering and vaccination in target population.

This orientation/training of routine immunization in districtSangharMCHIP/Jhpiego monitoring teams with immunization protocols, guidelines, vaccination schedule, cold chain and assessment of immunization services provided at health facilities. The manual will enable the team to conduct a purposeful supervision of the vaccinators and EPI services provided at health facilities.

Participant List

S #	Name Participant	Designation	Organization	Contact #
1	Muhammad Hassan	Senior Supervisor	MCHIP/HOPE	0333-2912663
2	Ameet Kumar	Senior Supervisor	MCHIP/HOPE	0333-2915865
3	Muhammad Iqbal	Senior Supervisor	MCHIP/HOPE	0300-3231640
4	FarzanaAbidAwan	Senior Supervisor	MCHIP/HOPE	0334-5160518
5	Maria Robin	Assistant Supervisor	MCHIP/HOPE	0313-3033727
6	RamzanBibi	Community Mobilizer	MCHIP/HOPE	0302-2445808
7	Muhammad Sharif	Assistant Supervisor	MCHIP/HOPE	0334-3826549
8	TahiraNaz	Assistant Supervisor	MCHIP/HOPE	0310-3969561
9	SaminaParveen	Community Mobilizer	MCHIP/HOPE	0332-3093408
10	Nurgis	Community Mobilizer	MCHIP/HOPE	0304-2709626
11	Fatima	Community Mobilizer	MCHIP/HOPE	0335-3145917
12	Atti-ul-zaman	Community Mobilizer	MCHIP/HOPE	0331-3320030
13	RiazHussain	Community Mobilizer	MCHIP/HOPE	0332-2890990
14	Syed Bachal Shah	Community Mobilizer	MCHIP/HOPE	0300-2271200
15	Samra Abbas	Community Mobilizer	MCHIP/HOPE	0335-2694695
16	BakhtawarBaloch	Clinical officer	MCHIP/HOPE	0310-3012085
17	Quratulain	Clinical officer	MCHIP/HOPE	0312-8294973
18	BakhtawarNisar	Clinical officer	MCHIP/HOPE	0313-3998358
19	Hafeezullah	Community Mobilizer	MCHIP/HOPE	0300-2517104
20	Maria bibi	Clinical officer	MCHIP/Jhpiego	0340-0960143
21	DrTosheeba	Senior Clinical Supervisor	MCHIP/Jhpiego	0333-7017144
22	Muhammad Khan	Dist: Cord: Com. Mob	MCHIP	0333-7067188
23	Dr .ZubairuddinQureshi	SR.Program Cord: NCH	MCHIP	0331-4216070
24	DrLalaAftab	Immunization Officer	JSI/MCHIP	0332-2664804
25	DrMuzafarHussainSamoo	D.I.O DC MCHIP	MCHIP	0300-3026575
26	AsifLaghari	MIS Assistant	MCHIP Jhpiego	0300-3313873
27	Dr. S.M Ashfaque Ahmed	District Coordinator	MCHIP/HOPE	0300-2509713
28	SohailMehmoodArain	Admin & Logistic  Officer	MCHIP/HOPE	0333-2922195

Overview of Immunization

Mr. LalaAftab Immunization Officer briefed that Immunization is a very successful and cost effective public health intervention to protect human from infectious disease. Over the time it has been learned that immunity is best achieved by introducing vaccine at certain age against particular disease for life long duration. Vaccination stimulates body’s own immune (defence) mechanism against vaccine preventable disease, annually millions of children and women are saved through vaccination.

This Program aims to reduce infant mortality and morbidity by immunizing children against poliomyelitis, tuberculosis, diphtheria, pertussis, tetanus, measles, hepatitis B, pneumonia, meningitis, and haemophilus influenza type B. It also vaccinates pregnant women to protect them from tetanus toxoid and their fetuses from neonatal tetanus.

Government of Pakistan provides free of cost vaccination against vaccine preventable diseases through static EPI centers, vaccination outreach sessions, mobile vaccination units and vaccination campaigns.

                      

Vaccine preventable diseases and vaccination schedule

Inactivated vaccine contains inactivated, but previously virulent, micro-organisms that have been destroyed with chemicals, heat, radiation, or antibiotics for examples Cholera, influenza etc. Vaccines contain live, attenuated vaccine is cultivated under conditions that disable their virulent properties, to produce a broad immune response are for example measles, rubella and mumps. Toxoid vaccine is made from inactivated toxic compounds, for example tetanus and diphtheria.

                   

New Immunization Schedule for Children (0-23 months) in Pakistan

Age	Vaccination	New Schedule
At birth	BCG + Polio	BCG + Polio Zero dose
6weeks	DPT 1 + HBV 1 + Polio 1	Pentavalent 1 + PCV-10-1+ Polio 1
10 Weeks	DPT 2 + HBV 2 + Polio 2	Pentavalent 2 + PCV-10-2 +Polio 2
14 Weeks	DPT 3 + HBV 3 + Polio 3	Pentavalent 3+ PCV-10-3 + Polio 3+  IPV*
9 months	Measles	Measles 1
12-15 months	Measles	Measles 2
*Note: IPV will be administered at 14 weeks with third dose or before the age of 12 months to all the children.

Vaccination of child starts at the birth and completes at first birthday. However; additional doses of vaccination against Polio lasts at five years of age.

Immunization Schedule for Pregnant and Child Bearing Age Women

Mr. LalaAftab briefed that Pregnant mothers and child bearing age women are at risk of being exposed to tetanus an infection caused by Clostridium Tetani during the process of delivery. The purpose of immunization is to protect women of child bearing age and pregnant women from tetanus and to protect their newborns against neonatal tetanus.

In case of neonatal tetanus is identified, administer one dose of TT vaccine as soon as possible to mother and treat baby as per guidelines.

Then facilitatorMr. LalaAftabimmunization officer JSI/MCHIPvisited Civil Hospital Sangharalongwith our 04 Supervisors, 03 Clinical Officers& Sr. Clinical Supervisors.  Mr. LalaAftabhave assigned different tasks to the participants for check list and have also trained them regarding the process of this immunization handling and storage.

Supplementary Immunization Activities (SIAs)

Supplementary Immunization Activities (SIAs) are additional immunization campaigns conducted to interrupt the transmission of disease; mostly these refer to intersect the circulation of wild polio virus. SIAs include National Immunization Days (NIDs) and Sub-National Immunization Days (SNIDs) target Polio in general. NIDs are conducted in line with the global immunization policies and recommendation of international Polio Technical Advisory Group (TAG) by government of Pakistan to target high risk, poor performing districts with low routine immunization coverage. In case of disease or case outbreak, crash immunization campaigns are also launched in high risk areas against single disease for example Measles vaccination during Measles outbreak.

Vaccine Handling and Storage

The Facilitator also briefed that Vaccines are costly items, therefore it is important to save each vaccine dose from wastage; each person who receives vaccine must ensure the following:

• Packs are intact (no damaged or leaked packs)
• Vaccine is potent (valid thermochromics indication)
• Expiry date not less than three months (at facility Level)

Cold Chain Maintenance

He also briefed that vaccines are sensitive biological products which may become less effective, or even destroyed, when exposed to temperatures outside the recommended range. Vaccines exposed to temperatures above or below the recommended temperature range experience some loss of potency with each episode of exposure. Repetitive exposure to heat episodes results in a cumulative loss of potency that is not reversible.

“Cold chain” refers to the process used to maintain optimal conditions during the transport, storage, and handling of vaccines, starting at the manufacturer and ending with the administration of the vaccine to the client. The optimum temperature for refrigerated vaccines is between 2 to 8 degree Celsius. In addition, protection from exposure to light or direct sun light is a necessary condition for vaccines.

Temperature Monitoring Chart  

Temperature monitoring chart is available at almost all EPI Centers and is maintained by vaccinator. Vaccinators are required to record the inside temperature of refrigerator atleast twice each day and record it in the chart. All supervisors must check the temperature monitoring record and compare the latest reading on chart with the thermometer.

                           

Common EPI Terminologies

Catchment area	Geographic area covered by the Health Facility
Cold Box	Cold box are insulated containers that can be lined with coolant packs to keep vaccines and diluents cold during transportation, these are also used to store vaccines temporarily when the refrigerator is out of order or being defrosted.
Vaccine Carrier	Vaccine carriers are insulated containers that, when lined with coolant packs, keep vaccines and diluents cold during transportation. They are smaller than cold boxes and are easier to carry during outreach activities.

Cold Chain	Includes all of the materials, equipment and procedures used to maintain vaccines at required temperature (range of +2 °C to +8 °C) until the vaccines are administered to individuals
Date of Expiry	Date till which the vaccine can be used safely
Defaulter	Children received vaccination once or more, but failed to complete the immunization schedule
Missed Children	Children missed by vaccinator during outreach visit
Refusal	Parents/guardian refused to vaccinate their child
Dropouts	Difference between numbers of children vaccinated and did not able to catch in subsequent visits. (Dropout calculation – Exercise)
Ice packs	Ice Packs are used to maintain the temperature inside vaccine carrier to desired limits. Ice packs must be freeze, the freezing status can be checked by shaking the pack near ear, in freezed pack there will be no sound.
Micro plan	Written information of district/Union Council, population, target population (no of children and pregnant women residing in area), no of villages, population of each village, visit schedule of vaccinators.
Outreach tour Plan	Visit plan of vaccinator for all villages
Adverse Events following Immunization (AEFI):	An adverse event is any unwanted medical reaction in a patient who has been administered a medicine or vaccine. An adverse event is any unfavorable and unintended symptom, disease or sign (for example, an abnormal laboratory finding), associated with the use of the medicine or vaccine. The medicine or vaccine does not necessarily have to have caused the adverse event. Fever, pain or swelling at the site of injection, anaphylaxis (very rare) are few examples of AEFI.
Static Centre	EPI Centre established within health facility.
Vaccine Vial Monitor (VVM)	A vaccine vial monitor (VVM) is a thermochromic label containing heat sensitive material which is placed on a vaccine vial to register cumulative heat exposure over time. The combined effects of time and temperature cause the inner square of the VVM to darken, gradually and irreversibly. A direct relationship exists between the rate of color change and temperature.
Ice Lined Refrigerator (ILR)	IRLs are specific refrigeration equipment designed to maintain a cabinet temperature between +2 to + 8 Degree Centigrade and are used to store vaccines. ILRs are so designed with an ice bank (Icepack lining) which keeps the internal temperature at a safe level despite electricity failure.

Temperature Chart	Charts displayed at the vaccine refrigerators with hourly recording of temperature. The temperature written at chart and the dial thermometer must be matched at the time of supervision.
Dial Thermometer	A thermometer is an instrument for monitoring the temperature of cold chain equipment like refrigerator, cold box or vaccine carrier. It enables to adjust the temperature to the correct range for the storage and transport of vaccines.
Tally Sheet	Tally sheets are forms on which health workers make a mark every time they administer a vaccination. These are used as a basis for reporting to the district level. Supervisors use them to monitor the accuracy of reporting from health facilities to districts.

As always particular attention was given by Dr Mubina Agboatwalla, Chairperson of HOPE and child specialist in Karachi,  who closely monitored the preparation and execution of this activity. Dr Mubina Agboatwalla, Chairperson of HOPE and child specialist in Karachi   ensured that all participants benefitted from it and became capable enough to replicate it with the working skilled birth attendants and other lady health workers.

HOPE Invited To Karachi Commissioner’s Meeting For Heat Related Health Risks & Mechanisim To Control It.

HOPE, an education related NGO in Pakistan, http://www.hope-ngo.com/Education/NorthernPakistanHomeSchools.aspx  attended the meeting along with several other organizations including the heads of  Civil Hospital Karachi, Jinnah Hospital, Abbasi  Shaheed Hospital and several other  Hospitals based in Karachi and different  cities of interior Sindh..

Once again the “LEAD” team members gave presentations on how they along with the Indian Gujrat Government have very successfully managed the heatwaves since the disasters of 2003 and 2006 by implementing early warning systems and that bring into motion a whole mechanism of disaster management – something they want to replicate here in Pakistan.The discussion first revolved around how the temperatures were extremely high  during last Ramadan and how its intensity persisted for the first ten days without any let up. And this scenario is very much expected to persist during the next summer season particularly during the Ramazan.

All the hospitals’ representatives advised how they planned to cope with such a  calamity should such a situation, although they did admit that they were ill-prepared for the situation.

However,there were disagreements amongst the participants as they could not figure out exactly who the stakeholders of such program really were and how could they be integrated  at the time of exact need to perform as the French do or the Gujrat government  did.

The other organizations including  HOPE, an education and Health related NGO in Pakistan, http://www.hope-ngo.com/Health/MaternalChildCenter.aspx advised the participants how they could provide mechanism of providing advanced awareness of such situations and teach and provide essential information as to how to cope should such a disaster occur in the future.

Grumblings of not taking all the right stakeholders on board continued and the dispute of  disbursement of funds still being held back and not extended to the stakeholders especially to the larger public hospitals who shoulder the major responsibilities looking after more than 90% of the affected victims was voiced by several participants – and many agreed to their points of view.

As always particular attention was given by Dr Mubina Agboatwalla, child specialist in Karachi, http://www.drmubinaagboatwalla.com/child-specialist-karachi/   who set up teams and instructed them to be ready and fully prepared and come into immediate action as and when needed.

HOPE’s Medical Camps For Eartquake Affectees of Birkot and Puran in Shangla, Swat.

HOPE,  a vital provider of health and education to the rural, poor masses since 1997 – and a very important and prompt provider of relief during natural calamities such as floods, earthquakes, storms and even the aftermath of terrorist attacks has  responded immediately to the floods since 2010, providing food and safe drinking water to the most vulnerable groups, particularly women and children. Over the past five years, we’ve reached over 700,000 people.

On this particular occasion, the earthquake in  Khyber Pakhtunkhwa, particularly the Swat valley, the areas of Shangla Birkot and Puran in Shangla – the areas most devasted by the recent earthquake in Swat, KPK.   After taking an NOC from the DCO’s office, HOPE, an educational and health related NGO in Pakistan  supported P&G, Metro Stores & Human Concer International set up two relief and medical camps – one in Birkot and one in Puran extending a very timely help to the earthquake victims of the area.flood affectees of Sindh. The area selected  was the flooded  delta region of river Indus, a place known as Allah Baksh Brohi .

The area was surveyed in advance and by some good fortune a fully erected building became available to HOPE which was a great help in setting up this much needed medical and relief camp for the earthquake affectees – who were advised in advance of the dates and places of their  setting up.

A very large number of men, women and children flocked to these camps and as many as 600 patients were treated and free medicines distributed. Four doctors participated in this medical camp and they had their hands completely full all day through. So also the dispensary which remained just as busy in giving out the medicines.

Some of the old and aged ones, in dire need of medical help, also managed to make it to the camps.

Besides medical help the camps provided free warm clothing, blankets, dried milk water, coolers and P&G’s purifier of water sachets. Demonstrations for the proper use of P&G’s purifier of water was provided so that clean drinking water could be made available to all displaced families  – the one major reason for the spread of bacterial and viral diseases in the affected areas.

As always particular attention was given by Dr Mubina Agboatwalla, child specialist in Karachi, in the selection  of the areas in need of such an activities  and everything was closely monitored by Dr Mubina Agboatwalla, child specialist in Karachi   in the formation of the whole team inclusive of the doctors and also in ensuring that all necessary medicines needed for this medical camp to ensure that  nothing short of very good medical treatment was provided to the earthquake affectees.

HOPE’s Zia Colony Hospital visited by Japanese Consul for Culture & Public Affairs.

It was in the year  2000 that the Japanese Consulate in Karachi very generously offered to assist in the erection  HOPE’s Zia Colony Hospital– the ground and first floor of what is now a three storey  structure of  housing a very busy maternity  hospital .  This hospital has now developed a very popular  reputation and patients from near and far throng this vital health facility for much needed mother and child medical help.

HOPE, a health and  educational NGO in Pakistan,    worked at a very fast pace and completed the project in  2002 –  and was inaugurated in 2002 by the then mayor of Karachi city.

Mr Mitsuaki Tosa, Consul for Cultural & public Affairs visited   HOPE’s Zia Colony Hospital to observe its  status and progress since 2002. The delegates were amazed to see how the  hospital has progressed since then. A new floor had been added and  many new departments and latest equipments were added – making the  Hospital a very modern one in a very underprivileged/slum area of Karachi

Mr Tosa was taken to all  departments of the hospital including ICU, Neonatal  ICU, X-Ray Room,  Physiotherapy Room, different wards, laboratory etc.  He was extremely happy to see  how HOPE’s  Zia Colony Hospital had progressed  so well over the  years.

Dr Mubina Agboatwalla, Chairperson of HOPE and child specialist in Karachi, has been the driving force in setting up this and other hospitals  at Gurumandir, Karachi  and Thatta in rural  Sindh  –  and in ensuring they are successfully and efficiently run  – which is why these hospitals  have been so effectively popular in the areas where they have been established.

Dr Mubina Agboatwalla, Chairperson of HOPE and child specialist in Karachi  has always maintained that the health assistance provided to the needy  should be of excellent quality.

HOPE’s Zia Colony School visited by Japanese Consul for Culture & Public Affairs.

It was in late 2012 that the Japanese Consulate in Karachi generously offered to assist in the expansion of HOPE’s Zia Colony School. The expansion actually was an addition  of another  much needed floor to fully accommodate the increasing number of students coming from the surrounding poor, slum areas. worked at a very fast pace and completed the project in mid 2013 – which greatly increased the capacity of the school.

HOPE, an educational NGO in Pakistan, worked at a very fast pace and completed the project in mid 2013 – which greatly increased the capacity of the school.

Mr Mitsuaki Tosa, Consul for Cultural & public Affairs visited  HOPE’s Zia Colony School to observe the status and progress of the school. The delegates were very pleased with the welcome they were given by the young students of the school.

Mr Tosa was taken to all the classes of the school and the library, computer labs, chemistry lab and the vocational center. He was extremely happy to see HOPE’s  school  had progressed  so well within just a short span of one year and some months of its completion.

Dr Mubina Agboatwalla, Chairperson of HOPE and child specialist in Karachi has been the driving force in setting up this and other formal and home schools across Pakistan –  and in ensuring they are successfully and efficiently run  – which is why these schools have been so popular in the areas where they have been established and enrollment of students have been increasing constantly.

Dr Mubina Agboatwalla, Chairperson of HOPE and child specialist in Karachi  has always maintained that the education provided to the children of HOPE’s home schools  should be of excellent quality and all reading materials, such as books etc  are all free of cost.

HOPE”s Attendance At Key Findings Report – Multiple Indicator Cluster Survey (MICS)

Karachi, October 15, 2015 – The Key Findings Report – Multiple Indicator Cluster Survey Sindh 2014, was launched here today in a local hotel. Senior Minister for Planning & Development, Mr. Murad Ali Shah was the Chief Guest. The Additional Chief Secretary (Development) Mr. Ajaz Ali Khan, Representative, UNICEF Pakistan Ms. Angela Kearney, and Director General, Bureau of Statistics Mr. Ali Dino Gahoti also attended the event. The Key Findings Report covering socio economic indicators for Sindh focuses on children and women. It has been put together by the Bureau of Statistics, Planning and Development Department, Government of Sindh. Technical and financial support for the survey was provided by United Nations Children’s Fund (UNICEF).  HOPE, a health and education NGO participated actively in the activity.

Sindh MICS 2014 is based on data collected during February to August 2014.More than 19,000 households were covered. Sindh MICS covers 125 socio-economic indicators. Five separate Questionnaires; household, women, children under five, health facility records, and water quality testing, were used for data collection.

Over the course of the day’s dialogue partners, including HOPE, a health and Educational NGO in Pakistan, exchanged insights of the progress made by the bureau of statisticsin Pakistan and
Sindh MICS 2014 noted considerable improvements in health indicators for women and children. Proportion of mothers receiving antenatal care from skilled providers has increased to 80 percent. Also, 28 percentage points improvement has been observed in births assisted by a skilled provider (from 38 percent to 66 percent). Moreover, births taking place in health facilities has also increased significantly from 42 percent in 2006-07 to 64 percent in 2014

A significant rise in continued breastfeeding at 1-year is observed from 35% in to 77%.
Overall, 35 percent of children age 12-23 months received all the recommended vaccinations by 12 months of age which reflects an improvement in the last few years. Similarly, an increase has been witnessed in measles vaccine coverage (53 percent).
Birth registration is one of the key indicators of child protection. MICS 2014 shows that 3 in 10 children (29 percent) under age 5 have been registered in contrast to only 20 percent reported in MICS 2003. Survey results show that at least one household member in 9 out of 10 households owns a mobile phone.
The objective of the MICS survey is to collect statistically sound and internationally comparable data essential for developing evidence-based policies and programmes, and for monitoring progress towards global, national and provincial goals. The MICS Survey focuses mainly on those issues that directly affect the lives of children and women. MICS has been a major source of data on the Millennium Development Goals (MDG) indicators and provide baseline for Sustainable Development Goals (SDGs).

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The efforts of HOPE as an NGO and in particular the efforts of  its chairperson, Dr MubinaAgboatwalla, child specialist in Karachi were lauded for her pioneering efforts and the immense work she had done both in the field of education and health.