Polio Eradication Initiative (PEI)

Balochistan
Technical Advisory Group (TAG) Meeting
Islamabad, Pakistan – January 2025

Inam Ulhaque
Coordinator, EOC Balochistan
Presentation Outline

1 Epidemiology 7 Social Behavior Change Communication

2 Implementation Status of TAG 8 Mobile and Migrant Population

Recommendations

3 Implementation of NEAP Roadmap 9 PEI-EPI Synergy

4 Surveillance Updates 10 Challenges Way Forward

5 Performance in SIAs 11 Conclusions

6 LPUCs and RDQA 12 TAG Guidance Requested

2
 Epidemiology: WPV Cases and ES Isolation
2020 2021 2022 2023 2024
Geographical Distribution of WPV Cases & Positive ES QTA BLOCK 14 1 14
Infected Districts = 24
32 WPV Cases REST OF BALOCHISTAN 12 13
2024 TOTAL WPV CASES
QTA BLOCK
26
68
1
13 21
27
88
28 ES Positive
REST OF BALOCHISTAN 31 5 6 112
TOTAL ES POSITIVE 99 18 27 200
24

20
23

16
20

(n)
18
12 20 22
16 22

8 12 15
10
10 11 11
4 8 7
6 5
3 3 4
2 2 1 2 1
0

Sep

Jan

Feb

Sep
Jun

Aug
Nov

May

Nov
Dec

Dec
Mar

Apr

Jul
Oct

Oct
2023 2024
YB3A4B; 21; 9%

YB3A4A; 163; YB3A4A- Cases ES

72% YB3A4B; 16; 7%
• Last WPV1 case from Kila Abdullah with date of onset 16 th Nov-2024
YB3A4A Case; • Most recent ES positive from Noshki with date of collection 18 th Dec 24
27; 12%
*Data as of 12th Jan-25 3
Quetta block: Implementation Status of TAG
Recommendations
S# TAG Recommendations Implementation Status

Program ownership at the highest level is maintained. (Chief Secretary, Commissioners & Deputy Implemented
1
Commissioners leading the program)

All polio cases and events investigated by PEOC/DEOCs to determine the causes of occurrence,
2 1,836 MMPs settlements with 79,000 <5 children tracked, mapped and incorporated in micro Implemented
plan/vaccinated

• 14 Health facilities added in surveillance network in Quetta Block

3 • 29 formal healthcare providers, 304 informal healthcare providers, 141 community Implemented
informants were oriented in Pishin and Killa Abdullah.
• Active search done in health facilities and in community. No missed AFP cases found

• Coverage of missed children clubbed with 03 Integrated Outreach Activities (IOAs), and
successfully implemented in Quetta & Chaman districts.
4 Implemented
• Full support for BCU provided in Round 1 (zero dose data collection , micro-planning,
mobilization, site identification, monitoring)

4
Cross Border: Implementation Status of TAG
Recommendations
S# TAG Recommendations Implementation Status

1 Could not be implemented due to circumstantial issues Pending

2 10 religious and community influencers engaged for mobilizing community on both sides, FM Radio 'Talim Ul Implemented
Islam' and 'VOA Dewa Radio' engaged to promote awareness among listeners on both sides of the border
01 face-to-face and 03 virtual meetings conducted with South region of Afghanistan, WhatsApp group created
3 with the Afghan team to facilitate timely information exchange, MMP data is updated before each campaign in Implemented
IDIMS
4 Joint action plan tracker maintained and updated regularly Implemented

5 Alliance building with PRCS and MSF to enhance awareness about RI and polio among women from Chaman and Implemented
across the border
6 The vaccination record is regularly updated & shared with each other at district level Implemented

7 03 out of 09 SIAs (In Feb, Jun, & Oct) synchronized with Afghanistan Partial

8 Both inbound and outbound population is vaccinated on cross border and data updated in IDIMS, In 2024, total Implemented
vaccination at 06 cross-border PTPs (Reduced to 04 CB PTPs following rationalization) remained 745,236

9 Joint Monitoring not done due to certain circumstances Pending

Refusals analysis and Social profiling of MMP shared with Afghanistan team , Developed video testimonials of
10 influencers having influence across the border and shared with Afghan team , 21 permanent gantries and Implemented
billboards placed at bordering areas with synchronized messages in Pashto and Urdu
5
NEAP (Roadmap 2*4*6) Implementation - Reset Phase
Revitalizing Emergency Mode of Working Plugging Operational Gaps Fixing HR Issues Especially in
Across the Programme Hampering SIAs Quality Core Reservoirs
• High-Level Government oversight; The Chief • Conducted thorough • Repositioning of WHO and
Minister & Chief Secretary chaired meetings for assessment to identify key NSTOP officers, placing best HR
strengthening PEI and RI issues affecting campaign in the most challenging districts
• Sensitization and refresher workshops organized quality – (District Reviews, • Shuffling of teams and AICs
for all DCs and DHOs in Balochistan RDQA) (n=518) in CBV districts in
• PEOC Task Teams notified, with clear Terms of • Risk analysis and prioritization suspicion of Fake finger marking
Reference (TORs) for their respective areas of work of Districts, UCs and Areas for • Deployed 70 COMNet surge
response staff in outbreak districts (Hub
• PEOC Focal persons assigned to support 07 high
risk districts and regular review of all outbreak • District improvement plans 19, Khuzdar 17, Zhob 19, Dera
districts prepared, implemented for the Bugti 12, & Sibi 3) and also
districts Increased female Community
• Co-created Social and Behavioral Change Mobilizers from 06% to 32% in
Communication (SBCC) strategy by engaging Chaman
district teams
• Sensitized and oriented 12 Bureau Chiefs, 90
Senior Journalists and Social Media Influencers, to
support shaping community perception regarding
anti-polio vaccination

6
NEAP (Roadmap 2*4*6) Implementation - Phase-2
Implement 3 High-Quality Synchronized Objective Reviews to Map Linking Performance With
SIAs Reaching All Children Issues/Gaps Accountability
• 2 of 3 synchronized Campaigns conducted • Post campaign reviews by PEOC/ Accountability of low/poor
whereas 3rd campaign delayed by 02 weeks due Chief Secretary/ Secretary performers is ensured from top to
to unavoidable circumstances ( Boycott of Grand Health( Data analysis, bottom:
health alliance ) identification of gaps,
communication to the districts for • Explanations to 01 Deputy
• Encouraged the teams to record true numbers corrections) Commissioner & 20 District
of missed children (Average missed children Health Officers, 01 DHO
recording increased from ~119,000 to ~152,000 suspended, while 1 DHO was
in Quetta block (28%). transferred
• 10,084 children registered in grey houses; 8,034 • 1,136 other staff including
grey houses cleared from June to December partners
2024
• Coverage in extended catch-up and in between
campaigns is 4,812 in Jul, 22895 in Sep, and Terminations = 100
18,329 in Oct (1632 unrecorded missed children Final warnings = 149
identified in 27500 zero and locked houses from
Explanations = 19
Jul-Oct) in Quetta block
Contract closures = 184
Warnings = 666
Probation = 18
7
 AFP Surveillance Indicators Balochistan 2023-2024*
BALOCHISTAN QUETTA BLOCK
S# Key Surveillance Indicators
2023 2024 2023 2024
1 WPV1 Cases Reported 0 27 0 14
2 Compatible Cases Reported 0 1 0 1
3 No of AFP Cases Reported 759 834 140 182
4 Non-Polio AFP Rate 11.8 12.6 7.8 9.4
5 Adequate Stool % 87 83 86 81
6 Detected within 7 days of onset % 81 82 80 76
7 Investigated within 48 hrs of notification % 96 98 99 99
8 EV Isolation % 15 14 15 11
9 SL Isolation % 4 5 1 6

Quetta Chaman Kila Abdullah Pishin

S# Key Surveillance Indicators in Quetta Block
2023 2024 2023 2024 2023 2024 2023 2024
1 WPV1 Cases Reported 0 3 0 2 0 7 0 2
2 Compatible Cases Reported 0 1 0 0 0 0 0 0
3 No: of AFP Cases Reported 68 93 27 37 12 20 33 32
4 Non-Polio AFP Rate 6.2 8.1 18.8 24.4 11.6 12.5 8.4 7.6
5 Adequate Stool % 85 88 93 76 58 55 91 81
6 Detected within 7 days of onset % 78 84 93 78 58 55 82 63
7 Investigated within 48 Hours of notification % 97 100 100 97 100 100 100 100
8 EV Isolation % 13 9 20 14 32 16 11 11
9 SL Isolation % 0 4 2 8 5 8 3 8
* Afp.rec Data as on 12-01-2025 8
Epidemiology: Environmental Sampling
Positive Environmental Samples with Current Status
2023 2024
S# DISTRICT SITE NAME Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24
RAILWAY PUL
SUR PUL
1 QUETTA
TAWOOS ABAD
JATAK KILLI & TAKHTHANI
ARMY KAZIBA
2 CHAMAN
HADI PACKET
3 PISHIN TURWA
4 DBUGTI LABOUR NALA
5 HUB JUMMA KHAN BAZAR PULL
6 MASTUNG ADALAT ROAD
7 KECH TURBAT TOWN
8 KHUZDAR KATAN PUL
9 NSIRABAD WAPDA COLONY
10 SIBI MAIN GHANDA NALA ALLAHABAD
11 LASBELA JAMALI MOHALLAH
12 USTA MUHAMMAD VAN STAND USTA MUHAMMAD
13 GWADUR GDA PLANT
14 DUKKI NASEERABAD MOHALLAH
15 KSAIFULLAH KILLI POTI
16 LORALAI RASALA LINE
17 ZHOB GANJ MOHALLA
18 BARKHAN MILL COLONY REHNI BAZAR
19 NOSHKI MAIN BAZAR NALA

Positive Negative Pending

9
 Genetic Linkages of WPV1 - 2024
Importation
Virus Importation and Local Circulation Outside Prov-
Genetic Linkages (Local/Importation)
ince, 38, 95%
n=227
Low High Importation from
Afghanistan, 2, 5%

Local Circula-
tions; 187; 82%

Virus Exportation to Other Regions

Genetic Linkages (Exportation) n=104

Exportation to
Afghanistan; 24;
23%

Exportation to
Other Province;
80; 77%

*Data as on 12-01-2025 10
 Details of the Wild Polio Cases (n=27) –2024
7 KAN-
DAHAR; KARACHI; 1
District wise WPV Cases

Linkages of WPV Cases

USTA 1
MUHAM
MAD;
SIBI; 11
KABDULAH; QUETTA; 9
3 3 1
2 2 2 2 TANK; 2
1 1 1 1 1 1
CHAMAN; 2
H A OB IN AN H AD SI KI TI AI AI AN
LA TT SH LA B G SH G L H ZHOB; 2
U E ZH I M U A A U R A G A R
D QU P A
AI
F
AR LM NO DB LO CH
A
KH
AB CH S F A PISHIN; 7
K K JA JH

Gender Adequacy Reporting Channel Reporting Contact Cross-Notified

6 6 4
8
11 10
5 13
16 17
19
15 5

Male Female Adequate Inadequate Public Private Community 1st 2nd 3rd 4th & above Yes No

Virus Isolation RI OPV Received SIA OPV Received Residual Malnourished

3 weakness
3 2
4 5
2 3 8
3 13 4
8 15 9 15
19
5
14
Zero 1-3 Doses 4-6 Doses YES NO DIED
Index Contact Index + Contact Zero 1 RI 2 RI 3 RI YES NO DIED 11
7 Doses PENDING
Surveillance activities – Improving Indicators

Monitoring of Sampling Log tags used in 100% samples. 97% index samples have reached lab with
in 72 hours of dispatch

Added ES site of Noshki in Oct Added ES site of Noshki in Oct 2024 (Northwest of Balochistan)
2024 (Northwest of Balochistan)

Considering Security compromised areas in Balochistan: 3752 Community

Training/Orientation in informants oriented in 2024 , which have reported 55 cases in 2024 along
Balochistan with 1 Polio case

AFP Cases in MMP 24 AFP cases reported from MMP in 2023 and 45 in 2024 (NPAFP rate:
4.5)

Contact Sampling Contact sampling of 57 cases in (Hard to reach , security compromised

areas) other than inadequate cases in Balochistan 2024

Outbreak investigations of positive ES sites and detailed EPID investigations

Outbreak Investigations of all polio cases done
12
 Campaign Modality 2023-24
NID Jan-23 SNID Mar-23 SNID May-23 SNID Aug-23 NID Oct-23 SNID Nov-23 NID Nov-23

NID Jan-24 NID Feb-24 OBR Mar-24 SNID Apr-24 SNID Jun-24 OBR Jul-24 SNID Sep-24 NID Oct-24 SNID Dec-24

69159 Implementation of Plan-B – SNID Dec-24

S# Cadre Excluding Quetta Block %
# of Leftover
Children

1 New UCMOs 81%

16887
8799
1305 919 880 335 228 2 New AICs 69%
3 3 3 4 4 4 4 24 4 24 4 24 3 New Teams 41%
t -2 -2 -2 -2 -2 -2 -2 n- l -2 p- t -2 c-
Oc
v v n b ar Ap
r
-Ju Oc e
No No - Ja - Fe M J- u S e
D-
D
D D- D- D D R- D- D R D- ID 4 % Teams with at least one female 41%
NI NI NI NI NI O B
S N I
S NI O B
S N I NI SN 13
S
 Assessed Coverages during SIAs

• Recall vaccination in Quetta block is <90% in recent SIAs, whereas between 91% - 93% in non-Quetta block districts,
• Due to implementation of Plan-B in December, operational issues increased in non-Quetta block

ICM Recall Vaccination (%) Operational Issues in HH Clusters

30.0%
100%

90% 91% 88% 91% 93% 92% 91% 91% 92% 92% 92% 27.4%
90% 88% 87% 88%

80%
25.0%
19.7% 18.8%
20.0% 17.8%
70%

14.7% 18.0%
60%
15.6%
50% 15.0%
40%

10.0%
30%

4.7% 4.5%
20% 5.0% 2.5%
1.2% 1.2%
3.6%
3.3%
10%

0.0%

SNID JUN 2024

NID OCT 2024

SNID DEC 2024

NID JAN 2024

NID FEB 2024

SNID APR 2024

SNID SEP 2024

0%
SNID JUN 2024

NID OCT 2024

SNID DEC 2024

SNID JUN 2024

NID OCT 2024

SNID DEC 2024

NID JAN 2024

NID FEB 2024

SNID APR 2024

SNID SEP 2024

NID JAN 2024

NID FEB 2024

SNID APR 2024

SNID SEP 2024

Quetta Block Rest of Districts Quetta Block Rest of Districts 14

 LQAS Results
• LQAS results have improved in Quetta block but declined in rest of the districts in last SIA
• Due to implementation of Plan-B in December, operational issues increased in non-Quetta block

% Lots Pass - LQAS Operational Issues in LQAS

93% 80% 75%
87% 67%
81% 83% 70% 66%
78% 80% 79% 64% 62%
76% 74% 74% 74% 65% 65% 58%
60%
65% 69%
63%
50% 53%
48%
40% 36% 45%

30%

20%

10%

0%

NID Jan 24

NID Feb 24

SNID Apr-24

SNID June 24

NID Oct-24
SNID Sep-24

SNID Dec 24
NID Jan 24
NID Feb 24
SNID June 24

NID Oct-24

NID Jan 24
NID Feb 24
SNID Apr-24
SNID June 24

NID Oct-24
SNID Sep-24

SNID Dec 24

SNID Sep-24

SNID Dec 24

Quetta Block Rest of Balochistan Quetta Block Rest of Districts 15

 Coverage and Still Missed

• Household coverage ranged from 95% to 104% in the Quetta block and from 98% to 101% in the other districts
• No significant change in proportion of still-missed children observed in non Quetta block

% Coverage at HHs % Still Missed

12.5%
3.4%

3.3%

7.1%

4.4%

5.0%

4.5%

1.7%

1.6%

1.7%

2.4%

1.6%

1.5%

1.6%
14.0% 100%

90%

101% 101% 99% 12.0%

100% 100%
97% 98% 98% 97% 96% 95% 98% 97% 98% 80%

10.0% 70%

8.0%
60%

9.8%
50%

6.0% 2.4% 40%

0.5% 0.6%
4.0% 0.5% 0.5% 30%

0.4% 0.4%
4.2% 0.5% 3.9% 4.4% 4.1%
20%

2.0%
3.0% 2.7%
2.2% 1.6% 1.6% 1.6% 2.1% 1.6% 1.5% 1.5%
10%

0.0% 0%

NID Jan-24
NID Feb-24
SNID Apr-24
SNID Jun-24
SNID-Sep-24
NID Oct-24
SNID Dec-24

NID Jan-24
NID Feb-24
SNID Apr-24
SNID Jun-24
SNID-Sep-24
NID Oct-24
SNID Dec-24
NID Jan-24
NID Feb-24
SNID Apr-24
SNID Jun-24
SNID-Sep-24
NID Oct-24
SNID Dec-24

NID Jan-24
NID Feb-24
SNID Apr-24
SNID Jun-24
SNID-Sep-24
NID Oct-24
SNID Dec-24
Quetta Block Rest of Balochistan

% Still NA % Still Refusals

Quetta Block Rest of Balochistan % Leftover % Still Missed 16
Insights from Missed Children Trend – Quetta Block & Mastung
(Identification of true extent of missed Children)

• On average, 56% recorded refusal are • Missed children covered in between

newly recorded campaigns is not the part of IDIMS
New Refusal Trend SBC Efforts In-Between Campaigns

1077 • 30% to 32% of the missed

38342 41157 1081
4450
38%

children covered in

10189
53%
13537
12594

21818

59%
60%

14420 570 17248 between the campaigns

9537
72%

4242
OBR July 2024 SNID Sept 2024 NID Oct 2024 • 10,084 hidden children
SMC as per IDIMS NA Cov Ref Cov were identified, and 8,034
grey houses were cleared
7313
62%

Grey HHs
8939
47%
since June 2024 SNID
9278
8496

41%
40%
3608
27%

9096
8157
10000

9000

7705 • 9,705 expected hidden

8000

7000
6900

children in 6,900 Grey

6000
OBR July 24
SNID June 24

SNID Sept 24

NID Oct 24

SNID Dec 24

3194 3442
5000

4000

2671 2207
1144 houses (Old 5884 & new
3000

620
2000

1000

1016)
0

n ... 24 p.
..
b ... 24
Ju ly e to c
ID Ju D
S
Oc De
Series1 Series2 SN B R NI D ID
O Still Grey S
HHs NI
Registered SN
Children
17
 Insights from Missed Children Trend – Quetta Block & Mastung
(Identification of true extent of missed Children)
Misconcep- Still Refusal Clusters SNID Sept – SNID Dec
OTHER; 26 tions; 2107
PASHTO; Demand; 313
2658 Still Refusal Cluster
PUNJABI; 22 406
Still Refusal Cluster
FARSI; 40 Language 353
Reasons of
Stratification Refusals 13%
Decreased
BALOCHI; 145 Sickness; 737

Repeated
BRAHVI; 812 Campaigns; 1 Religious; 503

Tribal Stratification
1600
39%
1451
SNID April 2024
1400

1200

1000
SNID Dec 2024
17%
800
637
600 10% Still Refusal Cluster 2024
385 5% 5% 5%
400
3% 3% 3% 3% 2% 2% 600
189 185 168 1% 1% 503
119 103 99 98 90 90 462
200
45 44 500 410 406 410
0
LANGOVE
400 364 353
SHAHWANI

BANGULZAI

NOORZAI

KHILJI

PIRKANI
ACHAKZAI

LEHRI
MENGAL
SYED

BARECH
OTHER

KAKAR

TAREEN

300
200
100
0
Jan Feb Apr Jul Sep Oct Dec 18
 Low Performing UCs and Routine Data Quality
Assessment
• RDQA conducted in 127 UCs of 21 districts; higher proportion of data accuracy reported in NID Oct-24
• The proportion of LPUCs have declined in Quetta block while increased in rest of districts due to plan B implementation

Trends of Data Accuracy - RDQA

Proportion of LPUCs # of Distt: 2 1 3 2 4 9
50% # of UCs 24 6 14 8 25 53
45% 100% 5% 7% 0.05953582240161450.0461061031476282
0.0698924731182796
6%0.1415716856628673%
45%

90% 4%
15% 16% 9%
40%
13% 4%
80% 16%
35%
33% 10%
31% 70%
30%

25% 26% 26% 26% 60%

25% 23%
20% 50%
18% 19% 19%
20%
17% 83%
40% 80% 77% 76%
15% 14% 72% 72%
30%
10%

20%
5%

10%
0%

0%
NID Jan-24

NID Feb-24

SNID Apr-24

SNID Jun-24

SNID-Sep-24

NID Oct-24

SNID Dec-24

NID Jan-24

NID Feb-24

SNID Apr-24

SNID Jun-24

SNID-Sep-24

NID Oct-24

SNID Dec-24

NID Jan-24

OBR Jul-24

NID Oct-24
NID Feb-24
NID Nov-23

SNID Sep-24
Quetta Block Rest of Districts Accuracy Over Reporting Under Reporting Not Available
19
 SBCC Road Map

The SBCC Road Map prioritizes Quetta Block and outbreak districts, guided by insights from social investigations and
community input.
Impact
Hidden 1. Effective first knock (through Ops / Comms collaboration)
Children /Grey 2. Female Influencers engagement 10,084 hidden children were registered
Houses 3. Asher (Joint sweeping) strategy in Chaman

Reaching Every 1. Following up on still missed children in-between Campaigns Vaccinated 4,812 OBR July, 22,895 In
2. Search for unrecorded missed children in 0/0 and lock between Sep, 18,329 In between Oct
Missed Child 1632 Unrecorded children identified
houses

1. Improve detection through community engagement and

listening 172 FFM cases found
Fake Vaccination 518 FLWs shuffled
2. Religious sentiment and FLWs encouragement to report

1. Remapping and Categorization 6856 remapped and categorized

Influencer
2. Influencer sensitization and training program (including key 1011 trained
Engagement Family Care Practices) 9822 missed children covered via influencers

1. Community engagement and Influencers engagement 5809 NA & 781 Refusal Covered
RI & Big Catchup 9724 sites arranged; 3997 influencers
2. Missed children coverage & Outreach Site identification
engaged
20
 Mobile and Migrant Population (MMP)
MMP Mapped Districts
HH Coverage in AFG Coverage at Pak-Afg Cross Border
Migrant 199,130 Refugees Camps (n=14) PTPs (n=6)
Mobile 92,831
Jan-24 117,656
Total 291,96
Feb-24 84,985
MMP 1

43,122

42,888

42,686

42,646
42,222

42,117
Mar-24 49,214

35,107
Apr-24 44,817
May-24 42,732
Jun-24 38,646
Jul-24 49,483

NID Jan-24

NID Feb-24

SNID Apr-24

SNID Jun-24

SNID-Sep-24

NID Oct-24

SNID Dec-24
Aug-24 54,976
Sep-24 58,811
Oct-24 65,486
Nov-24 64,218
Dec-24 74,212

Nomads Immunization in 15 Districts Registered Migrant Registered Mobile

Phase-I: Feb-Apr 2024 OP Population Population
Phase-II: May-Aug 2024 OPV Coverage
V 50,360 Agricultural
8000 Bordering /
migrant
7000 Core
6000 IPV 26,836 reservoirs
labour
Seasonal 13%
5000 /Endemic Migrants
4000 1% 42%
3000
2000 Brick Kiln
Afghan
1000
Migrant Straddling workers
0
78% Population 2%
I I I I I IDPs 2%
TTA HIN AH AR OB NG LA AD HH AD AD IB NA UR GS 10%
L D H U A B B M S R P A
E IS FU Z Z A C A T
Q
U P I U ST OR IR KA R AM H
A
B
A LM
H A L A
SA K M N
S F H H HA Returnees Economic
K JA MU SO J Nomads migrants
A 9% 24% 20%
ST
U 21
EPI-PEI Synergy

Integrated Outreach Development of National Digitization of Zero Dose

Activities (IOAs) & BCU Immunization Strategy Children in NEIR

• Zero dose data collection • Initially by UCMOs,

• Supporting preparation
& sharing with vaccinators followed by AICs
of provincial component
• Identification of outreach of NIS (Piloted in district
sites Quetta – 96% children
• Mobilization of parents for enrolled for Dec SNID)
RI vaccination
• Session monitoring

22
Challenges and Way Forward

Challenges Action Taken / Way Forward

Enhanced influencer engagements, recruitment of female community
Vaccine hesitancy, grey houses mobilizers & house to house mobilization through COMNet supported by
(n=6,900), and hidden children district administration
Sensitization of the teams; Directly observed vaccination in suspected
Fake finger marking households & Community listening for knowing the reasons
Cross border movement with
Ensure vaccination of all incoming & outgoing population
Afghanistan
fIPV is planned in Quetta block (February)
Low RI coverage Expand & strengthen NEIR in other districts
Implement EPI Roadmap with strengthened accountability
Uncertain security situation Maintaining close liaison with LEAs
Retention of volunteer polio
workers Increase in renumeration , motivation to the team
Identification and orientation of community informants
Late reporting of AFP cases
Including informal health care providers in surveillance network

23
Conclusion

01 Progressive spread of the virus since sept 2023 with highest number of cases
reported in September 2024.

02 Highest level commitment of political and administrative hierarchy at the

provincial, divisional & district levels

03
All out efforts made to conduct high quality SIAs as per the Phase II Plan

04
COMNet expansion across the province

05
Implementation of alternate plan by hiring volunteer UCMOs and other staff

Government, polio partners & the Program Management remain committed to the
Goal of Eradication 24
Requested Guidance from the TAG

Frequency of SIAs • Frequency of SIAs in outbreak

and low-risk districts?

• Campaign modality in Afghanistan

Campaign Modality in Afghanistan
especially southern region remains a
concern for Balochistan

• Discontinuation of CBV Strategy in

CBV Strategy Discontinuation Quetta Block ???
• Discontinuation of CBV at this crucial
point may risk the program interruption/
eradication efforts.

25
Thank You
Backup Slides