Media can play a vital role in health education and improving mother and child health-Lubna Hashmat

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CHIP Workshop on improving immunization & vaccination of children
Media can play a vital role in health education and
improving mother and child health - Lubna Hashmat
We are working to increase synergies between
CSOs and Government - Awab-us-Sibtain

KARACHI: Civil Society Human and Institutional Development Programme (CHIP) organized a workshop for the media personnel in Karachi on September 27th 2012. The main objective of this interactive session was to highlight the contributions which media can make in improving immunization coverage and Child Health in Pakistan. In her introductory remarks Ms. Lubna Hashmat Chief Executive Officer of CHIP highlighted the importance of mother child health and how media and civil society can improve it. Barriers to immunization and child health were also discussed. The programme also included discussion on how Civil Society Organizations (CSOs) are addressing barriers to immunization and how media can help the CSOs in achieving their objectives. How we can improve health indicators of Pakistan. This discussion forum was also meant to exchange information and discuss how we can promote moral values in Pakistan. CHIP,s main focus Ms. Lubna Hashmat opined was mother and child health and reproductive health. There is a need to improve sanitation and water supply, promote self-employment, health, human rights, need based rehabilitation wile CHIP was also sponsoring higher education of poor girls in Baluchistan.
Giving figures about vaccination and immunization, Ms. Lubna Hashmat said that according to PDH survey only 47% of our children are vaccinated. The remaining 53% are vulnerable, only 80% have received BCG vaccination, 75% have received DPT and 93% have received one dose of polio. Again 59% of children have received DPT second dose and only 60% have received measles vaccine. Dropout rate in DPT after first dose is about 22%. Only53% of mothers has received two or more injections of TTV. As regards health indicators of Pakistan, she gave the figures which are mentioned in the accompanying table.

Polio remains only in three countries i.e. Pakistan, Nigeria and Afghanistan. TB is seen in 22 countries and Pakistan is at No. 6 as regards prevalence. Many health facilities, she said, are not functioning or they are not accessible. Speaking about Sindh province, she said that here only 37% of children are fully immunized, BCG vaccination was 76.7%, 67.3% have received DPT and 92.2% have received polio drops. Only 47.6% of children have received third dose of DPT and 51.2% have received two or more injections of Tetanus Toxoid.
It may be mentioned here that EPI programme in Pakistan covers ninedeadly diseases which includes polio, measles, BCG, Diphtheria, Tetanus, Pertusis, Hib, Hepatitis-B and pneumococcal disease. Now anti-pneumonia vaccine has also been added in the programme starting from the province of Punjab. Pakistan will be the first country in South Asia to use this expensive vaccine to inoculate children less than five years against the pneumococcal diseases. The Global Alliance for Vaccines and Immunization (GAVI) is assisting the government of Pakistan for providing this vaccine.According to Prof. Tariq Bhutta chairman of the National Immunization Technical Advisory Group, GAVI would bear 95% of the cost for this vaccine and the remaining 5% will be borne by Pakistan.
Mr. Awab-us-Sibtain in his presentation gave details of a project which is an initiative on strengthening of CSOs engagement in health sector. We are trying to form an alliance of CSOs so that we can work with Government of Pakistan. GAVI which is the major funding agency for immunization and vaccination programme in Pakistan has subjected their funding to engagement of CSOs in health sector. Hence, we are working for harmonization of all foreign grants. The idea is that all CSOs get together to get financial assistance from funding agencies through one window operation. In the province of Sindh we are trying to find out in high risk districts the CSOs which are working in health sector so that they can be strengthened. We wish to find out CSOs working in the field of immunization. We have by now formed a fourteen member alliance of CSOs. We are collecting data about CSOs and identifying best practices. We wish that barriers should be identified. We are working for research based advocacy and increase synergies between CSOs and Government, he remarked.
Ms. Lubna Hashmat in her second presentation discussed barriers to routine immunization and referred to lack of health education of public. Now we have decided for resource allocation as per coverage. Timely supply of vaccines, its storage and transportation, wastage of vaccines, quality assurance and functional reporting is not there. Quality of EPI services also came under discussion and it was pointed out that vaccinators are not provided any training at all which is extremely important. Cold chain must be maintained and compliance of vaccinators should be ensured. It was also important to mobilize the community to utilize those services; CSOs are at present working for this at their level. We do have some hard to reach areas, red zones and high risk areas in different parts of the country, hence MCH indicators are very low in those areas. Low level of awareness in public, remote areas, affordability for accessing transportation was also highlighted. It was further stated that in areas where educationlevel is low, they have less coverage of immunization.
Dr. Ambreen from HELP an NGO discussed their work in health education and literacy programme and how they are working to ensure coordination between different departments. HELP, she said, has established MCH centers which are located in Khuda Ki Basti in Gaddap area, in Neelum Colony andlower Gizri. Prior to our work, baseline coverage, she said, was just 23%. TT coverage of women in child bearing age was just 9%. The problems they had to face was of electricity, barriers in community included lower social awareness, gender bias, large family size, family system, deliveries at home by Dais, Trust level of health care providers, frequent relocation of families and large family system. We involved local leaders in the community who enjoyed respect. We also engaged the religious leaders and teachers to create awareness. We moved forward with their help. Community Health Workers and Lady Health Visitors were trained. We run OPD and charge just ten rupees where we also do minor gynaecological surgical procedures and refer the cases which need specialized care. We have ensured strict monitoring and accountability at all levels. EPIcoverage in Gaddap area has now increased to 97.42% and upto 98% in Neelum Colony and lower Gizri. TT coverage has increased from 10% to 85%. We have ensured safety and convenient transportation for field workers besides mobilization of educated and dedicated citizens for this cause. We could achieve these results just because of strict monitoring and accountability at all levels which worked. Our target age is between 0-23 months and upto five years. After the recent introduction of Pneumonia vaccine, Rotavirus is also likely to be introduced. Hepatitis B vaccine and BCG is administered at birth.
Dr. Rozina who has been working with Aga Khan Health Servicesfor many years in her presentation pointed out that BCG should be given immediately after birth. Pentavalnt vaccination schedule is at six weeks, second dose at ten weeks and the third between 14-15 weeks. Five injections of Tetanus Toxoid should be given to women between the ages of 15-45 years. No vaccine, she said, provides hundred percent protection. BCG has over 85% efficacy. Cold chain failure will increase with electricity problems. Make sure while administering vaccines that the VUM cold chain is not broken. Hepatitis B vaccine at birth gives almost hundred percent protections. Pneumonia vaccination, she said, will reduce infant mortality rate drastically.
Dr. Shafq from Aga Khan Health Services gave details of their work done in Tando Allah Yar area in collaboration with GAVI Alliance. It is a CSO supported project. They have been working in that area for the last three years. Giving baseline figures before they started working in this area he said that immunization coverage was 56%. In 2009 BCG vaccination was 65.5%, 40.2% children were fully vaccinated, 61.9% had DPT coverage and TT coverage was 35%. After our work, there was 27% increase in EPI coverage, 2347 deliveries took place with skilled birth attendants, 26,255 children received EPI dose supplements, 5319 mothers were educated about danger signs of pregnancy and 21,576 people were educated about EPI and family planning. Male vaccinators were one of the barriers we faced but we ensured proper counseling of patients telling them about the likely side effects of vaccination, Dr. Shafq added.
It was further stated that now they have planned incentives for performance i.e. pay for performance work. The workers are paid for getting pregnant women registered, their referral and delivery at the centers. The health workers are also provided incentives for motivating children for vaccination. Now 3,750children in this area have been fully immunized, 3,584 pregnant women have been vaccinated. At present in 2012 95% of children in this area are fully immunized, 100% have received BCG vaccination, 99% have received first dose of DPT, 87.5% have received second dose of DPT, 84.8% have received measles vaccine and 74% of mothers have received Tetanus toxoid vaccine.

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